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We have previously used SEA in this novel way and reported an analysis of multiple SEAs of lung cancer diagnosis (Mitchell et al, 2013). This paper reports on the analysis of multiple SEAs for patients who were diagnosed with cancer as the result of an EP to hospital. Data were synthesised from four SEA generating initiatives with the aim of understanding the causes of EP and determining the degree to which earlier intervention by general practice was possible. In 2009, SEAs for lung cancer and cancers in teenagers and young adults (TYA), including EPs, were carried out by practices in the North of England Cancer Network. In 2010, SEAs Buy Adidas Gazelle Uk of upper gastrointestinal (UGI) and ovarian cancers were undertaken by practices in the South East London Cancer Network. Subsequently, SEAs of EP regardless of cancer type were carried out by practices in the North East Yorkshire and Humber Clinical Alliance (Cancer) in 2012 and in the Yorkshire and the Humber Strategic Clinical Network in 2014 (Box 1).

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al, 2011). Despite this, we know little about the circumstances and context surrounding the route to EP. Recent work has shown that the majority of patients with a diagnosis of colorectal cancer following EP have seen their GP within the 6 months before diagnosis (Sheringham et al, 2014). There is as yet little known about the content of these primary care contacts, and in particular whether there are opportunities for earlier diagnosis within them. Significant event audit (SEA) is a quality improvement tool designed to assist with and improve the quality of patient care in general practice (Pringle et al, 1995; McKay et al, 2009). It provides a structured narrative of the events surrounding an incident of interest, and as a tool for self reflection Adidas Gazelle Womens Cheap

These network areas encompass urban, rural and coastal areas, as well as a range of socio economic backgrounds. Box 1. Practices were provided with a standardised, cancer specific electronic template for documenting their SEAs. This was developed for and modified following the initial evaluation (Mitchell et al, 2009) and was based on the structure recommended by the National Patient Safety Agency (National Patient Safety Agency, 2006). It includes specific prompts designed to give a richer understanding of the circumstances surrounding pathways to diagnosis, and asks practices to consider and reflect on what happened, why it happened, what has been learnt and what can be changed. Completed reports Adidas Gazelle Og Trainers Sale

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and improvement is now part of the GP appraisal and revalidation process in the United Kingdom. Yet, although SEA is widely used in primary care practice, its utilisation to obtain insights into the process of care for specific conditions is relatively rare.

were returned to the local network team, subjected to peer assessment for quality control and anonymised versions forwarded to the research team.

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´╗┐et al, 2009; Coleman et Adidas Gazelle Dark Red

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Data analysisAs each SEA is a narrative account of a new cancer diagnosis and the circumstances surrounding it, qualitative methods, based on a modified framework approach.

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