Shortening Time to Diagnose Breast Lesions
When a group of SVMC physicians learned that some mammography centers across the country were advertising a concept called “no sleepless nights,” they were intrigued. Was it really possible to diagnose breast lesions without giving the women any anxious, sleepless nights? A team was formed to study this issue, and completed the project in 2007.
First they went to talk to women who had been through the process. Dr. Letha Mills, an oncologist, invited about 100 women to participate in this phase of the project and 55 of them did. They told us that they felt it should take no more than a week to get diagnosed. They also told us that they would like their test results in 2 days or less.
Our team then reviewed 263 cases and learned that only 40 had completed the diagnosis in 7 days or less (15%). The average time to diagnose was 18 days. Over 20% of the cases took over 30 days to diagnose! Our team sent letters to local physicians to understand how long it was taking for them to deliver results – on average, between 3 and 4 days!
The team set out to understand the root causes of the delays. Team members interviewed staff and physicians. They mapped out the diagnosing process to identify each step. They then began to see where things were breaking down. Their most important improvement efforts included:
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Updating the physician requisition form to give the radiologists more leeway in performing necessary tests without having to lose time by getting back to the ordering physician.
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Revising the schedule so that there were dedicated appointment slots for diagnostic mammograms, which are needed with short notice.
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Making more appointment slots available, and aligning them with the radiologists’ availability for reading mammograms.
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Hiring a Breast Health Navigator to meet with women after the tests, explain the next steps in the diagnosis process, and to reduce anxiety about the process.
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Issuing reminder letters for women with screening mammograms to reduce the no-show rate.
The improvements can be summarized by saying that the average time it takes to diagnose breast cancer is now 12 days. And for those women who do not have any additional medical concerns that might slow things down, for example, the use of a blood thinner, the time for diagnosing is only 7 days!
Our Breast Health Navigator is able to talk to 90% of the women to give them their test results on the same day that they have their test. Perhaps most importantly, the team has created a process that is reliable. Very few women (only 6%) now experience delays of over 30 days in the getting their breast lesions diagnosed.
The results of this improvement effort are remarkable!