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Prospective audit of gastroscopy under the `three‐day rule': a regional initiative in Italy to reduce waiting time for suspected malignancy
Author(s) -
Parente F.,
Bargiggia S.,
Bianchi Porro G.
Publication year - 2002
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2002.01241.x
Subject(s) - medicine , referral , malignancy , euros , prospective cohort study , cancer , audit , pediatrics , general surgery , surgery , family medicine , philosophy , humanities , management , economics
Background: A regional initiative, called the `three‐day rule', has recently been introduced in Italy to facilitate the earlier diagnosis of malignancy. It requires patients with suspected severe diseases to have a diagnostic procedure performed within three working days of referral by a general practitioner. Aim: To assess prospectively the effectiveness and compliance with the three‐day rule for upper digestive malignancies. Methods: We compared patients referred for gastroscopy under the three‐day rule initiative with contemporaneous open access referrals over a 12‐month period at a single large teaching hospital in west Milan. We compared the prevalence of malignancies and other serious non‐neoplastic diseases as well as the waiting times in the two groups. The appropriateness of the indications for each referral was also reviewed by a gastroenterologist blind to the outcome of the test. Results: One hundred and forty‐two patients referred for gastroscopy under the three‐day rule scheme and 767 routine referrals were studied. Significantly more oesophageal/gastric cancers (6% vs. 1%) and serious benign gastrointestinal lesions (grade II–III oesophagitis or peptic ulcer) were diagnosed in three‐day rule patients in comparison with routine referrals ( P < 0.05). The rate of inappropriate referral was significantly lower in the three‐day rule group than in the open access group (39% vs. 22%) ( P < 0.01). The estimated cost of the three‐day rule scheme (in extra list examinations alone) was 10 780 euros, with about 1198 euros per diagnosis of cancer, but only 229.5 euros per `useful' diagnosis (including peptic ulcer disease and oesophagitis). Conclusions: Significantly more upper gastrointestinal cancers and serious benign diseases can be found within a short period to comply with the three‐day rule scheme. However, some general practitioners appear to over‐interpret alarm symptoms, leading to some inappropriate referrals. Better awareness of appropriate urgent referral criteria is needed in order to ensure that the best use is made of the resources available.