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. 2009 May;91(4):310-2.
doi: 10.1308/003588409X391767. Epub 2009 Apr 2.

An audit of urology two-week wait referrals in a large teaching hospital in England

Anup Mathew  1 , K M Desai
Affiliations

An audit of urology two-week wait referrals in a large teaching hospital in England

Anup Mathew et al. Ann R Coll Surg Engl. 2009 May.

Abstract

Introduction: Two week wait referral guidelines have been published by the UK Department of Health for suspected urological cancers. Concordance to these guidelines is variable. Our objectives were to assess the incidence of urological malignancy and the proportion of inappropriate referrals in the two-week wait pathway.

Patients and methods: Retrospective audit of all two-week wait referrals to the urology department over 6 months. Inappropriate referrals were those not satisfying the referral criteria, but referred under the two-week wait system. Detection rates were calculated for each referral criterion based on diagnosis obtained from histology, imaging reports and clinic letters.

Results: Incidence of cancer was 90 of 400 two-week wait referrals (23%). The cancer-detection rate based on reasons for referral ranged from 50 of 122 (41%) for elevated prostate-specific antigen levels to 2 of 56 (4%) for scrotal lumps; 42 (11%) referrals were inappropriate.

Conclusions: The overall cancer-detection rate is acceptable. Most inappropriate referrals were for long-standing symptoms and non-specific testicular/scrotal symptoms. The testicular cancer detection rate raises questions about the two-week wait guidelines. Providing general practitioners with fast-track scrotal ultrasound and revising the guideline may reduce the disproportionately high number of patients referred with suspected testicular cancer. Other inappropriate referrals are a cause for concern as they add to the workload of the 'urgent-referral' pathway.

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Figures

Figure 1
Figure 1
Reasons for referral. [PSA, prostate-specific antigen]
Figure 2
Figure 2
Site of origin of cancer.
Figure 3
Figure 3
Rate of detection of cancer based on reasons for referral. DRE, digital rectal examination; LUTS, lower urinary tract symptoms.
See this image and copyright information in PMC

References

    1. Office for National Statistics. Cancer statistics registrations: registrations of cancer diagnosed in 2004, England. London: Office for National Statistics; Series MB1 no. 35.
    1. Office for National Statistics. Mortality statistics: review of the Registrar General on deaths by cause, sex and age, in England and Wales. London: Office for National Statistics; 2004. Series DH2 no. 31.
    1. Department of Health. Referral Guidelines for Suspected Cancer. < http://www.doh.gov.uk/cancer>.
    1. NHS Executive. Cancer information strategy. London: Department of Health; 2000.
    1. Lewis R, Collins R, Flynn A, Dean ME, Myers L, et al. A systematic review of cancer waiting time audits. Qual Saf Health Care. 2005;14:62–6. - PMC - PubMed

MeSH terms