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Streaming the chest clinic referral pathway: Is our hospital ready for the implementation of the National Lung Optimal lung Cancer Pathway (NLOCP)?
Streaming the chest clinic referral pathway: Is our hospital ready for the implementation of the National Lung Optimal lung Cancer Pathway (NLOCP)?
Submitted on 04 Oct 2018

Rachel Hubbard, S. Mohammad, T. Patrick, R. Cowburn, A.I. Rhodes
Kingston Hospital
This poster was presented at BIR
Poster Views: 211
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Poster Abstract
Implementing the National Optimal lung Cancer Pathway (NLOCP)- Lessons from a DGH audit.
The National Optimal Lung Cancer Pathway (NOLCP) aims to improve lung cancer survival (implementation planned: 2020), proposing that patients with abnormal CXRs should have CTs within 3 days of CXR.
Our 2016 Audit found 33% of patients with abnormal CXR waited over 14 days for CT.
We streamlined the “Abnormal CXR (CCR) pathway” to aim for CT by day 14, falling in line with TWR recommendations.
1) Does streamlining the CCR pathway lead to shorter CT waits?
2) Are CTs being performed within 72 hours?
3) Cancer conversion rates for CCR and TWR pathways.
Retrospective review of CCR and TWR referrals from 1st October to 31st December 2017.
Streamlined CCR pathway increased CTs undertaken by day 14 from 67% to 84%.
10/49 (20%) of CCR patients had lung cancer diagnosed.
All 10 had CXRs strongly indicative of malignancy, reported 0-4 days following the examination. 40% were scanned within 3 days (range 1-19), which represented 8% (4/49) of all CCR referrals.
11/118 (9%) of TWR patients had lung cancer diagnoses. 99/118 (84%) were scanned within 14 days.
3 patients with lung cancer had normal CXR reports but reported red flag symptoms (weight loss, chest pain, ex-smoker).
Triage of patients with grossly abnormal CXRs for rapid CT will aid successful NLOCP implementation, being achieved by training CXR reporting radiographers to work alongside operating radiographers.
Not all lung cancers are visible on CXR and may be missed. Public education of symptoms and signs should ensure appropriate TWR referrals.

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