Sandwell and West Birmingham NHS Trust, UK.
Kasturba Medical College Mangalore & Manipal Academy of Health Education, Manipal, India.
Ann R Coll Surg Engl. 2021 Sep;103(8):576-582. doi: 10.1308/rcsann.2021.0155.
The aim of this study was to establish a triaging system for assessment of breast referrals from primary care to ensure safe and effective breast services without compromising breast cancer management.
COVID-19 was officially declared a global pandemic on 11 March 2020, and with no effective treatment available, preventing spread has been paramount. Previously, all referrals from primary care were seen in the rapid-access breast clinic (RABC). Clinic appointments exposed patients and healthcare professionals to risk.
Initial triage during the lockdown was in line with national governing body guidance, rejected low risk referrals and streamed remaining patients through a telephone consultation to RABC or discharge. A modified triage pathway streamed all patients through virtual triage to RABC, telephone clinic or discharge with advice and guidance categories. Demographics, reasons for referral and outcomes data were collected and presented as median with range and frequency with percentages.
Initial triage (23 March-23 April 2020) found fewer referrals with a higher percentage of breast cancer diagnoses. Modified triage (22 June-17 July 2020) resulted in a 35.1% (99/282) reduction in RABC attendance. Overall cancer detection rate remained similar at 4.2% of all referrals pre-COVID (18/429) and 4.3% (12/282) during modified triage. After six months follow-up of patients not seen in RABC during the modified triage pathway, 18 patients were re-referred to RABC and none were diagnosed with cancer.
A modified triage pathway has the potential to improve triage efficiency and prevent unnecessary visits during the COVID-19 pandemic. Further refinement of pathway is feasible in collaboration with primary care.
本研究旨在建立一个分诊系统，以评估从初级保健转介的乳房，确保安全有效的乳房服务，而不影响乳腺癌的管理。
2020 年 3 月 11 日，COVID-19 被正式宣布为全球大流行，由于没有有效的治疗方法，预防传播至关重要。以前，所有来自初级保健的转介都在快速通道乳房诊所（RABC）就诊。诊所预约使患者和医护人员面临风险。
在封锁期间的初步分诊符合国家管理机构的指导原则，拒绝低风险的转介，并将其余患者通过电话咨询分流到 RABC 或出院。改良的分诊途径将所有患者通过虚拟分诊分流到 RABC、电话诊所或带建议和指导类别的出院。收集并呈现人口统计学、转诊原因和结果数据，中位数为范围，频率为百分比。
初步分诊（2020 年 3 月 23 日至 4 月 23 日）发现转介人数减少，乳腺癌诊断百分比更高。改良分诊（2020 年 6 月 22 日至 7 月 17 日）导致 RABC 就诊人数减少 35.1%（99/282）。总体癌症检出率保持相似，COVID 前所有转诊的 4.2%（18/429）和改良分诊的 4.3%（12/282）。改良分诊途径中未在 RABC 就诊的患者随访六个月后，有 18 例患者再次被转介至 RABC，无一例被诊断为癌症。
改良的分诊途径有可能提高分诊效率，并在 COVID-19 大流行期间防止不必要的就诊。与初级保健合作进一步改进途径是可行的。
