The Effectiveness of a Rapid-Access Flexible Sigmoidoscopy Clinic in a District Hospital

Historically rapid-access colorectal clinics have had high proportions of nonconforming referrals from primary care physicians, which calls into question the clinics'' efficacy. We aim to determine the effectiveness of our rapid-access flexible sigmoidoscopy clinic, and the adherence to the referral guidelines for suspected bowel cancer by general practitioners. We performed a 3-month retrospective audit to evaluate (1) the proportion of patients seen within 2 weeks, (2) the appropriateness of referrals, (3) the proportion of patients with findings, and (4) the proportion of patients who had further tests. A total of 59 patients (19 male, 40 female; age 35–86 years) were included in the study. All were offered an appointment within 2 weeks. Forty-one cases (82%) were appropriate referrals. Twenty-eight patients (47%) had pathology at sigmoidoscopy. Cancer pick-up rate was 6%. Thirty-seven patients (74%) had further investigations. We determined that our rapid-access clinic for symptomatic patients has high diagnostic accuracy and that access to early investigation is being used appropriately by general practitioners. In the current climate of spending cuts and streamlining services, our study confirms we are meeting targets for delivery of our colorectal service. The majority of referrals under the 2-week rule are appropriate. Rapid access to early investigation is being used appropriately by general practitioners contrasting previous studies with high proportions of nonconforming referrals.Key words: Rapid access, Department of health, Colorectal cancer, Screening, Flexible sigmoidoscopyEfforts to improve diagnostic and treatment services for colorectal cancer (CRC) have been implemented in the National Health Service (NHS) since the early 1990s. The NHS Bowel Cancer Screening Programme focusing on occult fecal tests has been piloted, assessed, and rolled out on a national level.^1,2Recommendations from the Department of Health of a maximum 2-week wait for initial specialist assessment of all urgent general practitioner (GP) referrals with suspected cancer led to the restructuring of colorectal services and the widespread establishment of dedicated rapid-access flexible sigmoidoscopy clinics in hospitals across the United Kingdom.^3,4 Evidence-based reviews for stratifying CRC risk have further contributed to the outline of current referral protocols for patients with high-risk symptoms.⁵Over the past decade, the service has significantly evolved, as a result of considerable work examining its effectiveness and efficiency. Various authors have commented positively on the suitability and safety of the use of flexible sigmoidoscopy in establishing a diagnosis of distal colonic pathologies and excluding carcinoma,^6,7 while others have highlighted the need for flexible sigmoidoscopy in order for a one-stop service to be effective and safe.^8,9Queen Mary''s Hospital (QMH) is a District General Hospital (DGH) situated in Kent and serving a population of approximately 300,000. Since its establishment, the rapid-access flexible sigmoidoscopy clinic averages 250 patients per year. There is a consultant-led dedicated endoscopy session each week. The majority of referrals come through primary care physicians, with some cases directly referred from the Trust''s Emergency Department.This study aimed to determine the efficacy of the rapid-access flexible sigmoidoscopy clinic in meeting the 2-week target from referral to preliminary assessment, including an assessment of the pathologies found, and the adherence to the Department of Health''s referral guidelines for bowel cancer by GPs.