{
  "abstract": "Introduction Gastroenterology consultants digitally vetted 910 urgent suspected cancer iron deficiency anaemia (USCIDA) referrals in 2024. In 2023, a direct to test (DTT) approach was adopted following a new iron deficiency anaemia protocol (SOP) to avoid low value outpatient appointments (OPAs) for patients meeting our fitness for test criteria. We compared 100 pre and post SOP patients with emphasis on saved OPA capacity, and time to investigations/OPAs.Methods Data was extracted via SLQ query from the backend from electronic health record. A retrospective analysis of 100 consecutive USCIDA referrals pre and post SOP implementation was conducted. Data on demographics, investigations, diagnosis and time to OPA/test were analysed. Statistical analysis was performed with Graphpad Prism.Results Median age of pre-SOP patients was 76 years (SD 13.9), 50% female. The post- SOP cohort were significantly older (median age 72 years, SD 13.9), 51% female (p<0.05). 100% of the pre-SOP group had OPAs (1 did not attend (DNA)). Only 47% in the post-SOP cohort had OPAs (1 DNA). Comparing pre with post-SOP cohorts; time to clinic was 9 versus 7 days, and time to first investigation was 21 versus 18 days. Investigation numbers were similar between groups. Gastroscopy, colonoscopy, flexible sigmoidoscopy, CT colonography and CT scans were predominantly requested, with only 1 DNA in the post-SOP group. Clinical findings showed a significantly higher colorectal cancer rate in the pre-SOP group (9.0% versus 1.0%, p<0.05). Similar lower GI findings were observed (colonic polyps, diverticular disease, angiodysplasia) in both groups. 1 gastric cancer was diagnosed in the pre-SOP group. Upper GI findings were noted in 27% versus 31%, and lower GI tract findings were noted in 41% versus 35% in the pre- and post-SOP groups respectively. Both groups had an average WHO score of 1. See table 1.Conclusion A DTT approach is effective in avoiding low value OPAs in the USCIDA pathway. 53% of OPAs were saved in the post-SOP group, equating to 482 OPAs per year. DTT digital triage is well accepted by patients, as evidenced by low DNA rates. Freed OPA capacity aids to reduce referral to treatment times for those requiring outpatient assessment.Abstract P268 Table 1SectionMetricPre SOPPost SOPp-valueCohort Number 100100 Demographics  Age, median 76 (66–86)72 (59–80)<0.05  Female, n (%) 50 (50.0%)51 (51.0%)nsProcess  Triage to Direct-to-test, n (%) 0 (0.0%)53 (53.0%)<0.05  Triage to OPA, n (%) 100 (100.0%)47 (47.0%)<0.05  Any test completed, n (%) 91 (91.0%)93 (93.0%)ns Any DNA, n (%) 1 (1.0%)2 (2.0%)nsTimeliness  Days to OPA, median 7 (6–11)9 (6–13)<0.05  Min days to first test, median 21 (15–26)18 (13–26)nsOutcomes  CRC, n (%) 9 (9.1%)1 (1.0%)<0.05  UGI finding, n (%) 27 (27.0%)31 (31.0%)ns LGI finding, n (%) 41 (41.0%)35 (35.0%)ns",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Southampton, Southampton, United Kingdom"
      ],
      "name": "Deborah Lim"
    },
    {
      "affiliations": [
        "University Hospitals Southampton, Southampton, United Kingdom"
      ],
      "name": "David Bacon"
    },
    {
      "affiliations": [
        "University Hospitals Southampton, Southampton, United Kingdom"
      ],
      "name": "Joshua Bird"
    },
    {
      "affiliations": [
        "University Hospitals Southampton, Southampton, United Kingdom"
      ],
      "name": "Abbie Haestier"
    },
    {
      "affiliations": [
        "University Hospitals Southampton, Southampton, United Kingdom"
      ],
      "name": "Philip Boger"
    },
    {
      "affiliations": [
        "University Hospitals Southampton, Southampton, United Kingdom"
      ],
      "name": "Richard Felwick"
    },
    {
      "affiliations": [
        "University Hospitals Southampton, Southampton, United Kingdom"
      ],
      "name": "Matthew Stammers"
    },
    {
      "affiliations": [
        "University Hospitals Southampton, Southampton, United Kingdom"
      ],
      "name": "Markus Gwiggner"
    }
  ],
  "title": "P268 Impact of a digital direct-to-test approach in the urgent suspected cancer iron deficiency anaemia pathway",
  "uid": "b99f500f-0f9b-5d62-a277-866c9161cf85"
}