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PTH-305 A review of recurrent referrals to the lower gastro-intestinal (lgi) fast track service – is one referral enough?
  1. J Stewart,
  2. N Appleton,
  3. D Vimalachandran,
  4. C McFaul
  1. Colorectal, Countess of Chester Hospital, Chester, UK

Abstract

Introduction Average monthly referrals to our institution fast track LGI clinics have almost doubled between 2010 and 2014. Patients are being repeatedly referred, increasing the workload and cost of this service. We examined the outcomes of those re-referrals.

Method A retrospective review of a prospectively maintained database and notes review was performed.

Results Over the three-year study period, 3696 were referred to the fast track clinic. Eighty (2.2%) were referred twice or more. 19/80 (24%) were re-referred having missed their first appointment. 29/80 (36%) had repeated investigations that were normal with 24/80 (30%) confirming the presence of diverticular disease. Seven patients had colorectal cancer (CRC) diagnosed following the second referral and one after the third. Five of these newly diagnosed individuals had failed to attend or declined investigation initially.

Discussion Re-referral of patients to fast track LGI clinics has significant cost implications. The implication of patients attending such a clinic needs to be emphasised in the primary care setting to minimise non-attendance. 66% of those re-referred had diverticular disease or normal bowel diagnosed on repeat investigation, suggesting that second referral or repeat investigation was unnecessary. Further education/guidelines for both patient and health care professional would help minimise this repetition. CRC detection miss rates are a known phenomenon and need to be audited and highlighted to the LGI MDT to improve service provision and excellence.

Disclosure of interest None Declared.

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