Situation

There is a target of a 2-week waiting (2WW) period for a referral for suspected cancer. The number of referrals from primary care, dentists and other sources has risen dramatically and hospitals have struggled to keep up with demand. This was made worse by the Covid epidemic.

Head and neck cancer is quite rare and the vast majority of referrals prove negative. One approach was to use a risk calculator to split patients into high and low risk groups using factors such as smoking history and gender. Head and neck consultants could then prioritise high-risk patients and defer or reject low-risk patients. However this is not really a satisfactory approach.

Some clinicians were keen to employ the latest technology to improve the situation.

Solution

endoscope-i is a cloud-based smartphone app that combines the high-quality optics of endoscopes with the high definition of Apple iPhones. The app also has an adapter that securely fits an iPhone or iPad.

These high-definition images are combined with a validated symptom score in the app. They are then sent securely through the cloud directly to the head and neck consultant for review.

Trained nurses perform the endoscopy in any primary or secondary healthcare setting. This means more patients are examined which increases the early diagnosis rates of head and neck cancer.

Images are still reviewed by the head and neck surgeon, ensuring the patient gets the best possible opinion despite having a virtual consultation.

Impact

Using this approach with low-risk patients, it takes an ENT consultant 1 minute to review the online consultation instead of 20 minutes.

Consultants now have more time to effectively pick out referrals presenting a high risk of cancer.

By reviewing low-risk patients using this new pathway, head and neck consultants can focus on seeing high-risk patients face-to-face much sooner. This significantly speeds up the diagnostic pathway, as cancer is found 4 to 5 times more frequently in a high-risk clinic.

(From NHS website, with edits)