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Optimising healthcare delivery in respiratory medicine

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V Dudzevicius, A Ahmad, C Fong, N Krishnaraj. The James Cook University Hospital, Middlesbrough, UK

Aim: To evaluate changes in performance and meeting targets in managing patients with suspected lung cancer after setting up an early diagnosis clinic—“two-week rule” (TWR) clinic.

Materials and Methods: Retrospective analysis of 210 consecutive patients who were referred with suspected lung cancer. Study period was January 2007 to April 2007 (pre-TWR clinic) and May 2007 to August 2007 (post-TWR clinic). The patients referred under TWR and non-TWR were compared. Different pathway times, type of the tests and treatments given were analysed. Statistical analysis was done using SPSS package (Chicago, USA).

Results: Analysing pathway times, no difference was found in time from referral to first seen between pre-TWR and post-TWR period, 6.3 ± 0.3 and 6.3 ± 0.4 (days, mean ± SEM, respectively). There were no breaches in “14 days target”. In the TWR group times from first seen to first diagnostic test (usually computed tomography; CT), between first and second diagnostic test (usually bronchoscopy/CT FNA; improved in the non-TWR group also), from first seen to definitive diagnosis have significantly improved after the clinic was set up (see table). If the second test was non-diagnostic and additional testing was required this resulted in significant delay from first seen to definitive diagnosis compared with other patients—35.6 ± 4.6 and 7.8 ± 1.3 (days, mean ± SEM, respectively). Similar findings were in the non-TWR group. It also prolonged time from referral to first treatment given. There was no improvement in time from referral to first treatment given after the TWR clinic was set up (see table). One “62-days target” breach pre-TWR and two breaches post-TWR clinic were detected. Shortest time to first treatment was found if palliative treatment was considered compared with surgery and chemo/radiotherapy treatment groups.

Conclusions: …

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