PWE-023 TSTT (triage to straight to test) improves early diagnosis of inflammatory bowel disease

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Abstract

Introduction

It is well know that there is a considerable delay in establishing diagnosis of inflammatory bowel disease, in case of Crohn’s disease it about 4–9 months and in case of Ulcerative is about 4 months1 Barts health NHS trust is one of the pioneer in establishing STT (‘straight to test’) service to reduce the wait until a definitive diagnostic test in patients with LGI symptoms. The aim of the study to look at whether this STT service improves early diagnosis of inflammatory bowel disease.

Methods

In STT service, routine referrals are vetted and prioritised by specialist colorectal nurses using information from the GP referral letter and patient-reported history during telephone assessment. However, it can be expedite to investigate within 2 weeks due to the onset and severity of their symptoms, particularly patients with symptoms suggestive of inflammatory bowel disease (IBD) including raised faecal calprotectin studies>150

Results

1531 patients have been triaged since July 2013 with 813 (53%) female 718 (47%) male respectively.The mean age of the patients is 51 years (range 16–94). Based on telephone triage, 56% were triaged to colonoscopy, 13% had flexible sigmoidoscopy. Only 12.5% of t STT were upgraded to 2 weeks wait. In total, 355 (23.2%) had any pathology encountered. Out of all pathology, 101 (28.5%) of these found to have new diagnosed of IBD. The mean age of these patients is 42 years (range 85–17) and the average waiting time on the tSTT pathway is only 17 days. Of the remaining 74% of non-upgraded patients (excluding 6% DNA), 25% had pathology of which 10% had newly diagnosed IBD with a mean age of 43 range 85–34 years and waited an average time on the t STT pathway of only 32 days. There is a significant difference in between in picking up pathology between upgraded triage and traditional 18 weeks pathways 17 days vs. 32 days (p<0.001).

Conclusion

These data suggest that there is significant improvement in diagnosing inflammatory bowel disease early through tSTT pathways. It appeared to be significantly more early diagnosis can be achieved if triage can be upgraded after telephonic discussion with the triage nurse.

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