Fast Track Head and Neck Referrals Audit

Abstract

Objective: The National Institute for Clinical Excellence (NICE) outlines 10 key urgent referral guidelines. The Department of Health in the UK requires all cancer referrals to be seen within 2 weeks. The audit’s aim was to assess the appropriateness of referrals to the Head and Neck Cancer Clinic.

Method: A retrospective analysis of all “2-week-wait” fast track referrals to the department over a 1-year period (starting August 2010). The referring diagnosis, time of consult, and initial management were recorded. A database of all referrals, the picture archiving and communications system (PACS), and computer and paper records were consulted.

Results: For the period of the study a total of 446 referrals were received, 425 or 95% were seen within 14 days. The average wait was 9 days. The most common reasons for referral included neck lumps, dysphagia, and voice change. Referrals for inappropriate symptoms were not uncommon, however the main issue was duration of symptoms prior to referral, which averaged over 6 months. The diagnostic yield for malignancy was 6%, significantly lower when compared with a number of comparative studies. Although 59.5% of referrals were females, 70.4% of cancer diagnoses were in men.

Conclusion: The use of the NICE guidelines by primary care physicians is far from common practice. A greater awareness of the guidelines would have several beneficial outcomes. The number of inappropriate referrals would be reduced and those with cancer should be picked up earlier, thus improving prognosis.