Assessing the Efficacy of Lower GI Red Flag Referrals

Authors

Departments / Institutions

Introduction

The red flag referral system for lower gastrointestinal malignancies is currently under significant stress due to high volumes of referrals. Effective referral pathways are essential to reduce the burden on waiting lists.

Aims

To evaluate the efficacy of the current Red Flag referral pathway for Lower GI malignancies over a seven month period, assessing malignancy detection rates as a metric of efficacy of referrals.

Methods

A retrospective review was conducted on 2,622 patients referred under the lower GI red flag pathway between December, 2023 and June, 2024. Following triage, 2,540 referrals proceeded to investigation. Confirmed cases of colorectal and anal cancers were recorded. Detection rates were calculated and compared to previous studies using chi-square tests for proportions, with a significance level set at p < 0.05.

Results

Seventy-eight cancers were diagnosed from 2,540 referrals—87 Lower GI Malignancies— resulting in a detection rate of 3.07%. This rate is significantly higher than the less than 1.5% reported in previous studies (chi-square = 25.89, p < 0.0001). Additionally, the high referral volume, averaging approximately 375 per month, indicates substantial pressure on the healthcare system, potentially due to inappropriate referrals.

Conclusion

The current red flag referral pathway demonstrates a significant improvement in the quality of red flag referrals for lower GI malignancies compared to previous reports, suggesting that the NICaN 2023 guidelines may be more effective compared to prior guidelines. Further analysis is required to optimize referral criteria, enhance the efficiency of the referral system, and ensure sustainable resource utilization.