title: Reducing referral delays in colorectal cancer diagnosis: is it about how you ask?
abstract: OBJECTIVE
  Delays in colorectal cancer (CRC) diagnosis related to colonoscopy referrals are not well studied. The authors tested whether certain details of information transmitted through computerised provider order entry (CPOE)-based referrals affected timeliness of diagnostic colonoscopy for patients with newly diagnosed CRC.
  
  
  METHODS
  The authors studied a 6-year cohort of all newly diagnosed patients with CRC at a large tertiary care Veterans Affairs hospital and its affiliated multispecialty clinics. Referring providers included primary care clinicians, resident trainees and other specialists. From the colonoscopy referral preceding CRC diagnosis, the authors determined request date, type and frequency of diagnostic clues provided (symptoms, signs, test results), notation of urgency, and documented evidence of verbal contact between referring provider and consultant to expedite referral. The authors compared distributions of proportions of diagnostic clues between patients with a lag of >60 and ≤60 day, and examined predictors of lag time.
  
  
  RESULTS
  Of 367 electronic referrals identified with a median lag of 57 days, 178 (48.5%) had a lag of >60 days. Referrals associated with longer lag times included those with 'positive faecal occult blood test' (92 days, p<0.0001), 'haematochesia' (75 days, p=0.02), 'history of polyps' (221 days, p=0.0006) and when 'screening' (vs specific symptoms) was given as the reason for diagnostic colonoscopy (203 days, p=0.002). Independent predictors of shorter wait times included three diagnostic clues, notation of urgency and documentation of verbal contact.
  
  
  CONCLUSIONS
  Attention to certain details of diagnostic information provided to consultants through CPOE-based referrals may help reduce delays in CRC diagnosis.
authors.affiliation: VA Medical Center 152, 2002 Holcombe Blvd, Houston, TX 77030, USA. hardeeps@bcm.tmc.edu
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
authors.forename: Kuang
authors.initials: K
authors.lastname: Daci
authors.forename: Clyde
authors.initials: C
authors.lastname: Collins
authors.forename: Myrna
authors.initials: M
authors.lastname: Khan
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D057210:Delayed Diagnosis / Q000517:prevention & control*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D012017:Referral and Consultation / Q000458:organization & administration*; D013997:Time Factors