The fourteen-day rule and colorectal cancer

Ann R Coll Surg Engl. 2002 Nov;84(6):386-8. doi: 10.1308/003588402760978166.


Objective: To examine the effect of the fourteen-day rule on the colorectal service of a district general hospital.

Methods: Prospective audit of all patients referred by general practitioners to the colorectal service of a district general hospital serving a population of approximately 300,000 people. The main outcome measures were: (i) mean interval in days from referral to first clinic appointment; (ii) first clinic appointment to diagnosis; and (iii) overall interval from referral to diagnosis.

Results: There was a change in the referral pattern with greater numbers of 'fourteen-day rule' and urgent referrals than expected (P < 0.001). The mean time interval from referral to diagnosis was reduced (P < 0.01). This was due to a reduction in the wait for a first clinic appointment (P < 0.01). The wait between first appointment and diagnosis was unchanged (P < 0.05). Waiting times for patients referred as 'routine' or whose GPs did not specify a priority also improved.

Conclusions: The 'fourteen-day rule' with respect to colorectal cancer has reduced waiting times for a first appointment to see a specialist. Further improvements will require additional resources to reduce the delay for investigations. The effect on long-term survival remains to be seen.

MeSH terms

  • Analysis of Variance
  • Appointments and Schedules
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / mortality
  • Family Practice / standards
  • Health Services Accessibility / standards*
  • Hospitals, District / standards*
  • Hospitals, District / statistics & numerical data
  • Hospitals, General / standards*
  • Hospitals, General / statistics & numerical data
  • Humans
  • Management Audit
  • Outcome Assessment, Health Care
  • Referral and Consultation / standards*
  • Referral and Consultation / statistics & numerical data
  • Survival Rate
  • Time Factors
  • United Kingdom / epidemiology
  • Utilization Review
  • Waiting Lists*