Abstract Background Delayed diagnosis of inflammatory bowel disease (IBD) is linked to worse outcomes including psychological distress and increased surgical complications.1,2 Long waits for gastroenterology clinics contribute greatly to these delays. Limited evidence suggest Direct-to-Test (DTT) pathways may expedite diagnosis.3 We aimed to evaluate pathways to diagnosis and whether a DTT virtual triage pathway can shorten time from primary-care referral to IBD diagnosis and treatment. Methods We conducted a retrospective analysis of all newly diagnosed IBD cases derived from a single centre multidisciplinary team (MDT) meeting between Jan–Jun 2023 (pre-pathway) and Jan–Jun 2025 (post-pathway). The virtual DTT pathway, introduced in Aug 2024, enabled clinicians to review primary-care referrals and request investigations directly without a prior clinic visit. For each case we recorded the referral pathway and time from: GP referral to colonoscopy request; GP referral to diagnosis; time to treatment or MDT review if not treated. Results There were 52 IBD diagnoses in 2023 and 42 in 2025. In 2023 (pre-pathway), 35/52 (67%) patients were referred via the 2-week wait (2WW)-faecal immunochemical test (FIT) positive-”cancer” pathway; 6/52 (9%) via routine GP referral and 8/52(15%) were diagnosed during acute admission. In 2025 (post-pathway), 23/42 (55%) were referred via 2WW pathway; 6/42 (14%) through the new virtual triage pathway and 6/42 (14%) during acute admission. For patients referred via routine GP pathways in 2023 (n = 6) versus the virtual triage pathway in 2025 (n = 6), median time from GP referral to colonoscopy request decreased from 77 days (range 69–139) to 41 days (18–80). Median time to diagnosis fell from 118 days (90–162) to 107.5 days (54–113). Median time from referral to treatment or MDT review improved from 146 days (124–181) to 114 days (92–138). Conclusion Our preliminary findings found DTT virtual triage pathway reduced time to colonoscopy request and improved time to diagnosis and treatment of IBD. Pathways to diagnosis remain disparate and include those intended for cancer diagnosis. Early triage and direct investigation offer a practical approach to expediting care. Larger multicentre evaluation is needed to confirm impact and assess sustainability. References: 1. Jayasooriya N, Smith J, Brown R, et al. Delayed diagnosis and worse outcomes in inflammatory bowel disease. Aliment Pharmacol Ther. 2023;57(6):635-652. doi:10.1111/apt.17370. Epub 2023 Jan 10. PMID:36627691. 2. Jayasooriya N, Taylor C, Moore G, et al. The impact of delayed diagnosis on IBD patients’ psychological and physical health. BMJ Open Gastroenterol. 2024;11(1):e001371. doi:10.1136/bmjgast-2024-001371. PMID:38802264; PMCID:PMC11131120. 3. Stammers M, Grant T, Miller A, et al. Evaluation of Direct-to-Test pathways in gastroenterology: a multi-centre study. Frontline Gastroenterol. 2022;13(6):477-483. doi:10.1136/flgastro-2021-102047. PMID:36250165; PMCID:PMC9555126 Conflict of interest: Dr. Lazarus, Samuel: None declared Hall, Richard: Honorarium from Takeda Auguste, Jean: None declared Dawson, Patrick: Advisory board for Dr Falk Pharma Honap, Sailish: Sailish Honap has served as a speaker, consultant, advisory board member, and/or received travel grants from AbbVie, AlfaSigma, Banook Group, Ferring, Johnson & Johnson, Lilly, Pharmacosmos, Pfizer, and Takeda. Patel, Kamal Vijaykant: Speaker fees, educational support: Abbvie JnJ DrFalk Pfizer Takeda Celltrion Adborads: Pfizer Abbvie JnJ Alfasigma Neild, Penny: None declared Poullis, Andrew: None declared Pollok, Richard: Consultancy for Galapagos
Lazarus et al. (Thu,) studied this question.