The Breast Imaging Nurse Navigator: Measuring the Impact on Coordinated Care Delivery – Results After the First Year

Objectives: Access, timeliness, patient satisfaction, and outmigration for breast care delivery were all identified as areas for process improvements in our community hospital breast center. In 2015, a dedicated imaging nurse navigator was added to our interdisciplinary breast team. The imaging nurse navigator would develop and define navigation, assessing barriers for access, improving timeliness, decreasing outmigration, and empowering and advocating for breast care that is patient centered and evidenced based. The imaging nurse navigator developed survivorship education and programming targeting adopting healthy lifestyle behaviors, cancer prevention, and decreasing cancer recurrence.

Methods: The dedicated imaging nurse navigator began seeing and tracking all patients January 2015 through December 2015. Patients were navigated and a diagnostic plan of care was completed for follow-up referrals to a dedicated breast specialist. The breast program leadership established the time from abnormal imaging to biopsy as 7 days. The imaging nurse navigator would impact outmigration by coordinating surgical consults within 48 hours. The imaging nurse navigator would develop survivorship programming through education and exercise.

Results: The imaging nurse navigator has been integral in impacting access, timeliness, and satisfaction with breast care delivery. Reduction in time from abnormal breast finding to biopsy decreased from 26 days in 2014 to 11 days. The imaging nurse navigator improved outmigration in 2015, from 5% to 1% of patients after 12 months. Navigational intervention at the point of an abnormal finding with breast imaging has resulted in increased patient volumes. The navigator has shown 234 additional cases in 2015 for breast care follow-up, referrals, and breast biopsies. Imaging nurse navigation has resulted in monthly increases in patient volumes that significantly impact overall financial increases attributed to navigational care. The imaging nurse navigator coordinated referral to the breast specialist targeting the 48-hour benchmark, showing significant improvement in access and increase in volumes across program breast specialty providers. Same-day referrals occurred in 38% of patients compared with 4% in 2014. Additional benefits of having a nurse navigator resulted in development of survivorship programming; a preoperative Breast Cancer 101 class, an Integrative Survivorship Journal Club, and Ready SET GO_Survivors Exercising Together, providing navigational support across an ongoing care continuum.

Conclusions: Implementation of the imaging nurse navigator role has helped remove barriers for breast care delivery surrounding access, timeliness, volumes, and outmigration. The imaging nurse navigator has been shown to be integral to breast care delivery improving patient and provider satisfaction and increasing financial success of the breast program.