Impact of a High-Priority Scheduling Guideline on Diagnostic Breast Imaging Timeliness Across a Multisite System

Delays in access to diagnostic imaging may postpone breast cancer diagnosis, particularly for patients with symptoms concerning for malignancy. Following a safety event analysis, our multisite health care system implemented a standardized scheduling guideline in August 2024 requiring completion of high-priority diagnostic breast imaging within 3 weeks of order placement. This study evaluated the impact of the guideline on diagnostic imaging timeliness.

This quality improvement study included diagnostic breast imaging examinations performed during preimplementation (August 1, 2023-July 31, 2024) and postimplementation (October 1, 2024-September 30, 2025) periods. High-priority indications included new breast or axillary mass, new nipple changes or unilateral nipple discharge, new skin dimpling or indentation, and new symptoms during active breast cancer treatment. The primary outcome was completion within 3 weeks of order placement. Comparisons of completion rates and time to completion between groups were performed using two-proportion z tests and Mann-Whitney U tests, respectively.

A total of 70,823 examinations were included (34,101 preimplementation; 36,722 postimplementation), including 7,224 high-priority postimplementation examinations (19.7%). Completion within 3 weeks improved from 57.4% (19,559/34,101) preimplementation to 65.3% (23,987/36,722) postimplementation (p<0.001), with median time to completion decreasing from 18 to 14 days (p<0.001). Before implementation, symptomatic examinations had lower 3-week completion than asymptomatic examinations (49.5% vs 61.3%, p<0.001). After implementation, high-priority examinations demonstrated higher 3-week completion than preimplementation symptomatic examinations (61.1% vs 49.5%, p<0.001).

Implementation of a standardized high-priority scheduling guideline improved timeliness of diagnostic breast imaging across a multisite health care system, particularly for patients with concerning symptoms.