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IntroductionAlthough the majority of cases of suspected lung cancer can be managed as outpatients where the diagnostic pathway is well developed, a proportion still present unwell via the emergency department where their subsequent journey is less certain. Along with same-day reporting for emergency scans, we have developed a rapid review service for such individuals and were interested in assessing its performance.MethodsWe looked at all patients with suspected lung cancer who presented through our emergency department for the first 6 months of 2017, focussing on outcome, time to be seen following admission, and the histological diagnosis rate.ResultsOf the 285 referrals to our lung cancer unit, 85 (32%) presented through the emergency department: 21 (25%) of these were discharged to outpatient cancer investigation. The remaining 64 (75%) were subsequently admitted to 29 different locations (8 medical specialities, surgical, vascular and orthopaedic wards). Of these, 55 (86%) were seen by the lung CNS within one working day and an appropriate management plan initiated. This was aided by our live CT database, where 50 suspicious scans were coded the same day enabling early review by the lung clinician and CNS, often before formal referral from the responsible clinical team was made.Overall 70 patients (82%) who presented as emergencies subsequently were diagnosed with a malignancy, and of these 34 (49%) had histological confirmation.ConclusionsOur Results show that, by coordinating care between the emergency and radiology departments and the lung cancer team, patients presenting unwell can be managed rapidly even if they remain in hospital. In addition, by actively seeking them out we can not only provide them with timely and appropriate investigations but also early CNS intervention, facilitating symptom management and psychological support.

Introduction: Blood transfusions are very common on a neonatal unit. Patients often need a large number of blood transfusions but each may be as little as 8mls. To reduce donor exposure and wastage of blood each standard unit is split into 6 parts or a Pedipack which may be all or partly allocated to 1 infant.Our guideline was developed in 2007 and a prospective audit showed good compliance with no unnecessary donor exposure, but wastage due to inappropriate allocation of a full pedipack.Aims: This was a retrospective re-audit of all babies who had received a blood transfusion to ensure continued compliance with the protocol and to monitor donor exposure and the wastage of blood units.Results: Babies received between 1 and 17 blood transfusions. For babies =28 weeks gestation who did not receive pedipacks as per protocol they were exposed to up to 6 unnecessary donors. For babies >28 weeks 15% were allocated an inappropriate full pedipack resulting in wastage.Conclusions: There was very poor adherence to the protocol resulting in unnecessary exposure to multiple donors and excessive wastage. This was felt to be due to poor compliance with the guideline, poor communication between the neonatal unit and blood bank staff and an increase in the need for blood transfusions resulting in a lack of availability of full pedipacks.Recommendations:To provide teaching sessions for all staff.To improve communication between the neonatal unit and blood transfusion.To re-audit to ensure that improvements have occurred.