McKevitt E C, Dingee C K, Warburton R, Pao J S, Brown C J, Wilson C, Kuusk U
Department of Surgery, Providence Health Care.
Department of Surgery, University of British Columbia.
Curr Oncol. 2017 Oct;24(5):e388-e393. doi: 10.3747/co.24.3767. Epub 2017 Oct 25.
In 2009, a Rapid Access Breast Clinic (rabc) was opened at our urban hospital. Compared with the traditional system (ts), the navigated care through the clinic was associated with a significantly shorter time to surgical consultation. Since 2009, many radiology facilities have introduced facilitated-care pathways for patients with breast pathology. Our objective was to determine if that change in diagnostic imaging pathways had eliminated the advantage in time to care previously shown for the rabc.
All patients seen in the rabc and the office-based ts in November-December 2012 were included in the analysis. A retrospective chart review tabulated demographic, surgeon, pathology, and radiologic data, including time intervals to care for all patients. The results were compared with data from 2009.
In 2012, time from presentation to surgical consultation was less for the rabc group than for the ts group (36 days vs. 73 days, < 0.001) for both malignant (31 days vs. 55 days, = 0.008) and benign diagnoses (43 days vs. 79 days, < 0.001). Comparing the 2012 results with results from 2009, a decline in mean wait time was observed for the ts group (86 days vs. 73 days, = 0.02). Compared with patients having investigations in the ts, rabc patients with cancer were more likely to undergo surgery within 60 days of presentation (33% vs. 15%, = 0.04).
The coordination of radiology and clinical care reduces wait times for diagnosis and surgery in breast cancer. To achieve recommended targets, we recommend implementation of more systematic coordination of care for a breast cancer diagnosis and of navigation to surgeons for patients needing surgical care.
2009年，我们城市医院开设了一家快速通道乳腺诊所（rabc）。与传统系统（ts）相比，通过该诊所的导航式护理与显著缩短的手术咨询时间相关。自2009年以来，许多放射科设施为乳腺疾病患者引入了便捷护理途径。我们的目的是确定诊断成像途径的这种变化是否消除了先前rabc所显示的护理时间优势。
2012年11月至12月在rabc和基于办公室的ts中就诊的所有患者均纳入分析。回顾性病历审查列出了人口统计学、外科医生、病理学和放射学数据，包括所有患者的护理时间间隔。将结果与2009年的数据进行比较。
2012年，rabc组从就诊到手术咨询的时间比ts组短（36天对73天，<0.001），无论是恶性诊断（31天对55天，=0.008）还是良性诊断（43天对79天，<0.001）。将2012年的结果与2009年的结果进行比较，ts组的平均等待时间有所下降（86天对73天，=0.02）。与在ts进行检查的患者相比，rabc的癌症患者更有可能在就诊后60天内接受手术（33%对15%，=0.04）。
放射学与临床护理的协调减少了乳腺癌诊断和手术的等待时间。为了达到推荐目标，我们建议对乳腺癌诊断实施更系统的护理协调，并为需要手术护理的患者提供导航至外科医生的服务。
