Fast track pathways for patients with suspected gastrointestinal (GI) cancers are an effective approach to improve outcomes, especially in healthcare systems with long waiting times for diagnostic endoscopy.
The RAGE pathway was developed by the Western Health Endoscopy Service in Melbourne, to improve the triage process and provide more timely access to gastroscopy and colonoscopy for patients with symptoms suggestive of cancer. As part of the implementation of the RAGE pathway, we conducted a step-wedge trial to test the effect of the following complex intervention: a. academic detailing visits to general practices by Cancer Council Victoria nurses; b. an educational resource card including symptom risk assessment tools for oesophago-gastric and colorectal cancer. c. an electronic referral template embedded into the GP medical record. We collected data on all endoscopies at Western Health arising from a GP referral between October 2014 and June 2016.
193 practices were randomly allocated to one of three intervention steps; 55.1% of practices accepted at least one educational visit. We analysed data on 2,378 colonoscopies and 1,347 gastroscopies. There was a statistically significant change over time in the proportion of GP referrals triaged as urgent but no changes in conversion rates suggesting improved selection of patients for urgent referral. This was consistent with a significant increase in the number of symptoms reported in GP referrals over time. There was a significant reduction in the waiting time for urgent colonoscopies. The median time from referral to cancer diagnosis was 55 days (lower GI cancers) and 32 days (upper GI cancers).
GP education visits and symptom risk assessment tools improved patient selection for urgent GI endoscopy. This study has informed the model to implement Optimal Care Pathways for cancer in Victoria, and the development and incorporation of statewide endoscopy triage guidelines.