Improving Patient Flow and Timeliness in the Diagnosis and Management of Breast Abnormalities: The Impact of a Rapid Diagnostic Unit

Abstract

Background Efforts to streamline the diagnosis and treatment of breast abnormalities are necessary to limit

Budget Impact Analysis of a Breast Rapid Diagnostic Unit

“…Arnaout et al 6 described the experience with their Rapid Diagnosis and Support breast clinic initiative. As at our institution, their new clinical model significantly lowered diagnostic wait times while improving patient satisfaction 6,10 . However, the only costs they reported were the incremental nursing salary ($20,731) and the increased cost for the required radiology technologist time and equipment after the addition of 10 biopsy days ($6100) 6 .…”

“…The annual costs for achieving a diagnosis can range from $136,080 to $702,675, depending on institutional case mix (based on our maximal capacity of 405 cases annually). The rdu has been shown to lower patient wait times to definitive diagnosis-a result achieved by changing system-level processes 10 . Similarly, at other institutions, the cost of streamlining and expediting the diagnostic journey has shown to be a valuable investment, reducing delays in breast cancer diagnosis 20,21 .…”

“…The most costly diagnostic scenario for an individual patient occurs when, in addition to the standard tests, requirements extend to bilateral breast ultrasonography, additional mammographic cone views, repeat or bilateral breast biopsies, a fine-needle aspirate of a suspicious lymph node for cytology analysis, fluorescence in situ hybridization for biomarkers to resolve equivocal immunohistochemistry results, and repeat surgical assessment (additional required visit). Our previous work showed that approximately 30% of rdu patients with invasive breast carcinoma require fluorescence in situ hybridization analysis 10 . Approximately 10% of patients require more than 1 core biopsy, and fewer than one quarter of referred patients require fine-needle aspiration to achieve a diagnosis 10 .…”

“…Our previous work showed that approximately 30% of rdu patients with invasive breast carcinoma require fluorescence in situ hybridization analysis 10 . Approximately 10% of patients require more than 1 core biopsy, and fewer than one quarter of referred patients require fine-needle aspiration to achieve a diagnosis 10 .…”

“…The rdu primarily made use of the pre-existing physical infrastructure at our institution (for example, clinical space and diagnostic equipment), but changed the process and philosophy, enabling us to significantly lower the wait time to a definitive diagnosis 10 . Moreover, the addition of support staff allowed the diagnostic process to be streamlined as illustrated in Figure 1.…”