Pathway of a Positive Breast Biopsy: Reducing Testing to Treatment Times

Objective: In a suburban community hospital where turnaround times for hormone receptor reports of positive breast biopsies averaged 8 business days, resulting in delayed initiation of treatment, an interdisciplinary breast team led by the breast navigator set out to revise the hormone receptor analysis process to decrease turnaround time by 20%.

Methods: Retrospective and prospective data collection looking at: date of biopsy to report scan date, order date of hormone receptors to report scan date, e-mail notification from outside pathology vendor to scan date, and pathologist review to same-day report scanning. Weekend days were eliminated from all data sets.

Results: During the initial meeting to discuss the project, the interdisciplinary team quickly identified 2 existing barriers to the current pathway: a 2- to 13-day return delivery on pathology slides from outside vendor, and that pathologists were unaware of the web-based results process. Careful data analysis validated the 2 previously identified barriers and did not identify additional barriers. Workflow revisions included improved communication with the outside pathology vendor for overnight slide return when applicable, the addition of e-mail notification from vendor when results are available, increased utilization of a web-based results reporting process, internal modifications of the result-scanning process, and education to the hospital pathologists concerning the process changes. These changes, identified through detailed data collection and interdisciplinary collaboration, yielded a decrease in turnaround time to 4 business days.

Conclusion: As a result of interdisciplinary collaboration, the team achieved a 50% reduction in the number of business days from the time of breast biopsy to availability of hormone receptor results, thus expediting initiation of treatment, decreasing psychosocial distress, and improving patient satisfaction. The team identified the benefit of having a dual role of diagnostic and oncologic navigator who had the ability to identify the issues surrounding turnaround times. This project highlights the importance of nurse navigators and interdisciplinary collaboration and demonstrates how they positively affect healthcare and patient outcomes.