McKevitt Elaine C, Dingee Carol K, Leung Sher-Ping, Brown Carl J, Van Laeken Nancy Y, Lee Richard, Kuusk Urve
Surgery, Providence Health Care.
Mt. St Joseph Hospital, University of British Columbia Vancouver.
Cureus. 2017 Dec 7;9(12):e1919. doi: 10.7759/cureus.1919.
Introduction Diagnostic delays for breast problems is a current concern in British Columbia and diagnostic pathways for breast cancer are currently under review. Breast centres have been introduced in Europe and reported to facilitate diagnosis and treatment. Guidelines for breast centers are outlined by the European Society for Mastology (EUSOMA). A Rapid Access Breast Clinic (RABC) was developed at our hospital applying the concept of triple evaluation for all patients and navigation between clinicians and radiologists. We hypothesize that the Rapid Access Breast Clinic will decrease wait times to diagnosis and minimize duplication of services compared to usual care. Methods A retrospective review was undertaken looking at diagnostic wait times and the number of diagnostic centres involved for consecutive patients seen by breast surgeons with diagnostic workups performed either in the traditional system (TS) or the RABC. Only patients presenting with a new breast problem were included in the study. Results Patients seen at the RABC had a decreased time to surgical consultation (33 vs 86 days, p<0.0001) for both malignant (36 vs 59 days, p=0.0007) and benign diagnoses (31 vs 95 days, p<0.0001). Furthermore, 13% of the patients referred to the surgeon in the TS without a diagnosis were eventually diagnosed with a malignancy and waited a mean of 84 days for initial surgical assessment. Of the patients seen at the RABC, 5% required investigation at more than one institution compared to 39% patients seen in the TS (p<0.0001). Cancer patients had a shorter time from presentation to surgery in the RABC (64 vs 92 days, p=0.009). Conclusion The establishment of the RABC has significantly reduced the time to surgical consultation, time to breast cancer surgery, and duplication of investigations for patients with benign and malignant breast complaints. It is feasible to introduce a EUSOMA-based breast clinic in the Canadian Health Care System and improvements in diagnostic wait times are seen. We recommend the expansion of coordinated care to other sites.
引言 乳腺疾病的诊断延迟是不列颠哥伦比亚省当前关注的问题，目前乳腺癌的诊断途径正在接受审查。欧洲已引入乳腺中心，据报道其有助于诊断和治疗。欧洲乳腺病学会（EUSOMA）概述了乳腺中心的指南。我们医院设立了快速乳腺诊疗门诊（RABC），对所有患者采用三联评估概念，并在临床医生和放射科医生之间进行协调。我们假设，与常规护理相比，快速乳腺诊疗门诊将减少诊断等待时间，并最大限度减少服务重复。方法 进行回顾性研究，观察乳腺外科医生接诊的连续患者在传统系统（TS）或快速乳腺诊疗门诊进行诊断性检查时的诊断等待时间以及涉及的诊断中心数量。仅纳入出现新乳腺问题的患者。结果 在快速乳腺诊疗门诊就诊的患者，无论是恶性（36天对59天，p = 0.0007）还是良性诊断（31天对95天，p < 0.0001），手术咨询时间均缩短（33天对86天，p < 0.0001）。此外，在传统系统中未确诊就转诊给外科医生的患者中，13%最终被诊断为恶性肿瘤，平均等待84天进行首次手术评估。在快速乳腺诊疗门诊就诊的患者中，5%需要在多个机构进行检查，而在传统系统中就诊的患者这一比例为39%（p < 0.0001）。癌症患者在快速乳腺诊疗门诊从就诊到手术的时间更短（64天对92天，p = 0.009）。结论 快速乳腺诊疗门诊的设立显著缩短了手术咨询时间、乳腺癌手术时间，以及良性和恶性乳腺疾病患者的检查重复情况。在加拿大医疗保健系统中引入基于EUSOMA的乳腺诊疗门诊是可行的，且诊断等待时间有所改善。我们建议将协调护理扩展到其他地区。
