1. 1st phase vs. 2nd phase Eligible patients identified: 87 vs. 118 The average waiting for an Oncology OPD was 67.4 days (SD:8.3 d) vs. 44.5 d. (SD:10.1 d) The waiting time for an Oncology OPD decreased by 34% (67.4 d. vs. 44.5 d.) Subgroup analysis showed DOO-MDT date: 28% decrease(24.7 vs.17.8 d.) MDT date-Ref. Letter dictated: 73.3.% decrease (10.5 vs. 2.8 d.) Reference letter dictated - Oncology OPD date: 33.6% decrease (32.1 vs. 21.3 d.) Christakis I. MD FRCS PhD, Qureshi Y. MD, MRCS, Poch L. MD PhD, Depala A. BSc, Abdel-Aziz T. FRCS PhD, Kurzawinski T. FRCS PhD University College London Hospital United Kingdom The implementation of a database in a General Surgery Department decreases the waiting time for a post-operative oncology appointment by 34% Christakis I., Qureshi Y., Poch L., Depala A., Abdel-Aziz T., Kurzawinski T Theatre diary used to identify patients. Patients with a histopathological diagnosis of malignancy identified. 1st part of the audit 1st of June 2013-1st of October 2013 (5 months) 2nd part of the study 1st of June 2014- 4th of September 2014 (3 months) An MDT database was created and maintained by clinicians exclusively keeping track of all actions involved in the MDT Patients with malignancy require discussion in the relevant Multi-Disciplinary Team (MDT) Meeting and may require referral to an Oncology Service for further treatment. The referral process in our hospital so far is the following: 1.Incidental finding of malignancy or known malignancy 2.1st OPD 2 weeks after surgery, patient is informed about it 3. and referral to MDT is decided 4.MDT discussion and referral to Oncologist if needed 5.2nd OPD, MDT decision isa communicated to the patient 6.Patient seen by Oncologist The use of a database can help reduce the waiting time for an Oncology appointment thus helping Institutions meet target points and avoiding financial penalties. To our experience, it can easily be maintained by clinicians thus avoiding the need for a dedicated coordinator that incurs financial burden to the Department and is not always available..It can potentially decrease the anxiety of patients waiting to receive cancer treatment by ensuring quicker appointments but this remains to be evaluated in a prospective study. Methods and Procedures Conclusions Background and Objectives Results

2. Background and Objectives Patients with malignancy require discussion in the relevant Multi-Disciplinary Team (MDT) Meeting and may require referral to an Oncology Service for further treatment. The referral process in our hospital so far is the following: 1.Incidental finding of malignancy or known malignancy 2.1st OPD 2 weeks after surgery, patient is informed about it and referral to MDT is decided 3.MDT discussion and referral to Oncologist if needed 4.2nd OPD, MDT decision isa communicated to the patient 5.Patient seen by Oncologist Study Goals Target population: Patients with malignancy (known preoperatively or discovered incidentally) Primary Outcome: Measure the overall amount of time from the day of the operation (DOO) until the first oncology consultation Evaluate if the use of the database can decrease the overall waiting time Secondary outcome: Identify which factor contributes most: MDT date, referral letter dictation The implementation of a database in a General Surgery Department decreases the waiting time for a post-operative oncology appointment by 34%, Ioannis Christakis

3. Methods and Procedure Methodology Theatre diary used to identify eligible patients. Patients with a histopathological diagnosis of malignancy identified. Electronic records and paper notes screened to evaluate the exact dates of appointments. Duration of study 1 st part of the study 1 st of June 2013-1 st of October 2013 (5 months) An MDT database was created and maintained by clinicians exclusively keeping track of all actions involved in the MDT 2 nd part of the study 1 st of June 2014- 4 th of September 2014 (3 months) The implementation of a database in a General Surgery Department decreases the waiting time for a post-operative oncology appointment by 34%, Ioannis Christakis

4. Results and Conclusion 1 st phase of study 87 eligible patients identified- 8 patients with malignancy The average waiting for an Onc. OPD was 67.4 days (SD:8.3 d) The average time between: 1.DOO to MDT:24.7 d. 2.MDT to Referral letter dictated: 10.5 d. 3.Referral letter dictated to Oncology OPD: 32.1 d. 2nd phase of study 118 eligible patients identified- 6 patients with malignancy The average waiting for an Onc. OPD was 44.5 d. (SD:10.1 d) The average time between: 1.DOO to MDT:17.8 d. 2.MDT to Referral letter dictated: 2.8 d. 3.Referral letter dictated to Oncology OPD: 21.3 d. The implementation of a database in a General Surgery Department decreases the waiting time for a post-operative oncology appointment by 34%, Ioannis Christakis Results The waiting time for an Onc.OPD decreased by 34% (67.4 d. vs. 44.5 d.) Subgroup analysis showed DOO-MDT date: 28% decrease(24.7 vs.17.8 d.) MDT date-Ref. Letter dictated: 73.3.% decrease (10.5 vs. 2.8 d.) Ref.Letter dictated-Onc.OPD date: 33.6% decrease (32.1 vs. 21.3 d.) Conclusions The use of a database can help reduce the waiting time for an Oncology appointment thus helping Institutions meet target points and avoiding financial penalties. To our experience, it can easily be maintained by clinicians thus avoiding the need for a dedicated coordinator that incurs financial burden to the Department and is not always available. It can potentially decrease the anxiety of patients waiting to receive cancer treatment by ensuring quicker appointments but this remains to be evaluated in a prospective study.

5. Disclosure No conflicts to declare from any of the authors The implementation of a database in a General Surgery Department decreases the waiting time for a post-operative oncology appointment by 34%, Ioannis Christakis