Introduction/Aims:
The two week wait (2WW) pathway fast-tracks patients referred with suspicious oral lesions. At Royal Bolton Hospital triage is bypassed avoiding delays but often leads to misuse of the pathway. The appropriateness and outcome of 2WW referrals was reviewed.
Materials and Methods:
A 2-cycle retrospective audit of 2WW referrals between August-October was performed over two consecutive years. Referrals were analysed assessing: if patients remained on 2WW, investigations, diagnosis from biopsy, overall outcome. Inappropriate 2WW letters were sent to GDPs to aid improved referrals.
Results/Statistics:
In the first cycle 142 referrals were identified. Only 36%(51) remained on the 2WW pathway; 37 underwent urgent biopsies. Six patients were diagnosed with a malignant condition and one with low-grade dysplasia. 16 patients downgrade to routine underwent routine biopsies wit majority(31) discharged. 4 referrals were deemed completely inappropriate for 2WW pathway. The second cycle yielded 136 patients; only 35%(47) remained on the pathway. 2 patients were diagnosed with a Squamous Cell Carcinoma and one with a Warthin’s tumour. 7 referrals were deemed completely inappropriate. 28 patients had routine biopsies with most(30) discharged or routinely followed up(15).
Conclusions:
The number of 2WW and appropriateness of referrals has not improved despite changes.This could be due to lack of training for GDPs. A guide or GDPs is being generated to help combat this.