Situation
There is a target of a 2-week waiting (2WW) period for a referral for suspected cancer. The number of referrals from primary care, dentists and other sources has risen dramatically and hospitals have struggled to keep up with demand. This was made worse by the Covid epidemic.
Head and neck cancer is quite rare and the vast majority of referrals prove negative. One approach was to use a risk calculator to split patients into high and low risk groups using factors such as smoking history and gender. Head and neck consultants could then prioritise high-risk patients and defer or reject low-risk patients. However this is not really a satisfactory approach.
Some clinicians were keen to employ the latest technology to improve the situation.
Solution
endoscope-i is a cloud-based smartphone app that combines the high-quality optics of endoscopes with the high definition of Apple iPhones. The app also has an adapter that securely fits an iPhone or iPad.
These high-definition images are combined with a validated symptom score in the app. They are then sent securely through the cloud directly to the head and neck consultant for review.
Trained nurses perform the endoscopy in any primary or secondary healthcare setting. This means more patients are examined which increases the early diagnosis rates of head and neck cancer.
Images are still reviewed by the head and neck surgeon, ensuring the patient gets the best possible opinion despite having a virtual consultation.
Impact
Using this approach with low-risk patients, it takes an ENT consultant 1 minute to review the online consultation instead of 20 minutes.
Consultants now have more time to effectively pick out referrals presenting a high risk of cancer.
By reviewing low-risk patients using this new pathway, head and neck consultants can focus on seeing high-risk patients face-to-face much sooner. This significantly speeds up the diagnostic pathway, as cancer is found 4 to 5 times more frequently in a high-risk clinic.
A New Practice Model
The team from University Hospital of North Midlands in Stoke receives approximately 1,600 2WW referrals to ENT head and neck a year. Of these 1,600:
- about 30% of referrals are for neck lumps
- around 70% are sore throats, hoarse voices or conditions that could be investigated quickly using an endoscope
Mr Ajith George, Consultant ENT and Head and Neck Surgeon, University Hospital of North Midlands and Mr Chris Coulson, ENT Consultant, Queen Elizabeth Hospital Birmingham have been key figures in the implementation of this novel approach.
Mr Ajith George said: “The new pathway has given the rapid cancer referral service the radical change it has long needed.
“These types of referrals are increasing exponentially whilst cancer diagnosis rates are not. Streamlining services helps keeps the focus on those unfortunate patients who get a cancer diagnosis.â€
So far over 1,800 patients at UHNM have been reassured they do not have a cancer of the throat within just a few days. This means patients can go home sooner with reassurance that they have the all-clear, while surgeons can focus their resources on the smaller numbers who have a confirmed cancer diagnosis.
(From NHS website with some editing)