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In December 1999, the administration at Grant/ Riverside Methodist Hospitals in Columbus, OH, launched a benchmark study to determine how long it took for a woman diagnosed with a breast abnormality to find out if she had breast cancer. Administrators determined that it took an average of 27 days, better than the national average of 42 days, but far below the gold-standard programs around the country that took 24 hours to five working days.
While a short delay in diagnosis does not change the medical outcome, it does create emotional stress for women. In one study, women rated the amount of stress at this time as a 14 on a scale of 15, says Patti Dunn, RN, BSN, OCN, director of breast health services at Grant/Riverside.
To remedy the situation, Dunn was asked to oversee the process and create a system that coordinated care across the continuum to better meet the needs of women with breast health problems. Critical to the success of the program are the trained breast health specialists who are located in the diagnostic imaging areas of the health care system. Those specialists were certified through a program called Educare, based in Columbia, SC.
When a woman is referred for a diagnostic mammogram, she is introduced to a breast health specialist who provides education, support, and guidance. "The radiologist gives the woman the results of the diagnostic mammogram at the time of the appointment, and the breast health specialist helps her understand what she has been told and helps her with the next step," says Dunn. The specialist may contact the referring physician, ask what surgeon he wants his patient to see, and provide her with materials and instruction on biopsies.
Through the continuum of care, the breast health specialist case manages the patient. If she has cancer, the relationship continues with the breast health specialist providing information on the surgical choices, pre- and post-op teaching, and acting as a bridge between such specialists as the radiation oncologist and plastic surgeon.
Breast health services can be quite fragmented, says Dunn. Usually, a woman must wait days for a mammogram if she finds a lump, and several more days to hear from her physician. If the doctor wants her to visit a surgeon to determine if the lump should have a biopsy, more time is involved and then she must wait for the laboratory report. If the diagnosis is cancer, she sees the surgeon again and then perhaps a medical oncologist, radiation oncologist, and then a plastic surgeon.
"A woman, in a difficult time of her life when she is under emotional and physical stress, is trying to navigate this complex system going from one physician to the next; and none of the care is coordinated, and the physicians aren’t communicating well with each other. The breast health specialist is a critical component of coordinating care," explains Dunn. With a breast health specialist overseeing the whole process, the detection-to-diagnosis rate has dropped from 27 days to 12 days, she adds.
At the start of the process of forming a cohesive program across the continuum of care, Dunn formed several work teams in the various departments including radiology, cancer services, and home care to help determine what is best for patients and help each see the broad spectrum of care. While the existing program was comprehensive and just needed to be coordinated, there were a few gaps identified that value-added services could fill.
One service was providing a way for a woman to get a second opinion if she chose to have one. Although she could contact another health care facility, a second opinion clinic was created to make it convenient. At this clinic, a woman can meet with a multidisciplinary team who reviews her mammograms and pathology report and gives their opinion for the best plan of care. It is an option available to women who want a second opinion before determining a treatment plan.
A second value-added service is the pretreatment planning conference that takes place before a new breast cancer patient receives treatment. At the conference, a multidisciplinary team of specialists, including a radiologist, pathologist, radiation oncologist, and surgeon, reviews each new case of breast cancer and recommends a plan of care. "It is very valuable, because it starts getting everyone collaborating and coordinating upfront instead of the previous way where a woman went from one physician to another in a vacuum," says Dunn.
Another program improvement has been the standardization of all patient education material. A team gathered and reviewed all the educational materials used across the continuum of care and is selecting literature that will be used in all departments. Gaps in educational materials also were identified and are being developed.
"Our goal is to achieve a better delivery of breast cancer care for our patients, which is more coordinated, more customer service-oriented, and customized to meet their needs. Care is expedited for them and they have the support and education throughout so they aren’t navigating a very complex health care system on their own. Hopefully, it will provide them with a better experience," explains Dunn.
[For more information about the comprehensive breast health care program at Grant/Riverside Methodist Hospitals, contact:
• Patti Dunn, RN, BSN, OCN, Director of Breast Health Services, Grant/Riverside Methodist Hospitals, 274 E. Towne St., Columbus, OH 43215. Telephone: (614) 566-0595. E-mail: email@example.com.]