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Organisation of respiratory care
P230 Inappropriate referrals to the rapid access lung clinic (RALC)
  1. S Huq,
  2. M Gautam,
  3. M Haris,
  4. A Ashish,
  5. M Ledson,
  6. M Walshaw
  1. Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK

Abstract

Introduction and Aims Urgent referral suspected lung cancer cases depends upon nationally agreed protocols (a suspicious chest x-ray, persistent haemoptysis in smokers over age 40, stridor and SVC obstruction). In order to best use resource intensive RALC facilities, it is important that these protocols are followed. We wished to look at inappropriate referrals to the RALC which serves our large lung cancer unit (450 cases per year).

Methods We looked at source of and reasons for referral, eventual placement of the referral, and the ultimate diagnosis of all inappropriate referrals during the calendar year 2009.

Results Of 452 referrals, 97 (21%) did not follow the protocol [68 (70%) primary, 14 (14%) secondary care, and 15 (15%) from the A&E department]; including 76 (78%) with a ‘suspicious chest x-ray’ and 6 (6%) with ‘haemoptysis’. In 46, the chest x-ray report did not suggest cancer, 6 had a normal chest x-ray, 2 from primary care had no radiology, 9 from secondary care had CT scans not suggestive of lung cancer, 5 did not meet the haemoptysis referral criteria, 8 were under specialist care for lung cancer/other malignancies, 11 were under chest physician/surgeon review and 3 were inpatients. One preferred investigation elsewhere, 1 had already been processed through the RALC, and one was a nursing home resident. In every case, a lung cancer unit clinician communicated with the referrer and channelled these referrals in timely fashion to appropriate services: 51 (53%) to a general chest clinic, 16 (16%) to other hospital specialists, 15 (15%) back to their GP, and one to palliative care. Ultimately, only 3 (3%) were subsequently diagnosed with lung cancer; 2 via the general chest clinics and 1 following re-referral with persistent haemoptysis.

Conclusion We have shown that almost a quarter of RALC referrals did not adhere to strict referral protocols and would have been better served by a more appropriate referral elsewhere. We are working to educate our primary and secondary care colleagues to ensure that the only appropriate cases are referred to the RALC in order to reap the maximum benefit from this resource intensive service.

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