Rotherham General Hospital, South Yorkshire, Rotherham, UK.
Hull York Medical School, University of Hull, HU3 2JZ, Hull, UK.
Ir J Med Sci. 2022 Jun;191(3):1099-1104. doi: 10.1007/s11845-021-02647-7. Epub 2021 Jul 20.
Patients suspected to have upper gastrointestinal (UGI) cancer can be referred directly for investigation; however, at times this may result to inappropriate referrals. This study explores the model of a "one-stop" clinic as an alternative to the direct referral system. The current study aims to assess the feasibility and outcomes of a one-stop UGI clinic and evaluate sensitivity and specificity of "on-the-day" diagnoses.
A retrospective analysis of case notes of patients seen in one-stop clinic, between January 2017 and January 2019, was conducted. All General Practitioner (GP) referrals were screened by a specialist nurse.
After completion of the post-GP referral screening process, 252 patients (median age 68 years, IQR 58.8-77.3 years; M:F ratio 118:134) were allocated to the one-stop clinic. OGD was not required, contra-indicated or declined in 27 cases (10.7%). The records of three patients could not be found. One patient did not attend. Overall, 221 patients underwent testing and received "on-the-day" diagnoses. Sensitivity was 94% (range 87-100%), and specificity was 92% (88-96%). Ninety-six percent of patients received a diagnosis on the day.
The one-stop clinic was feasible and had good specificity and sensitivity. The finding of 10.7% of cases not being suitable for OGD indicates that a patient/specialist consultation is necessary to prevent misuse of endoscopy appointments. The authors recommend widespread adoption of one-stop clinics in UGI surgery.
疑似上消化道（UGI）癌症的患者可直接进行检查；然而，有时这可能导致不适当的转诊。本研究探讨了“一站式”诊所作为直接转诊系统替代方案的模式。本研究旨在评估 UGI 一站式诊所的可行性和结果，并评估“当日”诊断的敏感性和特异性。
对 2017 年 1 月至 2019 年 1 月期间在一站式诊所就诊的患者病历进行回顾性分析。所有全科医生（GP）转诊均由专科护士进行筛查。
完成 GP 转诊筛查后，252 名患者（中位年龄 68 岁，IQR 58.8-77.3 岁；男女比 118:134）被分配至一站式诊所。27 例（10.7%）不需要、禁忌或拒绝进行上消化道内镜检查。有 3 例患者的记录无法找到。1 例患者未就诊。共有 221 名患者接受了检查并获得了“当日”诊断。敏感性为 94%（范围 87-100%），特异性为 92%（88-96%）。96%的患者在当天得到了诊断。
一站式诊所是可行的，具有良好的特异性和敏感性。10.7%的病例不适合进行上消化道内镜检查的发现表明，需要进行患者/专家咨询，以防止内镜预约的滥用。作者建议在 UGI 外科中广泛采用一站式诊所。
