The fourteen-day rule and colorectal cancer

Abstract

Objective: To examine the effect of the fourteen-day rule on the colorectal service of a district general hospital. Methods: Prospective audit of all patients referred by general practitioners to the colorectal service of a district general hospital serving a population of approximately 300,000 people. The main outcome measures were: (i) mean interval in days from referral to first clinic appointment; (ii) first clinic appointment to diagnosis; and (iii) overall interval from referral to diagnosis. Results: There was a change in the referral pattern with greater numbers of 'fourteen-day rule' and urgent referrals than expected (P < 0.001). The mean time interval from referral to diagnosis was reduced (P < 0.01). This was due to a reduction in the wait for a first clinic appointment (P < 0.01). The wait between first appointment and diagnosis was unchanged (P < 0.05). Waiting times for patients referred as 'routine' or whose GPs did not specify a priority also improved. Conclusions: The 'fourteen-day rule' with respect to colorectal cancer has reduced waiting times for a first appointment to see a specialist. Further improvements will require additional resources to reduce the delay for investigations. The effect on long-term survival remains to be seen.

The Two-Week Rule for NHS Gastrointestinal Cancer Referrals: A Systematic Review of Diagnostic Effectiveness

“…This should, in theory, have a negative impact on all other aspects of the service, although no evidence of this has been found to date. Three studies reported a decline in the routine endoscopy waiting lists following the introduction of the TWR [11,25,45], possibly due to an increased awareness of the guidelines for patient referrals, the more efficient organisation of services or the introduction of nurse endoscopists to cope with increased demand.…”

“…The effect of the TWR on long term survival remains unknown [11]. Many studies have reported no significant difference in the stage of the disease in CRC patients referred via the TWR compared with other referral routes [12,14,19,26,31].…”

Regulation, measurements and incentives. The experience in the US and UK: does context matter?

“…There are widespread examples of QI schemes and service redesign to achieve this result. 44,[47][48][49][50][51][52][53] However, the rigid nature of the measures that underpinned star ratings has been criticized for encouraging 'management to measure' , 44,50,54 although it is questionable how great the effect of this was. 46 In addition, gaming 44 48,51,55 and unsophisticated falsification of data 44,46,48 were also noted.…”

Analysis of Wait Times and Costs During the Peri-Diagnostic Period for Non-Small Cell Lung Cancer

“…Thus, reducing wait times may in turn confer psychosocial benefits. Moreover, a wait period of 8 weeks to reach a diagnosis in a high-risk patient population appears particularly unjustifiable when recently published series reported good compliance to a '2-week wait rule' from referral to treatment among breast and colorectal cancer patients [26,27].…”