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Two-week-wait referrals in otolaryngology in a tertiary centre: cross-sectional study of benign outcomes, with a systematic review

Published online by Cambridge University Press:  03 November 2021

B Mettias Open the ORCID record for B Mettias [Opens in a new window] ,
A Charlton  and
S Ashokkumar
B Mettias*
Affiliation:
ENT Department, University Hospitals of Leicester NHS Trust, Leicester, UK
A Charlton
Affiliation:
ENT Department, University Hospitals of Leicester NHS Trust, Leicester, UK
S Ashokkumar
Affiliation:
ENT Department, University Hospitals of Leicester NHS Trust, Leicester, UK
*
Author for correspondence: Dr Bassem Mettias, ENT Department, Royal Derby Hospital, Uttoxeter Road, DerbyDE22 3NE, UK E-mail: bassemadel@hotmail.com
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Abstract

Objective

The two-week-wait referral is designed to improve early detection in cancer patients. This retrospective study analysed those ENT two-week-wait referrals to out-patient clinics in a tertiary head and neck oncology centre, from January to June 2018, which were not compliant with National Institute for Health and Care Excellence guidelines (2015 update).

Methods

Referral symptoms were statistically analysed against National Institute for Health and Care Excellence guidelines, with detailed analysis of reasons for non-compliance. In addition, a systematic review of similar previously published articles was conducted.

Results

There were 1107 patients referred through the two-week-wait pathway. Of these referrals, 52 per cent were compliant with National Institute for Health and Care Excellence 2015 guidelines. Six errors were identified for non-compliant referrals, most commonly inconsistencies in referral (e.g. globus sensation) and intermittent disease course (e.g. intermittent hoarseness). Of all patients referred, 93 per cent were diagnosed with benign conditions, with laryngopharyngeal reflux being the commonest. Twenty-two per cent of referred patients were discharged after the first visit.

Conclusion

Two-week-wait referral is inappropriately overused. There are many non-compliant referrals, and most of the outcomes are benign.

Keywords

Head And Neck CancerBenignGuideline
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 11 , November 2022 , pp. 1051 - 1055
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr B Mettias takes responsibility for the integrity of the content of the paper

Presented at the Midland Institute of Otorhinolaryngology Winter Meeting, 18 January 2019, Nottingham, UK, and at the British Association of Otorhinolaryngology (‘BACO’) International Meeting, 10–12 January 2021 (virtual conference).

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