TY - BOOK
T1 - A systematic review of cancer waiting time audits
AU - Collins, Ros
AU - Dean, M.E.
AU - Wilson, P.
AU - Eastwood, A.
AU - Lewis, R.
AU - Flynn, A.
AU - Myers, L.
N1 - © 2005 Centre for Reviews and Dissemination, University of York. Available from the CRD web site.
PY - 2005/2
Y1 - 2005/2
N2 - OBJECTIVE: To assess the implementation and effectiveness of the two-week waiting time
policy for cancer referrals and to inform a review of the cancer referral guidelines by NICE.
DESIGN: Systematic review of clinical audits conducted in England and Wales.
SEARCH: Key staff in all NHS Trusts, Strategic Health Authorities, Cancer Networks and
relevant professional organisations in England were contacted and asked to provide details
of all cancer waiting time audits conducted since 1st April 1999. Searches of the Internet and
of a range of electronic databases were also undertaken. Conference proceedings were
hand searched.
SELECTION OF STUDIES: Obtained audit reports (sometimes only available as an abstract or
slide presentation) were independently assessed for inclusion by two reviewers using predefined
inclusion criteria. If an audit appeared to be relevant, but it was not possible to
confirm this because information was missing, attempts were made to contact the authors.
MAIN OUTCOME MEASURES: Waiting time to first appointment; GP conformity to guidelines;
cancer detection (both cancer rates for populations of referrals and type of referral for
populations of cancer patients); appropriateness of type of referral according to hospital
clinicians; ability of the guidelines to identify correct referrals (patients meeting guidelines
but who had a low suspicion of cancer, or not meeting guidelines but who had a high
suspicion of cancer); process of referral (referrals received by hospital within 24 hours and
mode of referral).
RESULTS: 241 clinical audits meeting the inclusion criteria were identified. 193 clinical audits
were classified as criterion based (i.e. where clinical practice is compared to explicit predefined
criteria), 36 as non-criterion based (i.e. where practice was not compared to predefined
criteria), and 12 as research studies. The majority of included studies were poorly
reported. Fewer than half (44%) provided sufficient detail on the methods used for the audit
to be reproducible.
Under the two-week wait system, there was wide variation in the proportion of site specific
cancer referrals that were seen within two weeks, in the proportion of referrals that were
found to be in accordance with the symptoms listed in the guidelines, and in the proportion
of two-week wait referrals deemed by consultants to warrant an urgent appointment. Less
than 20% of included audits provided details outlining any recommended changes to
service delivery or how any changes would be implemented. Fewer than 20% of included
audits provided details of any plans to re-audit.
CONCLUSIONS: Poor reporting can seriously compromise the integrity of the audit process.
Audit reports should be written up in sufficient detail to allow the reader to ascertain how the
audit was conducted and to assess the validity of the results and how these will be used to
improve existing practices and procedures. The methods by which clinical audits of site
specific cancers are conducted and reported should be standardised across the NHS.
AB - OBJECTIVE: To assess the implementation and effectiveness of the two-week waiting time
policy for cancer referrals and to inform a review of the cancer referral guidelines by NICE.
DESIGN: Systematic review of clinical audits conducted in England and Wales.
SEARCH: Key staff in all NHS Trusts, Strategic Health Authorities, Cancer Networks and
relevant professional organisations in England were contacted and asked to provide details
of all cancer waiting time audits conducted since 1st April 1999. Searches of the Internet and
of a range of electronic databases were also undertaken. Conference proceedings were
hand searched.
SELECTION OF STUDIES: Obtained audit reports (sometimes only available as an abstract or
slide presentation) were independently assessed for inclusion by two reviewers using predefined
inclusion criteria. If an audit appeared to be relevant, but it was not possible to
confirm this because information was missing, attempts were made to contact the authors.
MAIN OUTCOME MEASURES: Waiting time to first appointment; GP conformity to guidelines;
cancer detection (both cancer rates for populations of referrals and type of referral for
populations of cancer patients); appropriateness of type of referral according to hospital
clinicians; ability of the guidelines to identify correct referrals (patients meeting guidelines
but who had a low suspicion of cancer, or not meeting guidelines but who had a high
suspicion of cancer); process of referral (referrals received by hospital within 24 hours and
mode of referral).
RESULTS: 241 clinical audits meeting the inclusion criteria were identified. 193 clinical audits
were classified as criterion based (i.e. where clinical practice is compared to explicit predefined
criteria), 36 as non-criterion based (i.e. where practice was not compared to predefined
criteria), and 12 as research studies. The majority of included studies were poorly
reported. Fewer than half (44%) provided sufficient detail on the methods used for the audit
to be reproducible.
Under the two-week wait system, there was wide variation in the proportion of site specific
cancer referrals that were seen within two weeks, in the proportion of referrals that were
found to be in accordance with the symptoms listed in the guidelines, and in the proportion
of two-week wait referrals deemed by consultants to warrant an urgent appointment. Less
than 20% of included audits provided details outlining any recommended changes to
service delivery or how any changes would be implemented. Fewer than 20% of included
audits provided details of any plans to re-audit.
CONCLUSIONS: Poor reporting can seriously compromise the integrity of the audit process.
Audit reports should be written up in sufficient detail to allow the reader to ascertain how the
audit was conducted and to assess the validity of the results and how these will be used to
improve existing practices and procedures. The methods by which clinical audits of site
specific cancers are conducted and reported should be standardised across the NHS.
M3 - Commissioned report
SN - 1 900640 33 3
T3 - CRD Report
BT - A systematic review of cancer waiting time audits
PB - University of York
CY - York, UK
ER -