Khawaja A R, Allan S M
Eastbourne District General Hospital, Eastbourne, BN21 2UD, UK.
Eur J Surg Oncol. 2000 Sep;26(6):536-9. doi: 10.1053/ejso.2000.0942.
To determine the referral practice of GPs to a Fast Access Breast Clinic before and after the implementation of the 'two week wait' and to demonstrate the impact of this guarantee on the detection rate of breast cancer and access to the Breast Clinic.
A complete audit cycle was performed in a District General hospital (Eastbourne District General Hospital). The main outcome measures were detected breast cancer, clinical accuracy of the GPs and the waiting time for a Fast Access breast clinic.
Prior to the implementation of the Government's Directive, the detection rate of breast cancer was 22% and all cancers were seen within 1 week of referral letter. The routine waiting time for non-urgent assessment was 4 weeks. The clinical accuracy of GP referrals was 42%. On the basis of the findings in the first part of the audit, guidelines were sent to the GPs to aid in their referrals to FABC, prior to the 1 April deadline. After the implementation the re-audit showed that the cancer detection rate had dropped to 19% and only 85% of patients were seen in 2 weeks. The routine wait for non-urgent assessment had gone up to a minimum of 8 weeks. The clinical accuracy had slightly increased to 49%.
With the transfer of power on deciding the urgency of referrals from the specialist to the GP, there has been a decline in the cancer detection rate and an increase in the waiting time for patients not deemed urgent by the GPs. The decision on the urgency of referral should be in the hands of the relevant specialist who individually can decide the best way to run their Fast Access Breast Clinics and thus achieve the government's guarantee of a maximum two week wait for patients suspected of having breast cancer.
确定在实施“两周等待期”前后全科医生（GP）将患者转诊至快速通道乳腺诊所的情况，并证明这一保障措施对乳腺癌检出率及患者进入乳腺诊所就医的影响。
在一家区综合医院（伊斯特本区综合医院）进行了一个完整的审计周期。主要观察指标为乳腺癌检出情况、全科医生的临床诊断准确性以及快速通道乳腺诊所的等待时间。
在政府指令实施之前，乳腺癌检出率为22%，所有癌症患者在收到转诊信后的1周内都能就诊。非紧急评估的常规等待时间为4周。全科医生转诊的临床诊断准确性为42%。根据审计第一部分的结果，在4月1日截止日期前，向全科医生发送了指导方针，以帮助他们转诊至快速通道乳腺诊所（FABC）。实施后重新审计显示，癌症检出率降至19%，只有85%的患者在两周内就诊。非紧急评估的常规等待时间增加到至少8周。临床诊断准确性略有提高，达到49%。
随着决定转诊紧急程度的权力从专科医生转移到全科医生手中，癌症检出率下降，而被全科医生认为非紧急的患者等待时间增加。转诊紧急程度的决定权应掌握在相关专科医生手中，他们能够各自决定运营快速通道乳腺诊所的最佳方式，从而实现政府对疑似乳腺癌患者最长两周等待时间的保障。
