North Bristol NHS Trust South Gloucestershire CCG Why Use the ICE 2WW R eferral System Allows GPs to book straight to test Takes away the need for a structured referral form and internal triage to test ID: 1044357
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1. An Electronic 2 Week Wait Referral System for Colorectal CancerNorth Bristol NHS TrustSouth Gloucestershire CCG
2. Why Use the ICE 2WW Referral System?Allows GPs to book straight to testTakes away the need for a structured referral form and internal triage to testHas reduced the time to colorectal cancer diagnosis from 28 to 11 daysImproved 62 day cancer performanceGood feedback from GPs and patients
3. The important part for patients was to find out what was wrong quickly, and to get peace of mind and treatment as soon as possible80% of patients felt the GPs were good and explained the pathwayAll patients said they would prefer to be contacted as quickly as possible and would like tests as soon as possible All patients described that being informed by the GP in detail, and receiving an appointment quickly were the 2 most important things for themAll patients gave positive feedbackPatient Feedback
4. Improved Performance Against 62 day TargetMonthsnCancer performance increased from 69% to 82%
5. Referral pathway based on symptomsGuidance advises GPs what test to order We track the patient internally to meet cancer targetsTest shows cancer/significant abnormalityTest is normal or non cancer diagnosisBack to GP with adviceWe deal with ongoing testsGP books test via e booking system or clinic via C&BNew System
6. Important Points to ConsiderInform patients of risks of testsEnsure they are fit for testBe aware of the caveats for each test eg patients having CTC need a PRDo not book more than one test at a timeDo not book a test if the patient has had one within the year
7. ColonoscopyRequires full bowel prep with risks of dehydration/AKIRisk of perforationRisk of bleedingRisk of incomplete examinationRequires patient to have painkillers and sedationPatient needs to be mobile
8. Flexible SigmoidoscopyRequires no sedation. Patient can have entonoxPreparation is a phosphate enemaExtremely small risk of perforationSmall risk of bleedingPatient needs to be mobile
9. CT Colonoscopy (Virtual Colonoscopy)The patient must have a PR examination -CTC is not good at assessing anorectal junctionRadiation exposurePatient must be able toLie proneTolerate oral gastrograffin (not full bowel prep)Tolerate rectal insufflation
10. Who to send to clinic instead of straight to test?It is an option for anyoneThe pathway of choice for patients with an abdominal or rectal massFrail complex elderly if concerned they are not fit for any test including a plain CT scanPatients who are unable to give consent for a test
11. Please Make Sure your Patient is Free to Attend within 2 weeksIn the first year10% declined colonoscopy, 1.5% DNA6% declined flexible sigmoidoscopy, 1% DNAPlease check patient is willing to have the test and understandsDownload patient information and give to patient
12. New NICE GuidanceThere are many combinations of symptoms to consider now but in order to use ICE it is important that you start with the main symptom
13. Start with the main symptom as described in the guidance>50 with unexplained rectal bleeding-Book flexible sigmoidoscopy on the right side of the screen Abdominal or rectal mass-this test is a symptom that still requires clinic referral via NHS eReferrals found on the right of the screen For all other symptom complexes the recommended test is colonoscopy, CT colonoscopy or plain CT depending on fitness
14. AGE TEST60-75 colonoscopy75-85 CTC>85 CT with extended oral prepIron Deficiency anaemiaOGDUnexplained rectal bleeding age >50 Abdominal or rectal massFlexible sigmoidoscopy with PO4 enemaClinic via NHS eReferraland2WW Symptoms-recommended testAll symptom complexes in new NICE guidance requiring colonic imaging (all symptom complexes apart from rectal bleeding alone or a mass)Algorithms for age and symptoms built into the requesting system
15. Recommended Age for TestsColonoscopy up to age 75It is not possible to book a colonoscopy on the ICE system for a patient over 80CT colonoscopy between 75-85 or unfit for colonoscopyPlain CT over 85 or unfit for any other test
16. FinallyDownload patient information leaflets using the linksAny problems contactAnne.pullyblank@nbt,nhs.ukAnn.lyons@nbt.nhs.ukCancer office
17. 1751 CTC1980 colonoscopy5250 referrals80% straight to testReduced mean time to diagnosisFrom 28 days to 11 days1125 outpatient appointmentsImproved 62 day cancer performancePositive Feedback from patients and GPs