HNY Policy and Pathway Repository - Humber

Rapid Lung Patient is a new system to help HEY Radiology indentify patients with suspected lung cancer that need rapid reporting.

Nice guidance (CG121) gives clear recommendation (1.1.2 to 1.1.5.) which patients need an urgent Chest X-Ray. Patients aged 40 and over with unexplained haemoptysis no longer require an X-Ray but instead require a CT Thorax. The National Optimal Lung Cancer Pathway (NOLCP) suggests that time from Chest X-Ray request to CT scan report should be within 72 hours for suspected lung cancer. Currently in Hull this is 3-4 weeks.

Rapid Lung Patient is asking of GPs is to perform some clinical triage to optimise direct access to diagnostics, ensuring patients are in the “right place, first time”. By writing “Rapid lung Patient” in the clinical details alongside the relevant Nice CG121 symptoms  eg “cough smoker over 40” this tells Radiology Rapid Lung Patient clinical triage has occurred.

No Red Flags Listed

Rapid

• The patient may need an urgent CT scan within 72hrs of Chest X-Ray and so the GP has ensured that the patient has had U+Es within 3 months (Creatinine <250)* This is a pre- requisite for using this pathway     
• The patient over 40 with unexplained haemoptysis will need to attend CHH or HRI 10-12 Monday-Friday for open access CT.

Lung

• The patient is fit enough to stay unsupervised in Radiology (HRI/CHH) for up to 4 hours. ECOG Performance Status 0 or 1. Please click here to see the table.

Patient

• The GP has discussed with the patient that they are likely to be contacted by Radiology to arrange a CT scan either on the day of their CXR (CHH/HRI) or within 72hrs (satellite site.) 

The patient is willing to travel to the Radiology department to get their CT on the same day as their X-ray (CHH or HRI only) with a 4 hour turnaround time.

Rapid Lung Patient will need to be written in the clinical details so that our Radiographers can flag the patient for rapid reporting on HEY Radiology system. If the patient attends HRI or CHH between 9-12 Monday-Friday, their X-ray will be reported urgently during their attendance and a CT scan will be performed while they are in the department. If they have their X-ray at a site without CT they will be contacted by Radiology for a scan within 72 working hours.

Why
There is evidence to suggest that some patient’s performance status can deteriorate within the 6 weeks on the pathway. Performance status strongly influences surgical mortality at 90 days. This “Rapid Lung Patient” pathway is all about getting patients who are suitable for surgery worked up as quickly as possible.(Powell HA et al Thorax 2013;68:826-834) (Table 1 below)

When
HUTHT Radiology were given the green light to start this new pathway 1-5-2018. The process will not suit all patients or GPs and is not designed to replace the existing Lung 2ww pathway.

No Referral Criteria Listed