Implementing Standardized Ordering Pathways in a Breast Cancer Multidisciplinary Clinic Lifespan Cancer Institute,...

Area of Science:

• Oncology
• Genomics
• Quality Improvement

Background:

• Timeliness of cancer care, particularly from diagnosis to systemic therapy, is a critical quality metric impacting patient outcomes.
• Genomic assays like the 21-gene recurrence score (21-RS) are vital for prognostication and guiding treatment decisions in early-stage, estrogen receptor-positive, HER2-negative breast cancer.
• Significant variations in turnaround time (TAT) for 21-RS reports were observed at the Lifespan Cancer Institute (LCI), delaying care recommendations.

Purpose of the Study:

• To address process variance and identify barriers to efficient and consistent 21-gene RS ordering and tissue send-out.
• To implement a quality improvement project aimed at reducing the TAT for 21-RS reports.
• To enhance multidisciplinary team collaboration for streamlined breast cancer care.

Main Methods:

• Intervention focused on two key steps: 1. Surgeons attaching medical oncologists (MO) to electronic medical record (EMR) pathology reports for immediate notification, and MOs/Breast Cancer Navigators (BCN) ordering 21-RS per guidelines. 2. Pathologists identifying appropriate tissue blocks at sign-out for streamlined processing.
• Data on TAT from surgery to 21-RS ordering and results return were extracted from the 21-RS electronic order database.
• TAT was examined pre-intervention (Jan-Apr 2023, n=69) and post-intervention (Aug-Oct 2023, n=53).

Main Results:

• The average time from surgery to 21-RS order decreased by 6 days, from 16 days pre-intervention to 10 days post-intervention.
• The overall TAT from surgery to 21-RS report return decreased from 27 days to 21 days.
• These results demonstrate a significant improvement in the efficiency of the 21-RS ordering and reporting process.

Conclusions:

• Multidisciplinary collaboration within the LCI Breast Cancer Steering Committee (BCSC) effectively identified care barriers and initiated a successful quality improvement process.
• The established streamlined process for 21-RS orders, including EMR integration and pre-selected tissue, reduced internal processing time by 6 days.
• The project successfully focused on timely, patient-centric care, aiming to reduce patient anxiety through improved efficiency.