Expanding the MUO patient pathway

Status Past
Programme Innovation Time Awards
Partners Betsi Cadwaladr University Health Board

Project Lead(s)

Dr Elaine Hampton

Dr Elaine Hampton

Macmillan GP, Betsi Cadwaladr University Health Board

Anna Mullard

Anna Mullard

Consultant Medical Oncologist, Betsi Cadwaladr University Health Board


The MUO service makes sense for patients, cancer diagnostic pathways, the health board and for Wales; it delivers excellent patient care and saves diagnostic pathway time.

Dr Anna Mullard ― Consultant Medical Oncologist

This project saw the expansion of the Malignancy of Unknown Origin (MUO) pathway across each of the three District General Hospital sites in Betsi Cadwaladr University Health Board.

Prior to this work all patients in primary care, secondary outpatients or those discharged from hospital were not eligible for the MUO service. As a result, many were diagnosed during an emergency hospital admission and remained in hospital whilst further investigations were carried out.

Our funding facilitated the expansion of the service to include referrals from primary care, rapid diagnostic clinics and secondary care outpatients, enabling patients to come under the full care of the Unknown Primary team. The service allowed for timely investigation and follow up of patients by a team with the experience and knowledge of MUO. The patient if they wished, and were well enough, could remain at home with the confidence that they were cared for. The pathway also minimised the need for GPs and other non-specialist secondary services to be involved and thus reduced the risk of delay in patients receiving the appropriate care.

The expanded pathway resulted in improved patient care, with more timely diagnosis and better communication with the specialist MUO team . It also significantly reduced admissions and for those patients that were admitted the average length of stay dropped from 22 to just 5 days.

Owing to the success of the expanded pathway, in July 2023 Betsi Cadwaladr University Health Board guaranteed the continuation of the service across all 3 sites. However, later in 2023, due to budgetary constraints affecting nursing capacity the service reverted to an advisory only service for inpatients. We are disappointed by this decision and hope that the fully expanded pathway can be reinstated in 2024.

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