Finding a suspicious lump in your breast is disconcerting. Waiting to meet with a health-care provider for the diagnosis and treatment of the lump can be even more nerve-racking.
“The diagnostic period is highly stressful for women,” says Dr. May Lynn Quan, co-medical lead, Provincial Breast Health Initiative.
That’s why expediting diagnostic assessment is one of the key areas addressed by the Provincial Breast Health Initiative. Set in motion by the AHS Cancer Strategic Clinical Network (SCN) in October 2016, the initiative began with a provincial stakeholder meeting — with patients, surgeons, oncologists, radiologists, nurses, primary care physicians and support staff — to review every aspect of a breast cancer patient’s journey and find ways to improve it. Stakeholders included many committed and knowledgeable partners within AHS, but also outside of AHS, too. From that meeting, a number of goals were identified along the pathway, including shortening wait times to diagnosis and increasing recovery options after surgery.
Following that initial meeting, the Provincial Breast Health Initiative kicked off across Alberta with the goal of implementing best practices to improve the way care is delivered to women and their families.
One of the new practices involves simultaneously notifying a patient’s family physician and the breast health program as soon as that patient receives a recommendation from a radiologist to undergo a biopsy.
“By notifying the breast health program at the time a biopsy is recommended, an appointment can be booked shortly after the biopsy is done,” says Quan. This allows for expedited surgical consults for patients with highly suspicious breast lesions.
As part of the initiative, a breast health nurse coordinates the appointment and is also available to offer emotional support and answer questions. Once the appointment for the surgical consultation has been made, a notification is sent to all parties.
“The new diagnostic pathway was implemented in Calgary and Edmonton, and shortened wait time from biopsy recommendation to surgical consult from 19 days to six days,” says Angela Estey, executive director of the Cancer SCN. “There’s a lot of anxiety during that wait time so it made a real difference in improving access.”
Another major element of the initiative is implementing same-day mastectomies. “Most patients with breast cancer go on to have surgery,” explains Quan. “The initiative aimed to improve the quality of recovery, allowing women to go home the same day as a mastectomy. Returning home on the same day is safe and well-accepted. Our research shows that patients were very comfortable recovering at home.”
Through the support of Alberta Cancer Foundation donors, new educational materials were created to ensure patients and their families were well-informed before and after the surgery to safely recover at home. “Educational materials have been standardized for breast surgery so patients, wherever they are in Alberta, can access all the information on myhealth.alberta.ca,” says Estey.
The number of mastectomy patients who return home on the same day as surgery has increased from five per cent in 2014/15 to 54 per cent today. At-home recovery also has the added benefit of opening up hospital beds for others in need.
The Provincial Breast Health Initiative has also introduced a new data collection process to improve outcomes for future patients. This measurement system was developed to measure and track the initiative’s progress to continually improve the care that breast cancer patients receive. The data is collected and reported on a dashboard for administrators, funders and health-care providers to review and see what’s working and what may need improvement.
“The fundamental component is that we have a way to measure to ensure that we’re making a positive difference,” says Quan. “It’s ongoing, so data will continue to be reported, and centres can continue to make progress.”
Earlier this year, the Provincial Breast Health Initiative received a 2019 AHS President’s Excellence Award for quality improvement. These awards are given to AHS programs and people that demonstrate the highest standards in innovation, collaboration and patient-centred care.
“The success of this initiative really has been the involvement of many patients, administrators, clinicians and front-line staff,” says Quan. “It was a massive provincial undertaking, but we showed it can be done.”
Ultimately, the learnings from this initiative could be applied to other types of cancer patients, too.
“We’re hoping that what we’re doing can be exported to other cancers and improve the journey for all cancers,” says Quan.
By the Numbers: Improvements Made Through the Provincial Breast Health Initiative
Wait time (between suspicious imaging and surgical consult referral) down 60 per cent from 19 days in 2016 to 6 days in 2018
Of patients satisfied with information received
5% to 54%
Percentage of mastectomies performed as day surgeries increased from 5 per cent in 2014/15 to 54 per cent today
Hospital bed days per year released
Estimated savings in patient care