Validation of the lower gastrointestinal electronic referral protocol

Area of Science:

• Gastroenterology
• Oncology
• Health Informatics

Background:

• Variability in recognizing colorectal cancer symptoms and referral patterns impacts patient outcomes.
• The Lower Gastrointestinal Electronic Referral Protocol (e-RP) was developed to standardize referrals within the Choose and Book system.
• Validation of the e-RP is crucial for its effective implementation in diagnosing colorectal cancer.

Purpose of the Study:

• To validate the accuracy and effectiveness of the Lower Gastrointestinal Electronic Referral Protocol (e-RP).
• To assess the e-RP's ability to correctly identify and route patients with suspected colorectal cancer.
• To compare the e-RP's assigned referral urgency and destination against actual patient pathways.

Main Methods:

• Validation of the e-RP using three distinct patient datasets: colorectal cancer patients, suspected cancer referrals (2-week wait/TWW), and routine referrals.
• Comparison of actual patient destinations, diagnoses, and referral urgency with those assigned by the e-RP.
• Statistical analysis, including Pearson chi-squared test, to evaluate the e-RP's performance.

Main Results:

• The e-RP successfully upgraded 85% of actual colorectal cancer patients referred through the TWW system.
• The protocol redirected three out of four colorectal cancer patients from routine referrals to TWW clinics.
• The e-RP appropriately directed right-sided cancers to colonoscopy or outpatient investigation and left-sided cancers to flexible sigmoidoscopy clinics.

Conclusions:

• Implementing a dedicated referral protocol for all colorectal symptoms can significantly increase the detection rate of colorectal cancer via the TWW pathway.
• The e-RP has the potential to reduce diagnostic delays in secondary care by facilitating 'straight to test' pathways.
• Standardized electronic referral protocols are essential for optimizing colorectal cancer diagnosis and patient management.