Waiting time to lymph node biopsy is dependent on referral method: don't write, phone

Patients with lymphadenopathy are commonly referred to general surgeons for diagnostic lymph node biopsy. We were concerned at potential long waits for this service in our hospital and thus wanted to compare the efficiency of written and telephone referral with a view to identifying the optimum care...

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Bibliographic Details
Published in:	Annals of the Royal College of Surgeons of England Vol. 91; no. 8; pp. 673 - 676
Main Authors:	Pannick, S A J, Ingham Clark, C L
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 01-11-2009 The Royal College of Surgeons of England
Subjects:	Adult Biopsy Cancer Cellular biology Early Detection of Cancer General & Emergency Hematology Hospitals Humans Lymph Nodes - pathology Lymphatic Diseases - pathology Lymphatic system Lymphoma Neck Patients Referral and Consultation - organization & administration Referral and Consultation - statistics & numerical data Retrospective Studies Time Factors Tuberculosis Ultrasonic imaging Waiting Lists United Kingdom > UK
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Summary:	Patients with lymphadenopathy are commonly referred to general surgeons for diagnostic lymph node biopsy. We were concerned at potential long waits for this service in our hospital and thus wanted to compare the efficiency of written and telephone referral with a view to identifying the optimum care pathway for these patients. Sixty patients were included in a 2-year retrospective review (excluding referrals associated with breast lumps which were managed separately). Hospital Episode Statistics data were used to analyse notes for the source and method of referral, waiting time to biopsy, clinic attendance and diagnosis. Of referrals, 33% were from haematology and 28% from general practice. Overall, 47% of patients were referred by letter; of these, 64% were seen in clinic before biopsy. Personal referral between clinicians, by direct discussion, e-mail or fax led to a mean wait of 4 days, compared to 51 days when patients were referred by letter. Clinic attendance had no significant bearing on diagnostic accuracy or complication rate. Neoplasia accounted for 43% of diagnoses and infection (including four cases of tuberculosis) for 10%. Of biopsies, 33% showed benign changes, 8% were unrecorded and 5% were incorrect. In this study, 43% of biopsies revealed malignancy and we advise that lymph node biopsy requests should be managed on a fast-track pathway, expedited by direct personal request. Following this study, we have implemented a fast-track pathway for such patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0035-8843 1478-7083
DOI:	10.1308/003588409X12486167521118