Urgent suspected cancer referral from primary care: A closed loop audit

Quantitative faecal immunochemical test (FIT) is a simple triage tool to stratify patients with suspected colorectal cancer. The aim of this audit is to evaluate the colorectal referrals from primary care to the Urgent Suspected Cancer (USC) pathway in our health board.

A pre-interventional cycle was conducted from January to March 2024. Subsequently, FIT letter was introduced. Following its implementation, a follow up cycle was carried out to evaluate its effectiveness in guiding referrals for patients with suspected colorectal cancer from April to June 2024. The referrals were compared against NICE guideline DG56 "Quantitative faecal immunochemical testing to guide colorectal cancer pathway referral in primary care".

In the pre-intervention cycle, there are a total of 870 referrals through the USC pathway, of which only 456 (52.4%) referrals were accompanied with FIT test. A FIT letter was introduced to streamline the USC pathway and ensure that USC outpatient slots were used appropriately. After implementation, there are a total of 748 referrals, with 430 (57.5%) referrals with FIT test. This demonstrated an improvement of 5.1% compared to the pre-intervention (P = 0.041). 90 FIT letters were provided to primary care physicians as they don't meet the recommendation. The average time to first outpatient appointment has also decreased from 11.1 days to 10.2 days.

This closed loop audit demonstrated a significant improvement in appropriate colorectal cancer referrals from primary care to the USC pathway. This intervention enhanced the prioritisation of USC referrals, decreased delays and ensured more appropriate use of outpatient appointment slots.