Review of rapid access clinic referrals in breast care centre during the COVID-19 pandemic

Abstract

Background: The continuation of cancer services throughout the Covid pandemic has required careful consideration of referral numbers, footfall to the hospital and provision of a secure environment. Concerns regarding delayed diagnosis and resumption of near to normal activity has seen an increase in referrals. There is scope now to modify the referral into the two-week wait system and put units in better stance if future pandemic waves occur.Aim: To introduce and measure a guidance tool for primary care in determining actual need for one-stop clinic as per the Association of Breast Surgery Guidelines (October 2020) through an electronically distributed letter.Design and setting: Retrospective data analysis using information from electronic patient notes.Method: A snapshot audit was then undertaken over a two week long period before and after the tool was distributed. Referral criteria and triple assessment outcomes were measured to see if this guidance was being followed.Results: Following guidance to Primary Care, breast pain as the only presenting symptom fell by 58%, the number of patients being discharged with 'no pathology detected' halved, and there was no drop in the number of cancer diagnoses.Conclusion: Use of explicit guidance for Primary Care with regards to low risk symptoms as per NICE guidelines can have a significant effect on the pressures of the two-week wait system and reduce footfall to the hospital. A larger study period and close tracking of patients will help to ensure safety and allow units to manage referrals in a timely manner. Background: The continuation of cancer services throughout the Covid pandemic has required careful consideration of referral numbers, footfall to the hospital and provision of a secure environment. Concerns regarding delayed diagnosis and resumption of near to normal activity has seen an increase in referrals. There is scope now to modify the referral into the two-week wait system and put units in better stance if future pandemic waves occur. Aim: To introduce and measure a guidance tool for primary care in determining actual need for one-stop clinic as per the Association of Breast Surgery Guidelines (October 2020) through an electronically distributed letter. Design and setting: Retrospective data analysis using information from electronic patient notes. Method: A snapshot audit was then undertaken over a two week long period before and after the tool was distributed. Referral criteria and triple assessment outcomes were measured to see if this guidance was being followed. Results: Following guidance to Primary Care, breast pain as the only presenting symptom fell by 58%, the number of patients being discharged with 'no pathology detected' halved, and there was no drop in the number of cancer diagnoses. Conclusion: Use of explicit guidance for Primary Care with regards to low risk symptoms as per NICE guidelines can have a significant effect on the pressures of the two-week wait system and reduce footfall to the hospital. A larger study period and close tracking of patients will help to ensure safety and allow units to manage referrals in a timely manner.