P2.05-07 The Liverpool "Straight to CT" and "Virtual Working" Lung Cancer Pathway – 5 Years On

Streamlining the diagnosis of lung cancer is pivotal to improving outcomes and thereby the quality of the patient journey. As part of this, in 2014 Liverpool introduced the concepts of “straight to CT” (where patients with suspicious imaging or symptoms have a directly arranged rapid [<72 hours] CT scan), and also the “virtual assessment” service (where those with scans suggestive of lung cancer are contacted by a lung CNS and the initial clerking and investigation planning is made by telephone) into its lung cancer diagnostic pathway This pathway is now in its 5th year and we report our experience. As regards “straight to CT”, there has been no increase in the demand for outpatient scan capacity for suspected lung cancer (about 400 scans per year). Patients with scans arranged in primary care without suspicious changes remain in the community, but those with other changes can be referred to a general chest clinic (21%). Of those who enter the virtual assessment pathway, 81% are diagnosed with lung cancer. To date, approximately 1200 patients have been through the “virtual assessment” service. Audit has shown that 98% prefer telephone assessment rather than physical clinic attendance, and most wish to be called on the same day as the scan. Patients feel that they had been given correct and timely information and feedback from primary care colleagues is uniformly positive. Lung CNS job satisfaction has improved since skills are now focussed more appropriately. Although the cancer unit diagnoses about 400 cases per year, using the virtual working model means that on average only 7 physical patient clinic attendances per week are necessary to provide the service, thereby greatly reducing resource use, saving 40% of costs overall. Furthermore, the more efficient service easily exceeds the 14 and 62 day cancer targets (99% and 97% respectively). Many lung cancer services are now moving towards “straight to CT” and virtual working models. Our experience is positive, and we would recommend its adoption.