P323 Is pathology missed when GPs misrefer non-acute abdominal presentations to the wrong 2WW imaging pathway?

• Published in: Gut Vol. 71; no. Suppl 1; p. A197
• Main Authors: Rathore, Fahad, Kaderbhai, Husein, Billimoria, Bhavini, Verma, Ajay
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 19.06.2022; BMJ Publishing Group LTD
• Subjects: Abdomen; Colorectal cancer; Colorectal carcinoma; Computed tomography; Iron deficiency; Mucosa; Nutrient deficiency; Pathology; Patients; Pelvis; Polyps; Poster presentations; Quality control; Tumors
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2022-BSG.374

IntroductionOur region has specialised 2 week wait (2WW) pathways which offer different scans for different non-acute abdominal presentations to optimise the chances of detecting underlying pathology. An adult >60 years old with change in bowel habit (CIBH) for example should have a Faecal Immunochemical Test (FIT) and if positive will proceed to a CT colon with contrast scan (CCOLOC) . Anecdotally we felt that too many patients with CIBH were being referred on other pathways which resulted in CT abdomen and pelvis scans which were not colonograms (CABPEC) and we wanted to see if this was potentially resulting in a large proportion of patients having small mucosal masses/size significant polyps which could turn malignant and are left undiagnosed.MethodsWe performed a database search on our Radiology Information System (CRIS – Healthcare Software Solutions Ltd) for the first 200 referrals to our unexplained weight loss and/or abdominal pain > 40 years old pathway which should not have had CIBH and would only receive a CABPEC for the calendar year starting January 2020.We counted how many of these referrals were inappropriate if they contained features (CIBH, Iron Deficiency Anaemia (IDA), palpable abdominal mass), which could have got them on to an alternative pathway requiring a CCOLOC instead. We counted how many of these scans demonstrated pathology.We then reviewed the subsequent scans for the reviewed referrals until the present date (February 2022) on CRIS to see if any patients have later developed a colorectal cancer which might have been picked up at an earlier stage if the patient had the correct scan.ResultsTotal misreferred: 157 (78.5%).Abstract P323 Table 1Reasons for misreferral Reason Number Percentage of total referrals (%) Perecentage of misreferrals (%) CIBH only 138 69 87.9 Palpable mass only1 0.5 0.6 Unexplained IDA only 3 1.5 1.9 CIBH & palpable mass 3 1.5 1.9 CIBH and unexplained IDA 10 5 6.4 Combiniation of CIBH, palpable mass & unexplained IDA 1 0.5 0.6 Other1 0.5 0.6 Total157 78.5 100 Number of scans in which pathology was demonstrated: 31 (15.5%)Number of size significant colonic polyps or subsequent colorectal tumors proven to have developed in the audit population to date: 0.ConclusionsThe vast majority of referrals to this pathway are misreferred and this is a good quality improvement point to feed back to our GPs.We have been unable to demonstrate that getting the ‘wrong’ scan has resulted in having missed subsequent colorectal cancer.We are considering auditing older data from this pathway to see if a longer interval allows missed colorectal cancers to manifest.