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Removing hospital-based triage from suspected colorectal cancer pathways: the impact and learning from a primary care-led electronic straight-to-test pathway
  1. Philippa Orchard1,
  2. Nitin Arvind2,
  3. Alison Wint3,
  4. James Kynaston1,
  5. Ann Lyons2,
  6. Eric Loveday2,
  7. Anne Pullyblank2,4
  1. 1 Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
  2. 2 North Bristol NHS Trust, Bristol, UK
  3. 3 NHS South Gloucestershire Clinical Commissioning Group, Bristol, UK
  4. 4 West of England Academic Health Science Network, Bristol, UK
  1. Correspondence to Philippa Orchard, Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 3NG, UK; philippa.orchard{at}


Background The 2-week wait referral pathway for suspected colorectal cancer was introduced in England to improve time from referral from a general practitioner (GP) to diagnosis and treatment. Patients are required to be seen by a hospital clinician within 2 weeks if their symptoms meet the criteria set by the National Institute for Health and Care Excellence (NICE) and to start cancer treatment within 62 days. To achieve this, many hospitals have introduced a straight-to-test (STT) strategy requiring hospital-based triage of referrals. We describe the impact and learning from a new pathway which has removed triage and moved the process of requesting tests from hospital to GPs in primary care.

Method An electronic STT pathway was introduced allowing GPs to book tests supported by a decision aid based on NICE guidance eliminating the need for a standard referral form or triage process. The hospital identified referrals as being on a cancer pathway and dealt with all ongoing management. Routinely collected cancer data were used to identify time to cancer diagnosis compared with national data

Results 11357 patients were referred via the new pathway over 3 years. Time from referral to diagnosis reduced from 39 to 21 days and led to a dramatic improvement in patients starting treatment within 62 days. Challenges included adapting to a change in referral criteria and developing a robust hospital system to monitor the pathway.

Conclusion We have changed the way patients with suspected colorectal cancer are managed within the National Health Service by giving GPs the ability to order tests electronically within a monitored cancer pathway halving time from referral to diagnosis

  • healthcare quality improvement
  • patient-centred care
  • quality improvement
  • surgery

Data availability statement

Data are available upon reasonable request. Data available upon reasonable request from ORCID 0000-0002-0319-7801.

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Data availability statement

Data are available upon reasonable request. Data available upon reasonable request from ORCID 0000-0002-0319-7801.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.