Therefore, information regarding referral to adjunct services was not available for our study population. Our study focuses on access to colonoscopic diagnosis of emergency CRC as a surrogate for multidisciplinary care. However, referral to other subspecialty services may potentially confound our analysis, especially if procedures are needed to optimize patients prior to surgery, such
as placement of inferior vena cava filters (as EPZ5676 supplier prophylaxis to prevent pulmonary emboli), or performance of angiograms to diagnose and treat cardiovascular disease. We were also unable to obtain information regarding the number and timing of outpatient colonoscopies in our study population, because the procedures were often performed in community hospitals or private endoscopy clinics outside of our institution. This data would provide a true reflection of overall
wait-times for surgical resection among emergency CRC patients, and could be addressed by a prospective analysis. While it is possible that patients who underwent colonoscopy may have presented to a peripheral facility for management of their emergency CRC (thereby underestimating estimates of the study population overall), we believe this is unlikely in most cases because these patients are typically transferred to LHSC, BIBW2992 order which serves as the regional cancer centre, for surgical management. In conclusion, we demonstrate that the implementation of ACCESS expedites the treatment of emergency colorectal cancer patients by combining the diagnosis, workup, and surgical treatment within a single admission without delaying treatment. This study adds to the growing body of evidence that ACS programs effectively deliver surgical care, and can also potentially improve the quality of delivered care for patients who require more complex
care. Although the availability Thymidine kinase of colonoscopy resources for emergency CRC patients is only one of many equally valid outcomes for CRC, our experience demonstrates that the reorganization of resources can significantly improve access to emergency colonoscopies for a vulnerable population. Future multi-centre studies examining the impact of ACS services on emergency cancer care are needed to demonstrate differences in clinical outcomes among this population. Acknowledgements The authors would like to thank Ms. Lisa Creasor (Health Records, London Health Sciences Centre) and Ms. Frances Whiston (Clinical Research Unit, London Regional Cancer Program, London Health Sciences Centre).