Dental practice to dental hospital referrals - upgraded to urgent suspected cancer pathways: a three year service review

Timmis, W. H. D., Simms, M. L. and Atkin, P. A. 2023. Dental practice to dental hospital referrals - upgraded to urgent suspected cancer pathways: a three year service review. Oral Surgery 16 (4) , pp. 342-349. 10.1111/ors.12814

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Abstract

Introduction: Inappropriate General Dental Practitioner (GDP) patient referrals may delay cancer diagnosis, increasingthe risk oflate-stage presentation. Urgent suspected cancer (USC) referralsfrom GDPs are reviewed swiftly by clinicians. Non-USC referrals may wait up to a week before being reviewed by clinicians. Aims and Objectives: To investigate upgraded-to-USC GDP referrals to a University Dental Hospital (UDH) following the establishment of the pan-Wales electronic referral management system (e-RMS) in 2019. To examine reasons for their upgrade to the USC pathway, and to assess diagnostic outcomes, diagnostic delay and compliance with the National Institute for Health and Care Excellence (NICE) referral recommendations. Methodology: Upgraded-to-USC e-Referralswere reviewed and cross-referenced against the electronic patient management systemand patient files to assess waiting times fromreferral date to firstappointment. Each e-Referral was reviewed to determine the reason for upgrade to a USC referral. Patient outcomes and diagnoses were also examined. Results: 83 patient records were identified. Upgraded e-Referrals accounted for 18.6% of all USC e-Referrals. The majority of upgraded e-Referrals (66.3%) were upgraded because they included words describing key malignancy features. Malignant and oral potentially malignant disorders (OPMDs) accounted for 3.8% and 17.5% of diagnostic outcomes respectively. Overall, 18.8% of upgraded-to-USC e-Referrals didn’t meet the NICEguideline requirement of havinga first appointment within 2 weeks. Conclusion: Early diagnosis of malignancies is fundamental in improving oral cancer survival outcomes. Some GDP's clinical judgement and referral pathway choices need improvement. Reinforcing GDP education in regard to USC referrals will likely reduce inappropriate referrals.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Dentistry
Publisher:	Wiley
ISSN:	1752-2471
Date of First Compliant Deposit:	18 April 2023
Date of Acceptance:	2 April 2023
Last Modified:	15 Nov 2023 14:15
URI:	https://orca.cardiff.ac.uk/id/eprint/158930

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