OBJECTIVES: Delays in colorectal cancer (CRC) diagnosis related to colonoscopy referrals are not well studied. The authors tested whether certain details of information transmitted through computerised provider order entry (CPOE)-based referrals affected timeliness of diagnostic colonoscopy for patients with newly diagnosed CRC. METHODS: The authors studied a 6-year cohort of all newly diagnosed patients with CRC at a large tertiary care Veterans Affairs hospital and its affiliated multispecialty clinics. Referring providers included primary care clinicians, resident trainees and other specialists. From the colonoscopy referral preceding CRC diagnosis, the authors determined request date, type and frequency of diagnostic clues provided (symptoms, signs, test results), notation of urgency, and documented evidence of verbal contact between referring provider and consultant to expedite referral. The authors compared distributions of proportions of diagnostic clues between patients with a lag of >60 and ≤60 day, and examined predictors of lag time. RESULTS: Of 367 electronic referrals identified with a median lag of 57 days, 178 (48.5%) had a lag of >60 days. Referrals associated with longer lag times included those with 'positive faecal occult blood test' (92 days, p<0.0001), 'haematochesia' (75 days, p=0.02), 'history of polyps' (221 days, p=0.0006) and when 'screening' (vs specific symptoms) was given as the reason for diagnostic colonoscopy (203 days, p=0.002). Independent predictors of shorter wait times included three diagnostic clues, notation of urgency and documentation of verbal contact. CONCLUSIONS: Attention to certain details of diagnostic information provided to consultants through CPOE-based referrals may help reduce delays in CRC diagnosis.
OBJECTIVES: Delays in colorectal cancer (CRC) diagnosis related to colonoscopy referrals are not well studied. The authors tested whether certain details of information transmitted through computerised provider order entry (CPOE)-based referrals affected timeliness of diagnostic colonoscopy for patients with newly diagnosed CRC. METHODS: The authors studied a 6-year cohort of all newly diagnosed patients with CRC at a large tertiary care Veterans Affairs hospital and its affiliated multispecialty clinics. Referring providers included primary care clinicians, resident trainees and other specialists. From the colonoscopy referral preceding CRC diagnosis, the authors determined request date, type and frequency of diagnostic clues provided (symptoms, signs, test results), notation of urgency, and documented evidence of verbal contact between referring provider and consultant to expedite referral. The authors compared distributions of proportions of diagnostic clues between patients with a lag of >60 and ≤60 day, and examined predictors of lag time. RESULTS: Of 367 electronic referrals identified with a median lag of 57 days, 178 (48.5%) had a lag of >60 days. Referrals associated with longer lag times included those with 'positive faecal occult blood test' (92 days, p<0.0001), 'haematochesia' (75 days, p=0.02), 'history of polyps' (221 days, p=0.0006) and when 'screening' (vs specific symptoms) was given as the reason for diagnostic colonoscopy (203 days, p=0.002). Independent predictors of shorter wait times included three diagnostic clues, notation of urgency and documentation of verbal contact. CONCLUSIONS: Attention to certain details of diagnostic information provided to consultants through CPOE-based referrals may help reduce delays in CRC diagnosis.
Authors: K Robin Yabroff; Kathleen Shakira Washington; Amy Leader; Elizabeth Neilson; Jeanne Mandelblatt Journal: Med Care Res Rev Date: 2003-09 Impact factor: 3.929
Authors: Ann Oluloro; Amanda F Petrik; Ann Turner; Tanya Kapka; Jennifer Rivelli; Patricia A Carney; Somnath Saha; Gloria D Coronado Journal: J Community Health Date: 2016-08
Authors: Desmond Leddin; David Armstrong; Mark Borgaonkar; Ronald J Bridges; Carlo A Fallone; Jennifer J Telford; Ying Chen; Palma Colacino; Paul Sinclair Journal: Can J Gastroenterol Date: 2013-02 Impact factor: 3.522
Authors: Michael L Barnett; Ateev Mehrotra; Joseph P Frolkis; Melissa Spinks; Casey Steiger; Brandon Hehir; Jeffrey O Greenberg; Hardeep Singh Journal: J Gen Intern Med Date: 2016-03 Impact factor: 5.128
Authors: Simon J Craddock Lee; Mark A Clark; John V Cox; Burton M Needles; Carole Seigel; Bijal A Balasubramanian Journal: J Oncol Pract Date: 2016-10-31 Impact factor: 3.840