Cancer safety netting pathway.

Cancer safety netting pathway.

Introduction

PCIT have developed a cancer safety netting pathway which provides practices with an end to end solution for managing fast track referrals, incorporating FIT testing requirements for colorectal cancer in keeping with IIF CAN02.

This pathway incorporates a number of protocols, alerts, searches and also includes the use of our cancer referral templates where users are professional subscribers.

Overview of the pathway

The diagram below shows a visual representation of the pathway, highlighting where protocols are triggered, confirmatory codes are needed, and where searches can be used to safety net:


Description of the process

Fast track cancer referrals are made.  Following the referral, the system waits for an outcome to be recorded.
The search "OPERATIONAL: Fast track referral made, awaiting outcome coding" can be used to monitor referrals made where an outcome hasn't been recorded
Outcomes from referral can be recorded as:
  1. Referral rejected
  2. DNA
  3. Doctor or hospital cancelled
  4. Downgraded
  5. Patient cancelled
  6. Seen in fast track clinic
Where the outcome is recorded as anything other than "Seen in fast track clinic" the outcome needs to be reviewed by the referring clinician to ensure they're happy with the outcome.  Where the clinician is happy that the referral pathway can be completed the code "Care complete" is added to the record.

The searches:
  1. OPERATIONAL: Fast track referral made, awaiting outcome coding
  2. OPERATIONAL: Referred on 2WW but referral rejected
  3. OPERATIONAL: Referred on 2WW but did not attend
  4. OPERATIONAL: Referred on 2WW but doctor/hospital cancelled appt
  5. OPERATIONAL: Referred on 2WW but subsequently downgraded
  6. OPERATIONAL: Referred on 2WW but patient cancelled appt
can be used to identify patients who have had the relevant outcomes recorded but haven't yet been reviewed by a clinician
Where a patient is seen in fast track clinic, this can be coded by a user within the practice.  The protocol "HP292 Seen in fast track clinic checker" ensures that the user understands the importance of adding this code and is authorised to do so; where they are the additional code "Cancer monitoring administration" is added, closing the referral process.   Where this code isn't added, the patient remains in the "awaiting coding of the outcome" stage.

Managing colorectal referrals and FIT testing

PCIT have created a separate process for FIT testing and colorectal referral which feeds into the above described process.

Overview of the process


The easiest way to use this pathway is to use the PCIT colorectal cancer referral template which has the description of the codes and the processes of the pathway.  In this, the user can record if they are giving the patient a FIT test, or requesting the patient to collect one (if consulting remotely/arranging reception to provide the kits).  At the same time the clinician can record what they want to happen if the FIT test comes back as normal (it is assumed that an abnormal FIT test will automatically trigger a referral).
As soon as any of the FIT codes are added, the alert "Colorectal pathway including FIT prior to suspected cancer referral" will show users the status of the patient every time they are loaded:


When the FIT test is returned, the user receiving the result can review the detail in the alert and decide on appropriate action.

Ensuring FIT tests are done in line with CAN02

The protocol "IIF CAN02 Checker" checks the record any time a colorectal fast track referral is made.  If a FIT test has been done in the last 21 days, it does nothing.  Otherwise it flags to the user the requirement for a FIT test, and offers them the FIT exemption codes, in case any of these are appropriate:


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