The factors that lead to a delay between general practitioner referral of symptomatic patients and specialist diagnosis of colorectal cancer: an audit in the Bay of Plenty District Health Board.

AIM: To determine factors leading to delay between referral by the GP of symptomatic patients and subsequent specialist diagnosis of colon or rectum cancer (CRC).

METHOD: A retrospective audit of patients with new CRC referred by their GP over a 30-month period to the specialist services. Analysis of referral letters, specialist grading and subsequent results of investigations. We focused on the High Index of Suspicion (HIS) criteria for suspected CRC.

RESULTS: Only 65 out of 181 patients fulfilled the HIS criteria and of these only half were correctly identified in the referral letter. Only 48 who fulfilled HIS criteria were graded as urgent by the specialist and had their fast-track diagnostic test within a median of 21 days (5-114). The remaining 133 waited a median of 67 days (10-387) (p<0.001). The diagnosis was reached faster if the patient went straight to colonoscopy rather than initial outpatient assessment: median 32 versus 81 days (p=0.008).

CONCLUSION: The HIS Urgent pathway only identified a third of patients and so the criteria should be reviewed. GPs frequently failed to recognise and refer those who met the criteria. A standardised referral form prompting the inclusion of all required information would improve this.