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Rapid Access Clinic


Rapid Access Clinic Dr. Zena Salih ST3 October 2008 Introduction Presentation to inform you of the available Rapid Access Clinics 2 week wait Referral Criteria ... – PowerPoint PPT presentation

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Title: Rapid Access Clinic

Rapid Access Clinic
  • Dr. Zena Salih
  • ST3
  • October 2008

  • Presentation to inform you of the available
    Rapid Access Clinics
  • 2 week wait
  • Referral Criteria specific
  • If Suspicious gt refer

Head and Neck
  • Ulceration of tongue/oral mucosa gt 3 weeks
  • Oral/facial swellinggt3 weeks
  • Red or white patch of oral mucosa
  • Unexplained tooth mobility (not associated with
    periodontal disease)
  • Unresolving neck/salivary/thyroid mass gt3 weeks

Head and Neck
  • Orbital mass
  • Neuropathy of cranial nerve
  • Dysphagia gt 3weeks
  • Hoarseness gt6 weeks.
  • Persistent sore throat
  • Unilateral nasal obstruction with blood/purulent
  • Pinnal ulceration
  • Unilateral middle ear effusion

Urological Clinic
  • Macroscopic haematuria in any pt.
  • Microscopic haematuria gt5 RBCs on microscopy
  • Dipstick , , or for bld
  • Beware of common false positive dipstick e.g.
    infections, old urine, and out of date stix.
    Periods in women.

Urological Clinic
  • Palpable renal mass on examination
  • Solid renal mass identified on imaging
  • Swelling in body of testicle
  • Elevated age specific PSA or abnormal DRE in men
    with a 10 year life expectancy.
  • PSA gt20 ng/ml with bone pain or clinically
    malignant prostate on DRE.

Urological clinic
  • Suspected penile cancer
  • Malignancy on biopsy, cytology or other
  • Age adjusted PSA
  • values
  • 40-49 2.5
  • 50-59 3.5
  • 60-69 4.5
  • 70-79 6.5

Lung Clinic
  • CXR mandatory prior to Urgent Referral
  • Where done?
  • When done?
  • Normal ?
  • Abnormal-follow-up CXR recommended
  • Abnormal suspicious of cancer

Lung Clinic
  • Persistent haemoptysis in smokers/ex-smokers over
    the age of 40years.
  • Signs of superior vena caval obstruction
  • Stridor (consider emergency referral !)
  • Chest X-ray suggestive/suspicious of lung cancer
    (including pleural effusion or slow resolving
  • Features suggestive of metastases from a lung
  • Always mention smoking status !

Breast Clinic
  • Form requires information
  • Age of woman ?
  • Previous Screening Mammograms ?
  • If so, where and when ? Previous Clinical
  • Draw a quick picture of where you think the
    mass/lump is. Right or left ?

Breast Clinic
  • Discrete Lump in any woman 30 years and older
    that persists after their next period or presents
    after their menopause.
  • Any age Discrete lump with fixation /- skin
    tethering, a lump that enlarges, Previous history
    of breast cancer with a new lump or suspicious

Breast Clinic
  • Unilateral blood stained nipple discharge
  • Unilateral nipple eczema not responding to
  • Recent nipple retraction (lt 3 months)
  • Skin distortion
  • Male over 50 with unilateral firm subareola mass
    /- nipple discharge or associated skin changes
  • Mention the Duration of symptoms.

Breast Clinic (Proforma)
  • Always feel free to add current medications,
    medical history,allergies,etc.
  • Referral letter accepted with the proforma sheet

Gynaecological Clinic
  • Suspected Type of Cancer
  • Cervix
  • Endometrium
  • Ovary
  • Vagina/Vulva

Gynaecological Clinic
  • Lesion suspicious of cancer of cervix on speculum
  • Lesion suspicious of cancer of the vagina/vulva
    on speculum Ex.
  • Suspicious pelvic mass on US.
  • Palpable pelvic mass not obviously fibroids
  • PMB in women who are not on HRT
  • Inappropriate bleeding in women on HRT
  • PCB that persists for more than 4 weeks
  • IMB in women over the age of 40

Colorectal Clinic
  • High Risk
  • A definite palpable right sided abdominal mass
  • Rectal bleeding with change in Bowel habit
    persistent for 6 weeks.
  • Unexplained iron deficiency anaemia lt11g/dl in
  • lt 10g/dl in post-menopausal women
  • Abdominal pain only if severe,colicky, and in
    association with weight loss
  • A suspicious barium enema (enclose results)

Colorectal Clinic
  • Over 60 Years
  • Rectal Bleeding persistently without anal
  • Change of Bowel habit to looser stool and/or
    increased frequency of defecation without rectal
    bleeding and persistent for 6 weeks.
  • PR examination
  • A definite palpable rectal mass
  • Blood on glove
  • Mention duration of symptoms and family
    history/history of polyps/history of GI disease.

