Department of Head and Neck Surgery, Barts Health, London, UK,
Eur Arch Otorhinolaryngol. 2013 Nov;270(12):3121-6. doi: 10.1007/s00405-013-2453-9. Epub 2013 Mar 28.
The Rapid Diagnostic Clinic (RDC) was introduced to comply with NICE recommendations for improving head and neck cancer services (National Institute of Clinical Excellence 2004 Improving outcomes in head and neck cancer: the manual. NICE, London). It provides multi-modality specialist assessment for new referrals, with on-site sonography and cytology. We have critically appraised the efficacy of our RDC, with respect to its impact on patients' timelines and outcomes. A retrospective audit of new referrals to the head and neck clinic during a 6-month period was conducted (pre-RDC period); areas in delay in patients reaching a definitive outcome were identified. Following implementation of the RDC, a second cycle, prospective audit was performed and its impact on timelines for patients' journey and outcomes determined. One hundred and ninety-seven patients were seen during the pre-RDC period. The average time from referral to being seen was 11 days for 2-week wait (2WW) referrals and 34 days for other sources. During the RDC period, 299 patients were seen in total. The average waiting time was reduced to 9 days for 2WW referrals and 23 days for other referrals. During the RDC period, over one-third of patients utilised the provision of ultrasound ± FNAC, and consequently, the majority reached a definitive outcome (discharged or scheduled for surgery) following their first consultation. This was a significant improvement compared to the pre-RDC period, where the main outcome was referral for an investigation, with consequently longer waiting time for surgery. We report the first study to consider the effect of a 'one-stop' clinic on patients' journey timelines and outcomes. Our study has shown that the RDC provides an efficient and effective system, which facilitates the patients' pathway to a definitive management plan.
快速诊断诊所（RDC）的设立是为了遵循 NICE 关于改善头颈部癌症服务的建议（国家临床卓越研究所 2004 年改善头颈部癌症的结果：手册。NICE，伦敦）。它为新转介患者提供多模态专家评估，并提供现场超声检查和细胞学检查。我们对 RDC 的疗效进行了严格评估，考察了其对患者时间线和结果的影响。在 6 个月的时间里，对头颈部诊所的新转介患者进行了回顾性审核（RDC 前）；确定了患者达到明确结果的延误领域。在实施 RDC 后，进行了第二轮前瞻性审核，确定了其对患者就诊时间线和结果的影响。在 RDC 前期间，共对 197 名患者进行了检查。2WW 转介的平均就诊时间为 11 天，其他来源的平均就诊时间为 34 天。在 RDC 期间，共对 299 名患者进行了检查。2WW 转介的平均等待时间缩短至 9 天，其他转介的平均等待时间缩短至 23 天。在 RDC 期间，超过三分之一的患者利用了超声检查±细针穿刺抽吸（FNAC）的服务，因此，大多数患者在首次就诊后即可获得明确的结果（出院或安排手术）。与 RDC 前期间相比，这是一个显著的改善，RDC 前期间的主要结果是转介进行检查，因此手术的等待时间更长。我们报告了第一项考虑“一站式”诊所对患者就诊时间线和结果影响的研究。我们的研究表明，RDC 提供了一种高效、有效的系统，可促进患者明确管理计划的路径。
