A low cost, easily implementable method of shortening patient pathways in imaging incidentally suspicious for lung malignancy

In February 2017 we implemented a strategy for rapid escalation of incidental suspicious findings on chest radiology. A report suggestive of malignancy in the lung would be triaged directly to Rapid Access Lung Clinic (RALC), rather than awaiting formal referral by the GP. Furthermore we spread six new CT and RALC appointment slots across prexisting Monday, Wednesday and Friday Respiratory clinics. 30 data sets were collected prospectively from the date of implementation, and retrospectively using consecutive lung cancer diagnoses arising from incidentally abnormal imaging. Timings for each individual patient pathway were collected. Prior to implementation of this strategy, the mean number of working days from incidental abnormal image report to RALC appointment was 9.4 with a standard deviation (S.D) of 6.7 days. Comparatively, the prospective, post implementation data showed a significant improvement with a mean of 6.2 working days (p=0.04) and a greater consistency of service with a S.D of 2.85 working days. Comparing the number of working days from image report to MDT diagnosis; results were also encouraging. The mean number of days reduced from 20.2 to 16.3 (p=0.04). Similarly, service consistency improved with a S.D of 5.1 working days compared to 10.5 previously. To enhance a cancer pathway, points of delay should be identified and resolved wherever possible. In directly escalating incidental, suspicious radiology and strategically distributing ring-fenced secondary care appointments we have improved consistency and reduced the time to MDT diagnosis. We must continue to appraise our performance locally and implement effective change accordingly