Oesophageal, Gastric, Pancreatic
  • Dysphagia
  • at any age, progressive? Solids? Liquids? For
    how long?
  • Jaundice? If the patient is jaundiced, initiate
    US in Primary care.

Oesophageal, Gastric, Pancreatic
  • Upper Abdominal Mass? Also initiate US in Primary
    care if palpable abdominal mass.
  • Intractable unexplained lower thoracic back pain.

Oesophageal, Gastric, Pancreatic
  • Dyspepsia if combined with one or more alarm
  • Unexplained anaemia? Hb? MCV?
  • Weight loss how much as a ?
  • Vomiting? After meals? Projectile?
  • Barretts oesophagus?
  • Gastrectomy gt 20 yrs ago?

Oesophageal, Gastric, Pancreatic
  • Age 55 years or more
  • Dyspepsia with onset less than one year ago
  • Dyspepsia with continuous symptoms since onset

Melanoma Squamous Cell Carcinoma Only
  • Melanoma
  • Major features
  • Growing in size
  • Changing in shape
  • Changing in colour
  • Minor features
  • Largest diameter 7mm
  • Oozing
  • Inflammation
  • Change in sensation

  • Any major feature should prompt referral, and 3
    minor features should prompt referral.
  • It is not recommended that patients with
    suspected melanoma are biopsied in a general
    practice setting.

Squamous cell carcinoma
  • Usually occur on the face, scalp, or back of the
    hand (chronic sun exposed areas)
  • SCCs appear as a non-healing horny, crusted or
    oozy tumours which enlarge rapidly.
  • Immunosuppressed patients (following organ
    transplant) are especially at risk and SCCs may
    be atypical and aggressive.
  • Invasive SCCs refer via rapid access referral.

Do not refer
  • Basal Cell carcinoma NOT urgent skin cancer.
    (BCC are slow growing, without significant
    expansion over 2 months)
  • BCC usually on face,back,scalp chronic sun
    exposure areas.
  • Squamous Cell Carcinoma in-situ (Bowens disease)
    is NOT an invasive cancer and does not need
    urgent referral.

  • Documented expansion over 8 weeks.
  • lesiongt 1cm
  • Crusting non-healing lesion with induration.
  • Mention Location of the lesion.

Non-cancer rapid access clinics
  • Chest Pain clinic
  • TIA clinic
  • DVT clinic
  • Eye casualty

Rapid Access Chest Pain clinic
  • Department of Health NSF 2000 recommended all
    acute NHS trusts should offer a service whereby
    GPs should be able to refer any of their patients
    not previously diagnosed with CAD and
    experiencing symptoms related to this condition
    for Assessment/Treatment.

Essential Referral Criteria
  • Cardiac-type chest pain!
  • Retrosternal
  • Occurs on exertion
  • Resolves within 10minutes of rest/GTN
  • Symptoms must have occurred for the FIRST TIME
    within the last 8 weeks
  • Women lt 40 and Men lt 30 NOT ALLOWED!

Chest Pain Clinic Criteria..
  • Patients assessed within the last year should NOT
    be referred to this clinic
  • Patients suspected of having an acute MI or
    unstable angina ? AE.
  • Do bloods and ECG
  • Include PMH,Meds,Risk factors.

Acute TIA Clinic
  • Anterior Circulation Symptoms
  • Amaurosis fugax
  • Aphasia,dysphasia
  • Hemiparesis
  • Hemisensory loss
  • Hemianopic visual loss
  • Posterior Circulation Symptoms
  • Diplopia
  • Vertigo
  • LOC
  • Hemisensory loss
  • Hemianopic visual loss
  • Transient global amnesia
  • Dysarthria
  • Tetraparesis

TIA Risk factors
  • Hypertension
  • Smoking
  • Obesity / DM
  • Previous TIA/Stroke
  • IHD
  • Hypercholesterolaemia
  • AF

Rapid Access Clinic
  • Most specialities have a 2 week wait clinic for
    urgent suspected cancers/ clinical conditions
    that require urgent attention.
  • Fax the forms to the appropriate number
  • Include patients details accurately
    address/phone numbers/D.O.B./etc.
  • Ensure patient is aware to contact you if hasnt
    heard from the hospital

Rapid Access Clinics
  • Use them, dont abuse them.
  • Know the criteria for referring

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