P356 Straight-to-test referrals of iron deficiency anaemia: results from a trainee-led, pan-Yorkshire multi-site audit

Introduction Iron deficiency anaemia (IDA) is a common reason for gastroenterology referral. We aimed to see whether straight-to-test (STT) endoscopy referrals enable more rapid diagnosis in patients with cancer or improve chances of treatment success. Methods Retrospective audit across 10 sites in Yorkshire, by a newly formed trainee research network. We included patients referred on a suspected cancer pathway with IDA in November 2018. Data on referral criteria, initial review, investigations, time to diagnosis and outcome were collected. Anonymised data was pooled for comparative analysis. Results 508 patients included: median age 72 years (range 24–97); 55% female. 93 (18%) patients underwent STT investigations, varying significantly across 8 sites (1.4–78.2% referrals). Patients were more often seen in surgical (42%) or gastroenterology (23%) clinic. Cancer was diagnosed in 41 (8%) patients: 5% colorectal, 1% upper gastrointestinal (GI) and 2% other cancers. The STT group were younger and had a significantly reduced time to first investigation/cancer diagnosis, than those not referred STT (non-STT). However, patients were no more likely to receive curative treatment (table 1). All patients in the STT group were investigated (82% both upper and lower GI investigations). In the non-STT group, 71 (17%) underwent plain CT only (7%) or no investigations (10%): as the patient declined 7%; patient unfit 4%; not indicated (clinical decision) 2%; did not attend 2% or investigations previously performed 1%. There was no difference in laboratory values between groups. STT patients were less likely to be discharged without clinic review (18% vs. 48%) following normal investigations. Conclusions STT investigations removed the need for initial (but not follow-up) review in 1 of 5 patients with IDA and reduced time to diagnosis, but did not increase likelihood of treatment success. Patient choice was the main reason for incomplete investigation. We plan to re-audit after introduction of formal STT pathways in the region, to see if better patient selection can improve outcomes.