(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms

Publication
Article
OncologyOncology Vol 28 No 1S
Volume 28
Issue 1S

Patients with abnormal screening mammogram (abSM) often experience prolonged wait times for additional testing to resolve the cause of the abnormality. The purpose of this study was to initiate an intervention, termed ‘reflex testing’ (RefT), and analyze pre- and post-RefT timelines to determine if, where, and in whom RefT resulted in significant decreases in timelines for resolution of abSM of patients undergoing routine screening in an accredited community hospital-based breast center.

Meena S. Moran, MD, David Styren, BS, Joseph Colasanto, MD, Donna Slonski, RN, Stacy Spooner, MD; Yale University School of Medicine; Therapeutic Radiology, Backus Breast Center

Introduction: Patients with abnormal screening mammogram (abSM) often experience prolonged wait times for additional testing to resolve the cause of the abnormality. The purpose of this study was to initiate an intervention, termed ‘reflex testing’ (RefT), and analyze pre- and post-RefT timelines to determine if, where, and in whom RefT resulted in significant decreases in timelines for resolution of abSM of patients undergoing routine screening in an accredited community hospital-based breast center.

Methods: All patients with abSM (Breast Imaging Reporting and Data System [BIRADS] 0, IV, and V) from the diagnostic sites of our breast center program were eligible for analysis. The two cohorts consisted of women with abSM from January to June 2009 (preintervention) and January to June 2012 (postintervention), with timelines created for each patient from the date of abSM to date of: additional diagnostic tests (mammogram, ultrasound, magnetic resonance imaging [MRI]), upgrade to higher BIRADS score, biopsy, or resolution (BIRADS I/II). Based on analysis of the timelines, RefT was implemented to streamline physicians’ written orders as follows: All of the medical staff/referring physicians were notified that, as part of the initial written order, every abSM order would automatically result in additional diagnostic testing and/or biopsy reflexively (as deemed appropriate by the reading radiologist); thus, additional diagnostic test/biopsy-specific written orders would not be required by the referring physicians. Each abSM patient was contacted within 24 hours following the abnormal reading by the breast nurse navigation team to facilitate scheduling for additional testing. Data were collected from the hospital’s Meditech/PenRad electronic medical records. SPSS V.19 and Excel were utilized for statistical analysis.

Results: Analysis of the preintervention abSM timelines revealed that significant delays (defined as > 1 month) occurred only in patients starting with a BIRADS 0 assignment, and thus, the two cohorts that were analyzed consisted of 1,523 patients initially designated BIRADS 0 (npre-RefT = 647; npost-RefT = 876). Comparison of the two cohorts demonstrated that the overall mean interval from abSM to return for additional testing decreased from 23.5 days pre-RefT (median 20, standard deviation [SD]: 21.825, range: 0–256 d) to 8.2 days post-RefT (median 7, SD: 6.987, range: 0–99 d) (P < .001). For patients not requiring a biopsy (n = 1,190), the RefT decreased the mean time from abSM to first diagnostic test/resolution from 29.7 days to 10.77 days (P < .010). For the 333 patients requiring biopsy (npre-RefT = 138; npost-RefT = 195), RefT significantly decreased the mean time from abSM to first diagnostic test from 31.4 days (n = 138,) to 7.7 days (P < .001) and the interval from first diagnostic test to biopsy from 21 days to 17 days (P < .013). There was no difference in the median number of days from biopsy to pathology report (2.44 vs 2.30; P > .05) for pre- vs post-RF.

Conclusions: Reflex testing streamlines the resolution of abSM by allowing for supplementary diagnostic testing and/or biopsy reflexively (by the reading radiologist) without additional written orders from referring physicians. We have demonstrated that this simple initiative significantly decreases patient timelines to resolution of abSM and benefits both subsets of patients not requiring and those requiring biopsies. Implementation of this intervention should be considered in breast center programs wishing to further decrease scheduling times for resolution of abSMs.

Articles in this issue

(P113) Age and Marital Status Are Associated With Choice of Mastectomy in Patients Eligible for Breast Conservation Therapy
(P112) Single-Institution Experience With Intrabeam IORT for Treatment of Early-Stage Breast Cancer
(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management
(P111) Accelerated Partial-Breast Irradiation With Multicatheter High-Dose-Rate Brachytherapy: Feasibility and Results in a Private Practice Cohort
(P115) Breast Cancer Laterality Does Not Influence Overall Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality
(P117) Anatomical Variations and Radiation Technique for Breast Cancer
(P116) Bilateral Immediate DIEP Reconstruction and Postmastectomy Radiotherapy: Experience at a Tertiary Care Institution
(P118) Metadherin Overexpression Is Associated With Improved Locoregional Control After Mastectomy
(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer
(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient
(P121) Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004–2009
(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms
(P123) National Trends in the Local Management of Early-Stage Paget Disease of the Breast
(P124) Effect of Inhomogeneity on Cardiac and Lung Dose in Partial-Breast Irradiation Using HDR Brachytherapy
(P125) Breast Cancer Outcomes With Anthracycline-Based Chemotherapy for Residual Disease Burden After Full-Dose Neoadjuvant Chemotherapy and Surgery Followed by Radiation Treatment
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