Audit of Two-Week Rule Referrals for Suspected Testicular Cancer in Cornwall, 2003–2005

Kumaraswamy, Prakash; Cox, Robert A.; O'Rourke, John S; Willis, R. G.

doi:10.1308/003588409x391866

Cited by 5 publications

(18 citation statements)

References 15 publications

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“…Applying the inclusion criteria, 30 articles were included, whereas only three were from the database for mental health, PsycINFO. During the analyses, five categories evolved defining potential areas expected to be affected by the quality of referral information (with reference to the included papers in square brackets): timeliness and delay [31–33], attendance/drop-out [34–37], unnecessary consultations and investigations [32, 38–42], appropriateness of the referral [32, 43–53] and correctness of prioritisation of patients [36, 40, 44, 54–60]. Fifteen preliminary indicators were derived from the abstract of these five categories.…”

Section: Resultsmentioning

confidence: 99%

Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method

Hartveit

Vanhaecht

Thorsen

et al. 2017

BMC Health Serv Res

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BackgroundCommunication between involved parties is essential to ensure coordinated and safe health care delivery. However, existing literature reveals that the information relayed in the referral process is seen as insufficient by the receivers. It is unknown how this insufficiency affects the quality of care, and valid performance measures to explore it are lacking. The aim of the present study was to develop quality indicators to detect the impact that the quality of referral letters from primary care to specialised mental health care has on the quality of mental health services.MethodsUsing a modified version of the RAND/UCLA appropriateness method, a systematic literature review and focus group interviews were conducted to define quality indicators for mental health care expected to be affected by the quality of referral information. Focus group participants included psychiatrists, psychologists, general practitioners, patient representatives and managers. The existing evidence and suggested indicators were presented to expert panels, who assessed the indicators by their validity, reliability, sensitivity and feasibility.ResultsSixteen preliminary indicators emerged during the focus group interviews and literature review. The expert panels recommended four of the 16 indicators. The recommended indicators measure a) timely access, b) delay in the process of assessing the referral, c) delay in the onset of care and d) the appropriateness of the referral. Adjustment was necessary for five other indicators, and seven indicators were rejected because of expected confounding factors reducing their validity and sensitivity.ConclusionsThe quality of information relayed in the referral process from primary care to specialised mental health care is expected to affect a wide range of dimensions defining high quality care. The expected importance of the referral process for ensuring ‘timely access’-one of the six aims of high-quality health care defined by the Institute of Medicine-is highlighted. Exploring the underlying mechanisms for the potential impact of referral information on patient outcomes is recommended to enhance quality of care.Trial registrationClinicalTrials.gov: NCT01374035 (28 April 2011).

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Section: Resultsmentioning

confidence: 99%

Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method

Hartveit

Vanhaecht

Thorsen

et al. 2017

BMC Health Serv Res

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“…This has resulted in a diversion of hospital resources in terms of administration and bureaucracy towards meeting the 2WR in all cases, at the expense of those cases referred in a routine manner. 7,15 While increased clinical capacity has allowed for some slack in the system, the consistent findings from many centres across several specialties is that the 2WR confers no significant advantage to patients over standard referral pathways 3,7,16 but that it delays diagnosis and treatment for the latter. 3,5,7,17 Data from several North West Regional audits prior to the introduction of the 2WR reveal that for patients with frank haematuria in 1998 the mean delay from referral to first clinic appointment was 28 days across the region; for our unit it was 29 days.…”

Section: Discussionmentioning

confidence: 99%

Analysis of referral pathways in patients diagnosed with urological cancer

Somov

Irwin

2013

Journal of Clinical Urology

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Objective: To compare the clinical pathways of patients referred under the two-week rule (2WR) with those referred in a standard manner and subsequently diagnosed as having urological cancer. Patients and methods: A retrospective case note review was undertaken of 209 patients coded as having urological cancer over a six-month period. Patients that were not referred through either pathway, who had no symptoms or signs suspicious of cancer or who did not have a newly-diagnosed cancer during this period were excluded. The dates of relevant clinical events within each patient pathway were recorded and compared (e.g. dates of referral, first clinic appointment, diagnosis and first treatment). Results: Of the 209 cases reviewed, 58 cases were excluded. Eighty-two cases were referred through the standard referral pathway and 69 by the 2WR. Overall, patients referred through the 2WR pathway were seen sooner, had their cancer diagnosed earlier and received treatment more quickly than those referred through the standard route. However, the delay between diagnosis and treatment was similar for both groups. Prostate cancer accounted for two thirds of diagnoses, with 54% of 2WR referrals having advanced disease and 66% of cases with localised disease being referred by the standard route. Conclusion: The 2WR accelerates all clinical event times but with little clinical advantage to the patient. The 2WR for suspected cancer should be abandoned in favour of retention of the existing 18-week standard for the commencement of treatment following referral.

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“…The failure of the TWW pathway to translate into improved cancer outcomes in our study merits further discussion. Recent studies on thyroid [9], colon [10] and testicular [11] cancer have questioned the validity of the urgent suspected cancer pathway. Sharpe et al.…”

Section: Discussionmentioning

confidence: 99%

“…The failure of the TWW pathway to translate into improved cancer outcomes in our study merits further discussion. Recent studies on thyroid [9], colon [10] and Ó 2011 The Authors testicular [11] cancer have questioned the validity of the urgent suspected cancer pathway. Sharpe et al [12] investigated the cancer survival outcomes in oesophagogastric cancer patients referred via the TWW and routine referral pathways through their unit.…”

Section: Discussionmentioning

confidence: 99%