A multidisciplinary audit of head and neck referrals: considerations for patients’ timelines and outcomes

Abstract

The Rapid Diagnostic Clinic (RDC) was introduced to comply with NICE recommendations for improving head and neck cancer services (National Institute of Clinical Excellence 2004 Improving outcomes in head and neck cancer: the manual. NICE, London). It provides multi-modality specialist assessment for new referrals, with on-site sonography and cytology. We have critically appraised the efficacy of our RDC, with respect to its impact on patients' timelines and outcomes. A retrospective audit of new referrals to the head and neck clinic during a 6-month period was conducted (pre-RDC period); areas in delay in patients reaching a definitive outcome were identified. Following implementation of the RDC, a second cycle, prospective audit was performed and its impact on timelines for patients' journey and outcomes determined. One hundred and ninety-seven patients were seen during the pre-RDC period. The average time from referral to being seen was 11 days for 2-week wait (2WW) referrals and 34 days for other sources. During the RDC period, 299 patients were seen in total. The average waiting time was reduced to 9 days for 2WW referrals and 23 days for other referrals. During the RDC period, over one-third of patients utilised the provision of ultrasound ± FNAC, and consequently, the majority reached a definitive outcome (discharged or scheduled for surgery) following their first consultation. This was a significant improvement compared to the pre-RDC period, where the main outcome was referral for an investigation, with consequently longer waiting time for surgery. We report the first study to consider the effect of a 'one-stop' clinic on patients' journey timelines and outcomes. Our study has shown that the RDC provides an efficient and effective system, which facilitates the patients' pathway to a definitive management plan.

North East London coronavirus disease 2019 protocol for diagnostics in two-week wait head and neck cancer patients

“…In comparison, the introduction of a rapid diagnostic clinic at our institution in 2013 led to 27 per cent of patients being discharged after their first appointment. 9 There were 16 high risk patients (33 per cent); 13 of these (81 per cent) had imaging arranged prior to further virtual review. One patient had imaging and clinical review, and a further patient had clinical review only.…”

“…In comparison, the introduction of a rapid diagnostic clinic at our institution in 2013 led to 27 per cent of patients being discharged after their first appointment. 9 …”

Audit about first consultations on head and neck oncological surgery in Brazil

“…Despite the nuances among the different countries, all follow in a greater or lesser degree to the National Institute of Clinical Excellence (NICE) guidelines 6 . In England, the reality of a public structure similar to the one in Brazil, the expected waiting time for the first oncological care after the clinical suspicion is 2 weeks, and the waiting time from diagnosis to treatment of up to 30 days from the result of the biopsy, or 62 days from the referral of the general practitioner 1 . In Brazil, legislation on this topic is recent.…”

“…It is desirable that most patients referred to a cancer specialty center do not confirm that they are carriers of malignant neoplasms. However, the possibility of the event and the anxiety behind the diagnostic possibility require quick access to the specialist 1 . In 2005, the Ministry of Health issued the number 741, which, considering the need to guarantee the population's access to cancer care, regulates the establishment of high complexity centers in Oncology within the Unified Health System (Sistema Único de Saúde -SUS) 2 .…”

Impact of optimizing diagnostic workup and reducing the time to treatment in head and neck cancer

“…2 The organization and integration of the various aspects of health care for complex diseases such as HNC requiring a multidisciplinary approach have become increasingly important. 3 Simultaneously, the possibilities and complexity of diagnostic procedures and treatment options for patients with HNC are increasing, and this adds to the risk of increasing time-to-treatment intervals. 1,4,5 Time-to-treatment intervals are particularly important for patients with HNC because, as mentioned before, these tumors are relatively fast growing in an anatomically and functionally complex and delicate area.…”