title: DaPeCa-2: Implementation of fast-track clinical pathways for penile cancer shortens waiting time and accelerates the diagnostic process--A comparative before-and-after study in a tertiary referral centre in Denmark.
abstract: OBJECTIVE
  The aim of this study was to examine the feasibility and impact of a fast-track referral pathway on clinical time intervals in penile cancer.
  
  
  METHODS
  This observational study from a tertiary referral centre included 263 patients diagnosed before and after the introduction of an intervention to reduce clinical time intervals, the Cancer Patient Pathway (CPP). The CPP included fast-track referral and set time-frames for units participating in cancer diagnosis and treatment, and was introduced for penile cancer in Denmark on 1 January 2009. Median time intervals (in calendar days) with interquartile range were the main outcome measure.
  
  
  RESULTS
  A trend towards reduction was observed in all clinical time intervals, with a statistically significant reduction in the system interval (p = 0.01) and tertiary centre interval (p < 0.0001). The proportion of patients treated within the maximum accepted time-frame of 37 days after referral steadily increased after implementation of the CPP. In particular, unjustified waiting time was reduced significantly. This was mainly achieved through pre-booking of appointments and diagnostic time slots by a dedicated clinical coordinator.
  
  
  CONCLUSIONS
  To the authors' knowledge, this is the first study examining the feasibility and impact of an intervention to reduce clinical time intervals in penile cancer. The Danish CPP was successful in reducing system and tertiary centre intervals. Future interventions need to address the long patient interval. Longer follow-up is needed to study the impact of CPP on mortality.
authors: a Department of Urology, Aarhus University Hospital , Aarhus, Denmark.
authors: Jakob Kristian
authors: JK
authors: Jakobsen
authors: a Department of Urology, Aarhus University Hospital , Aarhus, Denmark.
authors: Jørgen Bjerggaard
authors: JB
authors: Jensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000628:therapy; D065187:Controlled Before-After Studies; D019091:Critical Pathways; D057210:Delayed Diagnosis / Q000517:prevention & control; D003718:Denmark; D006801:Humans; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000175:diagnosis* / Q000628:therapy; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cancer patient pathway; clinical pathway; clinical time intervals; delay; penile cancer; squamous cell carcinoma of the penis; time intervals; urgent referral