TY - JOUR
T1 - DaPeCa-2
T2 - Implementation of fast-track clinical pathways for penile cancer shortens waiting time and accelerates the diagnostic process - A comparative before-and-after study in a tertiary referral centre in Denmark
AU - Jakobsen, Jakob Kristian
AU - Jensen, Jørgen Bjerggaard
PY - 2016/2
Y1 - 2016/2
N2 - Objective: The aim of this study was to examine the feasibility and impact of a fast-track referral pathway on clinical time intervals in penile cancer. Materials and methods: This observational study from a tertiary referral centre included 263 patients diagnosed before and after the introduction of an intervention to reduce clinical time intervals, the Cancer Patient Pathway (CPP). The CPP included fast-track referral and set time-frames for units participating in cancer diagnosis and treatment, and was introduced for penile cancer in Denmark on 1 January 2009. Median time intervals (in calendar days) with interquartile range were the main outcome measure. Results: A trend towards reduction was observed in all clinical time intervals, with a statistically significant reduction in the system interval (p = 0.01) and tertiary centre interval (p < 0.0001). The proportion of patients treated within the maximum accepted time-frame of 37 days after referral steadily increased after implementation of the CPP. In particular, unjustified waiting time was reduced significantly. This was mainly achieved through pre-booking of appointments and diagnostic time slots by a dedicated clinical coordinator. Conclusions: To the authors knowledge, this is the first study examining the feasibility and impact of an intervention to reduce clinical time intervals in penile cancer. The Danish CPP was successful in reducing system and tertiary centre intervals. Future interventions need to address the long patient interval. Longer follow-up is needed to study the impact of CPP on mortality.
AB - Objective: The aim of this study was to examine the feasibility and impact of a fast-track referral pathway on clinical time intervals in penile cancer. Materials and methods: This observational study from a tertiary referral centre included 263 patients diagnosed before and after the introduction of an intervention to reduce clinical time intervals, the Cancer Patient Pathway (CPP). The CPP included fast-track referral and set time-frames for units participating in cancer diagnosis and treatment, and was introduced for penile cancer in Denmark on 1 January 2009. Median time intervals (in calendar days) with interquartile range were the main outcome measure. Results: A trend towards reduction was observed in all clinical time intervals, with a statistically significant reduction in the system interval (p = 0.01) and tertiary centre interval (p < 0.0001). The proportion of patients treated within the maximum accepted time-frame of 37 days after referral steadily increased after implementation of the CPP. In particular, unjustified waiting time was reduced significantly. This was mainly achieved through pre-booking of appointments and diagnostic time slots by a dedicated clinical coordinator. Conclusions: To the authors knowledge, this is the first study examining the feasibility and impact of an intervention to reduce clinical time intervals in penile cancer. The Danish CPP was successful in reducing system and tertiary centre intervals. Future interventions need to address the long patient interval. Longer follow-up is needed to study the impact of CPP on mortality.
KW - Cancer patient pathway
KW - clinical pathway
KW - clinical time intervals
KW - delay
KW - penile cancer
KW - squamous cell carcinoma of the penis
KW - time intervals
KW - urgent referral
UR - http://www.scopus.com/inward/record.url?scp=84954372349&partnerID=8YFLogxK
U2 - 10.3109/21681805.2015.1077472
DO - 10.3109/21681805.2015.1077472
M3 - Journal article
C2 - 26271679
SN - 2168-1805
VL - 50
SP - 80
EP - 87
JO - Scandinavian Journal of Urology
JF - Scandinavian Journal of Urology
IS - 1
ER -