A prospective audit of the implementation of the 2-week rule for assessment of suspected urological cancers.
BACKGROUND
All urology departments are under considerable pressure to comply with the UK Government's implementation of the 2-week rule for suspected cancer referrals. A prospective audit was planned to begin 6 months after introduction of cancer referral guidelines and a central data collection process, to investigate the local workload generated by these referrals, and compliance with the 2-week rule.


METHODS
Data were collected prospectively over an 8-week period. All referral letters were examined by an independent urologist for any of the criteria defined by the regional tumour working group as suspicious of urological cancer. For suspected cancer referrals, the patient journey was followed to assess efficiency of the referral process. Results were compared with figures for '2-week rule' referrals for the Trust obtained from the UK Department of Health (DoH) website.


RESULTS
In all, 234 GP referrals were reviewed, 82 fitting regional criteria for suspected cancer. Of these, (i) 13% were either marked urgent with a clear statement of 'cancer' or included a clear request to be seen within 2 weeks; (ii) 23% included no implication of cancer; (iii) 72% were seen in haematuria clinic, median time to clinic visit being 56.5 days, none complying with the 2-week rule; and (iv) of referrals not seen in haematuria clinic, median time to clinic was 21 days, with 34% compliance. With more stringent definitions of a cancer referral, DoH figures for the Trust recorded just 18 referrals over 3 months, with 89% compliance.


CONCLUSIONS
GP referral letters meeting guidelines for suspected cancer often failed to imply or mention this. Compliance with the 2-week rule was poor, especially for the haematuria clinic. This is variably attributable to wording of GP letters, communication issues, and the sheer load of patients to be seen.


CONCLUSIONS
DoH criteria for cancer referrals grossly underestimate the true magnitude of workload demanded of the service.
Department of Urology, St Helier Hospital, Carshalton, Surrey, UK. jcoxon@orange.net
J P
JP
Coxon
H J
HJ
Harris
N A
NA
Watkin
D000553:Ambulatory Care / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013997:Time Factors; D006113:United Kingdom; D014571:Urologic Neoplasms / Q000175:diagnosis* / Q000628:therapy; D016526:Workload