Turnaround times in breast cancer: From screening to diagnosis to treatment

Abstract

To compare our institution with national benchmark times, and identify rate-limiting steps in the process by conducte a retrospective review of the turnaround times in 2009 at the Carilion Clinic Breast Care Center (CCBCC). To evaluate patient satisfaction with the turn around times. A retrospective chart review was performed to evaluate the time intervals from abnormal screening mammogram to diagnostic mammogram, diagnostic mammogram to biopsy, biopsy to MRI, and MRI to surgery of all patients seen for breast cancer in 2009. A patient survey was mailed out to all patients (131) managed from abnormal screening to surgery in 2009, assessing their satisfaction with the turnaround times from screening mammogram to call back, call back to diagnostic mammogram, diagnostic mammogram to biopsy, biopsy to results call, biopsy result to MRI appointment, MRI appointment to surgery consult, and surgery consult to surgery; and assessing possible reasons why patients may perceive the process to be delayed. The MEANS procedure was applied to evaluate the turnaround times, and a Box and Whisker Plot statistical comparison was made between patient satisfaction and turnaround times. The mean turnaround time at the CCBCC in 2009 from abnormal screening mammogram to surgery was 45 d. This falls within the 75th %ile of the National Quality Measures for Breast Centers (NQMBC), established by the National Consortium of Breast Centers (NCBC). Of 131 surveys mailed out, 57 were returned (44%). The patient satisfaction rates for each interval ranged from 96%–100%, with an overall satisfaction rate of 98% for abnormal screening mammogram to surgery. The CCBCC ranks at the 75%ile in overall turnaround times; however, this turnaround time included an interval of MRI, not previously measured in NQMBC benchmark. Rate-limiting steps were identified as the time from screening mammogram to diagnostic mammogram, and biopsy to surgery-specifically, the sub-interval MRI to surgery. Since 2009, the CCBCC has already improved the process for obtaining insurance approval and preauthorization for MRIs; and has added an additional breast surgeon to share the burden of benign cases, and a nurse practitioner to see post-op and follow up patients, improving the accessibility to the primary breast surgeon specialist. Consideration should be given to future time interval studies that evaluate breast cancer turnaround time including MRI to help establish benchmarks.