Efficient management of new patient referrals: Further data with increased numbers confirms the safety of advanced nurse practitioner (ANP) led telephone breast pain clinics

Robinson, Claire; Ellis, Katie; Fatayer, Hiba; Touqan, Nader; Gandhi, Ashu

doi:10.1016/j.ejso.2022.03.034

European Journal of Surgical Oncology

2022

DOI: 10.1016/j.ejso.2022.03.034

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Efficient management of new patient referrals: Further data with increased numbers confirms the safety of advanced nurse practitioner (ANP) led telephone breast pain clinics

Claire Robinson

Katie Ellis

Hiba Fatayer

et al.

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The association of breast surgery ASPIRE: breast pain pathway rapid evaluation project – study protocol

Hubbard,

Isaac,

Cui

et al. 2024

International Journal of Surgery Protocols

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Background: Breast pain accounts for 20–40% of new referrals to breast units in the UK and these patients have a very low risk of breast cancer. Patients have previously been assessed in resource-intensive, cancer-exclusion, one stop clinics, which are now failing to meet government targets due to excessive demand. UK Breast units are increasingly piloting Breast Pain-only Pathways (BPP) to assess these patients, and there is no consensus for the optimal pathway. The aim of this prospective multicentre study is to assess the safety and patient satisfaction of different BPPs to inform future BPP design and implementation. Methods: All UK breast units will be invited to join the ASPIRE study between January 2023 and December 2023. Units with a BPP are invited to submit their pathway for evaluation; and those without a BPP who see patients with breast pain-only in a one stop clinics setting are also invited to join the study to evaluate the traditional pathway model concurrently. Patient satisfaction assessments will be collected after their initial consultation and patient outcomes, including subsequent cancer diagnosis, will be followed up at 12 months to determine if they have cancer diagnosis after discharge to assess pathway safety.

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The association of breast surgery ASPIRE: breast pain pathway rapid evaluation project – study protocol

Hubbard,

Isaac,

Cui

et al. 2024

International Journal of Surgery Protocols

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Evaluating a novel patient pathway to manage symptomatic breast referrals (the blue flag clinic): a longitudinal observational study

Hubbard,

Liu,

Sulieman

et al. 2023

annals

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Introduction A novel referral pathway for exhibited breast symptom (EBS) referrals to manage increasing referrals of urgent suspected cancer (USC) was implemented in our trust. We report on the safety and effect on compliance with the 2-week-wait rule (2WW). Methods A single-centre longitudinal observational study included all patients referred to a UK breast unit during 13 May 2019 to 27 March 2020 (period 1) and 8 February 2021 to 31 January 2022 (period 2). USC referrals were assessed in a one-stop clinic (red flag clinic [RFC]); EBS referrals were assessed in a new clinic in which clinical evaluation was performed and imaging occurred subsequently (blue flag clinic [BFC]). Patients were followed up to determine the symptomatic interval cancer rate. Results There were 9,695 referrals; 1,655 referrals (17%) were assessed in the BFC after 63 exclusions. Some 95.9% of patients had a benign clinical examination (P1/P2), 80.1% had imaging (mammogram or ultrasound) and 4% had a tissue biopsy. In total, 16/1,655 (0.97%) BFC patients and 510/7,977 (8.2%) RFC patients were diagnosed with breast cancer (breast cancer detection rate). Some 1,631 patients (with 1,639 referrals) were discharged and followed up for a median of 17 months (interquartile range 12–32) with one subsequent cancer diagnosis (symptomatic interval cancer rate, 0.06%). Implementation of the BFC pathway increased 3-month average trust performance of USC referrals with 2WW standard from 8.5% to 98.7% (period 1) and from 30% to 66% (period 2). Conclusions The BFC pathway for EBS patients is safe and implementation led to improvement against the 2WW target for USC referrals, ensuring resources are prioritised to patients with the highest likelihood of breast cancer.

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Efficient management of new patient referrals: Further data with increased numbers confirms the safety of advanced nurse practitioner (ANP) led telephone breast pain clinics

Cited by 2 publications

References 0 publications

The association of breast surgery ASPIRE: breast pain pathway rapid evaluation project – study protocol

The association of breast surgery ASPIRE: breast pain pathway rapid evaluation project – study protocol

Evaluating a novel patient pathway to manage symptomatic breast referrals (the blue flag clinic): a longitudinal observational study

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