A colorectal straight-to-test cancer pathway with GP-guided triage improves attainment of the 28-day diagnosis target and increases outpatient clinic capacity.

Sagar, Alex; Mai, Dinh Van Chi; Divya, G S; Al-Habsi, Ruqaiya; Wothers, Tracy; Ni Bhroin, Orna; Singh, Sandeep; O'Hara, Ichard; Keeler, Barrie D

AIMS This study investigates whether a straight-to-test colorectal cancer pathway improves attainment of the NHS England 28-day Faster Diagnosis Standard and the effect of the pathway on reducing face-to-face outpatient clinic appointments. Patient satisfaction and the safety of a novel GP-led patient triage system regarding suitability for colonoscopy are also evaluated. METHODS This is an observational study of all patients managed via a straight-to-test colorectal cancer pathway between 1st September 2019 and 19th March 2020. Comparison is made with all patients referred on the suspected colorectal cancer pathway prior to implementation of the straight-to-test pathway from 1st January 2019 to 30th July 2019. Patient satisfaction with the straight-to-test pathway was assessed with a telephone-based questionnaire. RESULTS Attainment of the 28-day diagnosis target for all suspected colorectal cancer referrals improved following the establishment of the straight-to-test pathway (88% vs 82%, p<0.0001). From a potential total of 548 outpatient colorectal clinic appointments for patients on the straight-to-test pathway, 504 (92%) were avoided. In those eligible for the straight-to-test pathway, GP assessment of patients suitable for colonoscopy agreed with that of the colorectal department in 93% of cases. Of the 50 patients who undertook the satisfaction survey, 86% were satisfied or very satisfied with the pathway. No patient suffered adverse events as a result of their straight-to-test investigations. CONCLUSION A straight-to-test pathway for suspected colorectal cancer referrals with novel GP-led patient triage safely streamlines patients through the suspected colorectal cancer diagnostic pathway and significantly reduces requirement for face-to-face outpatient clinic attendance. This is achieved with high patient satisfaction.