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

Abstract

AbstractIntroductionInappropriate General Dental Practitioner (GDP) patient referrals may delay cancer diagnoses, increasing the risk of late‐stage presentation. Urgent suspected cancer (USC) referrals from GDPs are reviewed swiftly by clinicians. Non‐USC referrals may wait up to a week before being reviewed by clinicians.Aims and objectivesTo 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.MethodologyUpgraded‐to‐USC e‐Referrals were reviewed and cross‐referenced against the electronic patient management system and patient files to assess waiting times from referral date to first appointment. Each e‐Referral was reviewed to determine the reason for upgrade to a USC referral. Patient outcomes and diagnoses were also examined.Results83 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 did not meet the NICE guideline requirement of having a first appointment within 2 weeks.ConclusionEarly diagnosis of malignancies is fundamental in improving oral cancer survival outcomes. Some GDPs' clinical judgement and referral pathway choice needs improvement. Reinforcing GDP education in regard to USC referrals will likely reduce inappropriate referrals.