Two-week rule: has prioritisation of breast referrals by general practitioners improved?
BACKGROUND
A 9-month audit, soon after the introduction of the 2-week rule in the UK in 1999, showed that a significant number of breast cancer patients were referred as non-urgent by their GPs, when the goal is that all suspected breast cancer patients should be seen by a hospital specialist urgently within 2 weeks of referral. The aim of this study was to determine whether GP grading of referrals into urgent and non-urgent had improved.


METHODS
A retrospective review of GP referrals over 8 months, between September 2003 and April 2004, with regard to their urgency, subsequent diagnosis and the use of proformas (standardised referral formats) was carried out. The results were compared to the 1999 audit.


RESULTS
Eighty-two of 1178 patients referred by GP had breast cancer, versus 115 of 1176 patients referred in 1999. Sixty-eight per cent (56/82) of breast cancer patients were referred as urgent, compared to 47% (54/115) in 1999 (P=0.005). A proforma was used in 47% (548/1178) of GP referrals while no proforma was used in 1999. Sixty-five of the 82 cancer patients were referred with a proforma and 85% (55/65) were referred as urgent.


CONCLUSIONS
GP prioritisation of referrals has improved since 1999. With the use of proformas a significant number of patients with cancer were referred urgently.
The Breast Unit, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK. a.imkampe@gmx.de
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Imkampe
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Bendall
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Chianakwalam
D001943:Breast Neoplasms / Q000453:epidemiology / Q000628:therapy*; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology; D014850:Waiting Lists