Optimizing Workflow for OncotypeDX Result Turnaround Time at a Safety Net Hospital

The OncotypeDX test for patients with breast cancer with early-stage, hormone-receptor-positive, HER2-negative disease can predict the benefit of adjuvant chemotherapy in addition to hormone therapy. Delivering OncotypeDX results in a timely manner is important to inform treatment decisions. We implemented a strategy to reduce the turnaround time (TAT) from breast surgery to OncotypeDX report at a large urban public safety-net hospital in New York City.

The Plan-Do-Study-Act model was used to implement quality improvement changes. The goal was to improve efficiency to get treatment information for treatment decisions for patients with breast cancer and encourage teamwork with existing resources in the large public hospital. The primary measure was TAT from surgery to receiving OncotypeDX results in the electronic medical record (EMR). We compared TAT before and after the implementation of our strategy. The historical control included patients from May 2021 through March 2022, whereas the timeline after strategy implementation was from June 2023 to February 2024. The strategy involved the creation of a smartphrase in the EMR for breast surgery to identify and order OncotypeDX in eligible patients, and collaboration between breast surgery, pathology, vendor, and medical oncology.

The patient characteristics were similar both before and after implementing the strategy, including patient number (26 vs. 27) and mean age (61 vs. 59 years). Both groups were composed predominantly of ethnic minorities (64% vs. 59%). A higher percentage of patients were from medically underserved areas and populations (MUAs and MUPs) in the group after strategy implementation (35% vs. 44%, p = 0.65). Our strategy reduced the average TAT from 42 to 30 days.

We developed a strategy to optimize the OncotypeDX workflow in a large safety net health system despite an increase in patients from MUAs and MUPs. Initiating ordering of OncotypeDX by breast surgery, along with communication with pathology, vendor, and medical oncology, significantly reduced TAT.