Step 4: Review excluded patients
This section covers the following steps:
|Step 4.1 Understand what diagnoses are excluded from screening by your software|
|Step 4.2 Extract a list of excluded patients and undertake clinical review of their screening eligibility|
When you use data audit tools or your practice software to generate lists of patients who are overdue for screening, the software excludes:
- patients who have certain diagnoses in their patient record (see the table in step 4.1)
- patients who have been manually excluded (“opted out”) from screening (for clinical reasons or because of personal preference) (CAT4 does not exclude these patients, but practice software may).
This function is helpful for limiting the probability that you send a screening reminder to a patient inappropriately. However, some patients can return to screening following treatment or, over time, they may no longer wish to be opted-out from screening reminders due to personal preference. While this might represent a small number of patients, it is important to not overlook them.
In addition to patients for whom “Not required” or “Excluded” has been manually selected in practice software, patients with the diagnoses listed in the links below will also be automatically excluded from screening eligibility lists:
|Software provider||Bowel screening exclusions||Breast screening exclusions||Cervical screening exclusions|
|CAT4||Diagnosis codes that PEN uses to assign patients to ‘ineligible’|
|Medical Director||N/A||N/A||Cervical screening result searches|
Step 4.2 Extract a list of excluded patients and undertake clinical review of their screening eligibility
Step 4.2.1 Use the instructions in the table below to extract a list of patients who are excluded from screening
Use the same tool (your data audit tool or practice software) that you use to generate reminder lists.
|Software provider||Viewing patients excluded from bowel screening||Viewing patients excluded from breast screening||Viewing patients excluded from cervical screening|
|CAT4||When you complete cancer screening searches using the provided recipes a pie chart will be produced, a section of which is ‘ineligible’, click on this section and export a list to excel using the standard process.|
|Medical Director||N/A||N/A||Excluding patients from cervical screening searches|
Step 4.2.2 Have an appropriate staff member (practice nurse or GP) review the list to identify any patients who may be eligible to return to screening
It is important to periodically review patients who have been excluded from screening to assess the appropriateness of them returning to screening, based on clinical guidelines.
If any patients are identified as being eligible to return to screening, it is important that the reason for the decision is explained to them prior to inclusion back into screening reminder processes.