(A009) Reducing VOMIT and waste in Head and Neck cancer pathways : A two cycle study

Introduction: Whilst an increased number of urgent referrals to head and neck clinics to rule out potential cancer helps in early diagnosis and strives towards NHS long term targets of diagnosing 75% of cancers in T1/T2 stages, it causes a huge load of referrals with only 3% cancer pick-up rate. Majority of these patients get referred for unnecessary investigations and end up as victims of VOMIT(Victims Of Modern Imaging Technology), and serves as a caution against over-investigation. The aim is to assess the number of ultrasound scans and barium swallows reported as negative or normal and use this to look for patterns of over investigation to subsequently reduce this rate.

Methods: The first cycle involved a retrospective case study of patients referred to our head and neck unit from September-December 2023. Data was sourced from our electronic patient records across different systems. The results were discussed in our departmental meeting, new strategies were put in place and pathways further streamlined. A second cycle involved three months of consecutive data collected during 2024 after dissemination of information from the first cycle and informing the respective staff.

Results: None of the 12 barium swallows requested on the urgent suspected pathway for dysphagia patients demonstrated any malignancies. 70% of ultrasounds also showed normal findings with reactive lymphadenopathy being the commonest result. The results of the second cycle will be presented at the time of the conference.

Conclusions: Strategies have been put in place to reduce VOMIT and waste, thus decreasing the pressure on the trust's radiology department and improving pathways. This consequently reduces financial load on healthcare trusts. The main strategies include dissemination of this proposal, requesting clinicians to use the Edinburgh Dysphagia score to refer for gastroscopy, stopping the use of barium swallow on cancer pathways and ordering ultrasound neck scans only if any suspicious lump is palpable. Ultrasound training in head and neck clinics is another strategy that we plan to introduce to meet our national faster diagnosis standards of 80%.