Potential to Improve Patient Care Through Identifying Inefficiencies

• Recommendations and current evidence to inform and encourage improved surgical timeliness to care and adjuvant therapy after initial biopsy

• Recommendations relative to process and efficiency improvements for breast needle localizations followed by surgeries

• Recommendations for reduction in outmigration

The Leica Biosystems team conducted a three day on site visit to the breast center and found several opportunities for improvement.

Potential to improve efficiencies from biopsy to surgery

Use of needle localizations was a cumbersome process and was identified to cause delay in surgery. Earlier start times for needle localizations were instituted. The team should explore, pilot, and record any efficiencies from the move of the use of needle localizations to the magnetic seed to see if there is improvement in surgical timeliness.

Potential to improve efficiencies from surgery to adjuvant therapy

Oncotype Dx testing: The test is intended for use in all newly diagnosed patients with early-stage (stage I, II or IIIa), breast cancer who have node-negative or node-positive (1-3), estrogen receptor-positive (ER+),  HER2 -negative disease, and with DCIS for determination of appropriate therapy. The test can be run on a post-lumpectomy tumor sample or on a core biopsy. Oncotype Dx should be ordered by the breast surgeon so it does not delay further treatment. Turnaround time for the test is approximately two weeks.

Program Promotion

The Leica Biosystems team recommends this facility should display banners or information regarding the CoC accreditation, NAPBC accreditation and Center of Excellence awards.

Projected Outcomes include:

• Decrease in the number of days from biopsy to initial surgery – currently at 31 days.
• Decrease in the number of days from biopsy to adjuvant therapy – currently at 68–77 days.
• Reduction of the outmigration percentage – currently at 19.3%.