Problem The need to develop a patient pathway for emergency admissions who have a previously undiagnosed cancer.

Design The existing patient pathway was audited and process-mapped to identify delays and areas for improvement. Discussions with key stakeholders were held to identify their needs from an acute oncology service.

Strategies for change A new patient pathway was developed, and a new online referral process was implemented. The publicity and education campaign was repeatedly aimed at referring physicians at consultant and junior level, and took the form of emails and presentations with handouts at all teaching sessions, multidisciplinary team meetings, the Consultants Committee and Junior Doctors' induction.

Effects of change The new system was piloted for 6 months. 12/18 patients were referred via the new pathway. 15/18 patients were referred via the new online system. Length of stay, endoscopies, biopsies and blood tests were all statistically significantly reduced during the study period compared with the original audit.

Lessons learnt The challenge was to convince the referring general physicians to use the new patient pathway and referral method. Incorporating their ideas for improvement and implementation made it more likely that they would take up the new ideas. Education and publicity were also extensive, often repeated, and at both junior and senior level. Having the Lead Cancer Clinician and Acute Medicine Consultant engage directly with consultant colleagues, as well as strong support from the Medical Director, was also crucial to the project's success.