Authors (including presenting author) :
Shum NF(1), Tam CK(1), Tang YC(1) Lau SM(2), Leung KY(2), Lam SC(2), Choi HK(1)(2), Rockson Wei(1), Foo CC (3), Wong KY(2), Chung HP(2), Law WL(3), Cheng WK(3)
Affiliation :
Department of Surgery,(1) Queen Mary Hospital;(2)Tung Wah Hospital;(3)The University of Hong Kong.
Introduction :
Colorectal cancer is the second most common cancer in Hong Kong1. Rectal bleeding is one of the common symptoms among all age groups and could be due to underlying colorectal neoplasms or from other benign causes. In the past, patients with rectal bleeding need to wait (in term of years) before first seen by the Colorectal Specialist in clinic. Also, patients seen by different healthcare providers in different settings from diagnosis to treatment. Theoretically, the idea of a “single point of access” for diagnostic assessment and treatment of rectal bleeding is attractive. As there is a large discrepancy between TWH and QMH colorectal service particular for patients with rectal bleeding, a fast track rectal bleeding clinic is established for better coordinate service.
Objectives :
This study aims to (1) shorten consultation waiting time for PRB service;(2) shorten endoscopy waiting time;(3) early detection of colorectal neoplasms; (4) provide a “fast track rectal bleeding clinic” from screening to diagnosis to treatment and follow-up at one day and without prior appointment.
Methodology :
The fast track rectal bleeding clinic established in TWH since October 2021. The clinic adopted integrated model approach and bundled with a colorectal specialist and a colorectal specialist nurse. All patient referrals are triaged by a colorectal specialist to the colorectal nurse. Telephone pre- assessment conducted by colorectal nurse to identify any high risk patients and ensure patient readiness before attending clinic such as dietary and bowel preparation, medication etc. Prioritization of patient appointments was driven by division protocol. Patient need only attend clinic ‘once’ with flexible sigmoidoscopy and proctoscopy done with /without banding of piles. Home care education was provided before discharged.
Result & Outcome :
From October 2021 to November 2022, a total of 838 patients (392 females and 446 males) attending the rectal bleeding clinic with the mean age of 53.87 years. 37.59 % (315) patients required early colonoscopy and in which 4.44% (14) patients found to have colorectal cancer. The rectal bleeding clinic consultation waiting time shorten from 12 to 4 weeks. The flexible sigmoidoscopy service waiting time in QMH shortened from 20 to 6 weeks. The integrated model of colorectal nurse clinic enhanced cluster patient service, shorten consultation waiting time for rectal bleeding care and early detection of colorectal cancer.
