Authors (including presenting author) :
Shing KKD(1), Wong WY(1), Chan YC(2), Chan KK(1), So KY(1), Yip CW(1), Wong TC(1)
Affiliation :
(1)Department of Medicine, Haven of Hope Hospital, (2)Accidents and Emergency Department, United Christian Hospital
Introduction :
This project aimed to provide support to Accidents and Emergency Department (AED) of United Christian Hospital (UCH) for a timely evaluation of lung shadow. All referrals were triaged by senior respiratory physician of Haven of Hope Hospital (HHH) according to patient's history (e.g. any hemoptysis or weight loss) and chest X-ray. Patients highly suspicious of malignancy will be assessed in respiratory clinic within 2 weeks.
Objectives :
To evaluate the efficiency of lung shadow diagnostic workup referred by UCH AED to HHH
Methodology :
The medical records of Patients with lung shadow referred from UCH AED to HHH from 1/9/2018 to 30/9/2019 were retrieved. Duration from AED referral to first assessment in HHH, from first HHH assessment to time of diagnosis of lung cancer, and outcome of the patients were reviewed.
Result & Outcome :
Total 118 referrals were retrieved during the audit period and 5 patients defaulted first assessment in HHH. The mean age of these 113 patients was 66.9 +/- 13.6 years and 47% were male. Lung cancer was diagnosed in 17 patients (15.0%) and the mean waiting from AED referral to first assessment in HHH was 12.3 +/- 5.5 days and was shorter compared to patients with other diagnosis (29.9 +/- 16.7 days) which included lesions either not confirmed or resolved, benign and non-specific lung shadows. All 17 patients with final diagnosis of lung cancer agreed for private early CT scan in view of high probability of malignancy. Among these 17 patients, 13 patients (76.5%) got the diagnosis by first diagnostic procedure (11 bronchoscopy, 4 endobronchial ultrasound (EBUS), 2 fine needle aspiration (FNA) of peripheral lymph nodes) and the median waiting time was 12 days. Remaining 4 patients confirmed diagnosis by second procedures including 3 EBUS and 1 CT-guided FNAC. The median time of reporting histology results was 2 days. Overall, the median time from first assessment in HHH to diagnosis of lung cancer was 29 +/- 28 days. Four patients finally received curative surgery and 8 patients received anti-cancer treatments from oncology. In conclusion, rehabilitation hospital with expertise in respiratory medicine could support the management of lung shadow identified by AED efficiently. A combination of revamping system factors including clinical oriented screening of suspicious referrals by senior respiratory physician, private-public collaboration of imaging, modern diagnostic by EBUS, and efficient pathology reporting service all contributed to the shortened time of diagnosis.
