title: Providing a quality service: direct referral from the cytology laboratory to the colposcopy clinic.
abstract: OBJECTIVE
  To compare the time taken for the referral process and the accuracy of referrals before and after a process review and the introduction of a system of direct referral from the cytology laboratory to the colposcopy clinic.
  
  
  METHODS
  The colposcopy service in a large teaching hospital in Teesside.
  
  
  METHODS
  Data on time points within the referral process and smear histories were collected. Data on time points were obtained retrospectively from the case-notes from before the new system of referral ('pre' group) and from an electronic database after the changes ('post' group). Smear histories were retrieved from the cytology database.
  
  
  RESULTS
  The overall time that patients waited from the time the smear was taken until the time they were seen in the colposcopy clinic was significantly reduced. The median time between smear and colposcopy decreased from 92.5 days (range 35-254 days) in the 'pre' group to 33 days (range 13-43 days) in the 'post' group (P=0.0001). The median time taken from the smear report being issued until the report arrived in the colposcopy clinic was 14 days (range 4-123 days) in the 'pre' group, compared with two days (range 0-17 days) in the 'post' group (P=0.0001). There was a significant reduction in the number of inaccurate referrals in the 'post' group compared with the 'pre' group (P=0.02).
  
  
  CONCLUSIONS
  Direct referral significantly reduces the time patients wait for colposcopy appointments and improves the accuracy of referrals.
authors.affiliation: Department of Obstetrics and Gynaecology, James Cook University Hospital, Middlesbrough, Cleveland TS4 3BW, UK. fiona@drsmiller.freeserve.co.uk
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Kew
authors.forename: Denise
authors.initials: D
authors.lastname: Appleby
authors.forename: Vicki
authors.initials: V
authors.lastname: Whittaker
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Cruickshank
authors.forename: Sandra
authors.initials: S
authors.lastname: Knott
mesh_terms: D000328:Adult; D003585:Cell Biology; D003127:Colposcopy; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007755:Laboratories, Hospital; D008403:Mass Screening; D008875:Middle Aged; D012017:Referral and Consultation; D013997:Time Factors; D006113:United Kingdom; D002577:Uterine Cervical Diseases / Q000175:diagnosis; D014626:Vaginal Smears