Rapid access to pulmonary investigation days: the RAPID programme in suspected lung cancer University Hospital of South Manchester NHS Foundation Trust

Greater Manchester has some of the worst outcomes for lung disease in the UK, and lung cancer is one of the area’s biggest killers. Diagnostic challenges are that pathways are complex, typically involve multiple Trusts and offer a poor patient experience. The RAPID programme is a patient-focused approach to early diagnosis of lung cancer, aiming to ensure all patients have a clear diagnosis within seven days of referral. Any patient with suspected lung cancer is eligible.

The core aims of the programme were to: improve patient experience; reduce variation and standardise diagnostic evaluation; eliminate medically unjustifiable delay; and offer a co-ordinated programme of multiple investigations on a single day.

The programme has evaluated over 1,000 referrals since March 2016 and has embedded:

• next day access to CT scanning for GP two-week wait referrals
• daily triage of referrals with a CT scan and same day confirmation of no cancer
• integrated nursing and navigation support for patients requiring investigation
• a clear investigation plan on first clinic attendance with all appointments pre-booked
• a RAPID hub, with dedicated patient and physician contact details.

The key successes of the programme include:

• elimination of two-week waits and 31-day breaches
• increased number of CT scans performed by day seven (92% of GP referrals)
• reduced time from GP referral to outpatient clinic, with a fully reported CT scan, from an average of ten days to four days
• increased MDT discussions by day 14 from GP referral by 42%, and by day 21 by 77%
• absence of cancer confirmed on the day of CT scan (previously an average six-day wait)
• improved patient experience and satisfaction, despite the pathway’s increased speed.

The RAPID programme is now an established service within UHSM.

Contact information

For more information about this project, please contact Dr Richard Booton, Consultant Respiratory Physician, University Hospital of South Manchester NHS Foundation Trust, and Honorary Senior Lecturer at Manchester University.