title: Straight to colonoscopy: the ideal patient pathway for the 2-week suspected cancer referrals?
abstract: BACKGROUND
  The UK has a higher mortality for colon cancer than the European average. The UK Government introduced a 2-week referral target for patients with colorectal symptoms meeting certain criteria and 62-day target for the delivery of treatment from the date of referral for  those patients diagnosed with cancer. Hospitals are expected to meet 100% and 95% of these targets, respectively; therefore, an efficient and effective patient pathway is required to deliver diagnosis and treatment within this period. It is suggested that 'straight-to-test' will help this  process and we have examined our implementation of 'straight-to-colonoscopy' as a method of achieving this aim.
  
  
  METHODS
  We carried out a retrospective audit of 317 patients referred under the 2-week rule over a 1-year period between October 2004 and September 2005 and were  eligible for 'straight-to-colonoscopy'. Demographic data, appropriateness of referral and colonoscopy findings were obtained. The cost effectiveness and impact on waiting period were also analysed.
  
  
  RESULTS
  A total of 317 patients were seen within 2 weeks. Cancer was found in 23 patients  and all were treated within 62 days. Forty-four patients were determined by the specialist to have been referred inappropriately because they did not meet NICE referral guidelines. No cancer was found in any of the inappropriate referrals. The use of straight-to-test colonoscopy lead to cost  savings of £26,176 (£82.57/patient) in this group compared to standard practice. There was no increase in waiting times.
  
  
  CONCLUSIONS
  Straight-to-colonoscopy for urgent suspected cancer referrals is a safe, feasible and cost-effective method for delivery of the 62-day target  and did not lead to increase in the endoscopy waiting list.
authors.affiliation: Department of Colorectal Surgery, Mayday University Hospital, Croydon, UK.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Beggs
authors.forename: Ravinda D
authors.initials: RD
authors.lastname: Bhate
authors.forename: Shashi
authors.initials: S
authors.lastname: Irukulla
authors.forename: Mayen
authors.initials: M
authors.lastname: Achiek
authors.forename: A Muti
authors.initials: AM
authors.lastname: Abulafi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration*; D006113:United Kingdom