Evaluation of a ‘lower GI electronic referral protocol’: analysis of 300 referral episodes

Introduction:  Appropriate destination and referral urgency of patients with colorectal symptoms is a prerequisite for efficient diagnosis of colorectal cancers (CRC). We aim to evaluate the efficacy of an electronic referral protocol (ERP) for lower GI symptoms in primary care.Method:  Three hundred referrals including 100 consecutive CRC (group A), 100 actual fast‐track referrals (group B) and 100 routine referrals (group C) were run through the ERP. The ability of the ERP to filter out CRC from all three groups was assessed.Results:  Only 25% of group A had actually been referred as ‘fast‐track’. The ERP appropriately identified 73% of these cases as ‘fast‐track’ (P = 0.02). The ERP identified 49% of group B patients as ‘fast‐track’, including eight of the 11 cancers in this group. The ERP downgraded from fast‐track 19 of the 28 patients in group B without pathology. In group C, three of the four patients with CRC were upgraded to ‘fast‐track’ and overall 18 routine referrals were directed ‘fast‐track’.Conclusion:  This preliminary study suggests that a ‘Lower GI electronic referral protocol’ in primary care might be more efficient in achieving the twin aims of channelling more patients with CRC through the fast‐track referral pathway, whilst reducing inappropriate referrals through this route. Further studies are needed to see if this ERP will increase the yield from the ‘fast‐track’ referral pathway.