P297 Yield of investigations for fast-track iron deficiency anaemia referrals in Yorkshire: a multi-site trainee-led audit

Introduction Patients with iron deficiency anaemia are commonly referred to gastroenterology for exclusion of significant pathology. Some of these patients will have been previously investigated. We aimed to ascertain how often a cause of anaemia is found and subsequent action if no cause found. Methods Retrospective audit across 10 sites in Yorkshire, by a trainee-led research network. We included patients referred on a suspected cancer pathway with IDA in November 2018. Data on referral criteria, investigations, diagnosis and follow-up were collected. Anonymised data was pooled for comparative analysis in Excel and SPSS. Results 508 patients were included: median age 72 years (range 24–97); 55% female. 48% of these patients were asymptomatic. 42 cancers (8%) were diagnosed: 25 colorectal (5%), 6 oesophageal/gastric (1%), 2 renal, 1 bladder, 2 pancreatic, 2 hepatobiliary, 1 prostate, 2 lung and 1 unknown primary. There was no correlation between patient and age and likelihood of malignancy, but an association was seen with mean Haemoglobin (Hb) and gastrointestinal cancer diagnosis. Other pathology was found in 33% of those investigated: erosive gastritis 8%, oesophagitis 5%, erosive duodenitis 1%, peptic ulcer 3%, gastric polyp 1%, gastric antral vascular ectasia 1%, angiodysplasia 1%, coeliac disease 2%, colonic polyp >10 mm 2%, colonic polyp Where no significant pathology was found, 43% patients were discharged without clinic review, 30% patients were discharged following discussion of results, 9% were seen again in clinic with no further investigations requested and 16% required ongoing follow-up or further investigations. Advice regarding Hb monitoring (with timeframe) was given in 11%, vague advice was given in 19% and no advice was given to general practitioners (GPs) in 48%. Conclusions An expected rate of significant pathology was found. 1 in 5 patients had undergone gastrointestinal investigations previously. 1 in 3 patients were seen in clinic following normal investigations. Better advice to GPs regarding Hb monitoring and subsequent management is needed and may reduce unnecessary re-referrals. Further exploratory work to identify additional predictors of significant pathology is planned.