AOS Referral

Objectives

The aim of this SOP is to:

  • Ensure there is a clear pathway for a senior OUH ED doctor to refer directly to the acute oncology service. 
  • To prevent delays for patients by being referred back to the GP including reducing 62-day breaches.

It is not designed to replace: 

  • Where the ED consultant believes it is in the best interests of the patient to be referred back to the GP.
  • Referral for Spinal/ Brain findings via OARS

Scope

This SOP has been developed by the Oxford Cancer Team, Oxford Clinical Commissioning group (OCCG) and MRC Division. The SOP sets out the pathway when a patient attends ED and imaging results in an unexpected finding which may be indicative of a cancer. The SOP should be used where individual patients are to be or have been discharged from ED but require on-going investigation or follow up for the suspicious finding.

Process and agreed referral pathway 

This pathway to be followed when cancer is suspected on Cross-sectional, or exceptionally plain film,  imaging during or endorsing results after an ED encounter and the patient is being/ has been discharged home or into another community healthcare setting.

Please ensure any findings and plans are documented:

  • Confirm that the patient is aware of the possibility that they have cancer 
  • Referral to the Acute Oncology Service (AOS) has been made on EPR. 
  • Patient has been given an AOS PIS 
  • GP is informed by ED of findings and AOS referral 
  • New brain metastases and unknown primary ED referring team to examine patient’s skin to exclude melanoma 

Responsibilities 

ED Referrer 

  • Ensure the patient has been informed of the findings, suspicion of cancer and referral to AOS 
  • Ensure GP is informed of the possible cancer diagnosis and AOS referral by ED team 
  • If it is in the best interest of the patient to be referred back to GP to assess next steps ED team to make this referral
  • New brain metastases and unknown primary examine skin to exclude melanoma

AOS Team 

  • Review referrals received via EPR and arrange next steps including onward referral and investigations
  • Appropriate referrals to be registered under AOS Consultant until transferred on 
  • Where most likely primary apparent refer to site specific MDT as contacts in table 1 
  • Site specific CNS to contact patient within 2 working days of referral
  • Ensure CNS support from AOS/CUP team where primary site yet to be determined 
  • AOS team to write letter on referring patient on to specialist team or back to GP 
  • If abnormality triggering AOS referral on plain film then for review by site specialist radiologist prior to requesting imaging with ionising radiation 
  • AOS team discuss patient at weekly board round and arrange all onward tests and MDT referrals