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P86 Optimising patient flow and use of resources in the two week wait pathway
  1. K Goffe,
  2. P Ruparelia,
  3. CR Sander,
  4. C Butler
  1. Cambridge University Hospitals, Cambridge, UK


Introduction Lung cancer is the most common cause of cancer death in the UK. Survival is improving but is worse than in some European countries and North America.¹ NICE guidelines recommend that patients with suspected malignancy are seen within two weeks of referral.

An earlier local audit found that 22% of patients referred on the pathway had lung cancer and identified a need to streamline the service. Referrals are triaged as high, intermediate and low risk by a respiratory Consultant based on chest X-ray and clinical details. High-risk patients are prioritised for CT imaging and lung clinical nurse specialist (CNS) time. All patients remain on the two week pathway regardless of triage status.

This study reviewed whether this triage system is accurate in identifying patients with malignancy, thereby improving resource utilisation.

Method Data was collected retrospectively on two week wait referrals during June and July 2015, using referral forms and electronic medical records. Data included key dates in the pathway, triage status and diagnosis.

Results 25 of 60 patients were triaged as high risk. Thirteen of these patients had cancer. Two patients with lung cancer were not triaged as high risk.

Triaging a patient as high risk had a sensitivity for lung malignancy of 86.7% and specificity of 71.4%. Positive predictive value was 0.52.

Nineteen patients triaged as high risk had a CT prior to clinician review and the remaining three had a CT within 3 days. This was three times higher than in the low/intermediate group.

The CNS attended the majority of initial clinic appointments in prioritised patients, unless CT showed benign disease.

Conclusion The triage method correctly identified patients with malignancy in the majority of cases. This led to efficient use of resources. Patients with lung cancer had earlier imaging and access to the CNS. Lung cancer symptoms can overlap with other respiratory conditions and following the initial clinical review, the respiratory clinician may decide to investigate some patients less urgently. In future, this method could help stratify urgency of referral.

Abstract P86 Figure 1

Number of patients triages high/intermediate/low with benign or malignant disease


  1. Global surveillance of cancer survival 1995–2009: (CONCORD-2). Lancet 2015;385:977–1010.

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