Shaping better health
REMEDY : BNSSG referral pathways

Lung - 2WW

Checked: 04-02-2019 by Rob.Adams Next Review: 04-02-2020

Service Overview

Services provided by UHBristol at the Bristol Royal Infirmary and NBT at Southmead Hospital. The services are for patients who meet the Lung Cancer Two Week Wait criteria. The service offers consultation with diagnostics and onward referral for treatment as required.

Local Pathway

Refer to the local pathway for Suspected Lung Cancer (PDF).

Patients referred for open access CXR

All patients who are referred for open access CXR should be encouraged to attend within 72hours. CXR requests should include all relevant clinical details - particularly if they raise suspicion of malignancy. Patients should also be made aware that they may be contacted by secondary care for further tests if their CXR findings are unclear.  This is also supported by the relevant patient information leaflets for instructions on how to get direct access to radiology:

All GP requested CXRs should be reported within 24hours.

If the CXR is suspicious for lung cancer then this will result in the patient being booked for CT (reflex CT) which will be arranged by secondary care. GPs must also submit a 2WW referral (see section below) with any relevant details at this point. For further details please see  the following document:

Direct referral to CT following abnormal CXR  - this is now active at NBT, UHB and Weston.

 

Patients with normal CXR but who still have red flag symptoms or signs

Up to 25% of chest X-rays can be falsely negative in lung cancer, so if the clinical suspicion is high, or there is clinical lymphadenopathy or finger clubbing, refer urgently to the fast track lung cancer service using the 2WW referral form (see Referral section below).

 

The following NICE guidelines may also be helpful:

CKS Guidelines on the recognition and referral of Lung Cancer.

 

Referral

Please use the  BNSSG 2WW Lung Cancer Referral Form (word doc) which should be embedded on practice EMIS systems.  This form also lists the 2WW criteria for referral.

All patients referred on this form MUST have had a chest x-ray and/or CT chest within the last 4 weeks. If no chest x-ray has been performed at time of referral please request urgently to be performed before referral.

At time of referral please issue the relevant patient information leaflet as below:

NBT's 2WW Patient Information Leaflet

UHB's 2WW Patient Information Leaflet.

WAHT 2WW Patient Information Leaflet