Breast care center finds success with same-day service

After 16 years of remarkable growth and evolution, the Center for Breast Care in Boca Raton, FL, was in trouble, despite performing 44,000 exams per year. Patient and employee satisfaction was at an all-time low, even though 150 patients were examined daily.

Services included digital screening and diagnostic mammography, ultrasound, MRI, bone densitometry, and biopsy. But a patient could not schedule a screening mammogram for five months, and callbacks from batch read screening exams could not be scheduled for six weeks. As a result, many patients left the center to have their evaluations done elsewhere.

Larraine Chrystal, a nurse practitioner with a background in women’s imaging who joined the team as director, proposed an answer. She evaluated the situation and found that what women really want is same-day evaluation and reporting of all their exams. The center followed her advice.

Suspicious findings on screening mammography are now evaluated the same day, and patients receive a report before they leave the center. In addition to implementing same-day evaluations, two satellite screening centers were opened to diminish the overload at the main site.

By staffing each of the four digital mammography units at the main center with two mammography technologists, patients are scheduled every 15 minutes from 7 a.m. to 4:15 p.m., permitting the evaluation of 120 patients per day. Following image acquisition, the mammography technologist presents each case individually to one of two mammographers. Patients with negative results can schedule their next appointment prior to leaving the center.

Women who need additional imaging stay until their studies are performed and a diagnosis with follow-up recommendations is made. Should a patient require biopsy, one of two nurse navigators notifies her referring physician, receives a faxed prescription, and makes the appointment for biopsy. Diagnostic and screening mammograms can now be scheduled the same day within our system, a dramatic change from three years ago.

SPECIALISTS

In another significant change, several breast health specialists with advanced degrees were hired, such as advanced registered nurse practitioner and physician assistant. These specialists offer a focused clinical breast exam to any woman requesting one. As nearly 45% of our screening patients are selfreferred, we thought this service would be a welcome one for our patients, and we would ultimately find more cancers and reduce our liability.

Our BI-RADS 4 and 5 patients are seen by our clinical staff, which includes Dr. Louise Morrell, a medical oncologist who specializes in genetics and risk assessment. This approach assists us in keeping patients within our system, from performing of the biopsy until the diagnosis of cancer is made. At that point, we schedule the patient for an MRI, schedule her case for our weekly multimodality conference, and refer her to a surgeon.

Our primary care physicians have welcomed this flow pattern, knowing their patients will be shepherded through the system in a consistent and secure fashion. As many mammographers feel overwhelmed with the “primary care” demands of the mammography population, these breast health specialists welcome the business and are very well-suited to provide clinical information for patients at all phases of a woman’s life. These professionals also contribute to the financial success of the comprehensive breast center.

Research and education have been a growing component of our center for many years. We have participated in the early evaluation of many breast imaging products, including iCAD’s computer-aided detection mammography system; DynaCAD, an MRI CAD system; Naviscan’s PEM; and U-Systems’ automated ultrasound. We have found that in this financial climate, with limited capital for equipment purchases, research gives us an opportunity to work with the latest technologies in return for providing clinical data to our vendors. The women in our community have been very willing to participate in clinical trials.

We have been able to acquire new equipment as well thanks to a close relationship with the Boca Raton Community Hospital Foundation. Through the “Go Pink Challenge” fundraising effort for the Center for Breast Care, the foundation has been able to raise enough money in the past two years to purchase a new breast ultrasound machine as well as a positron emission mammography unit. We recently took ownership of a new digital mammography mobile screening van. We have accomplished this through local fundraising events, the largest occurring every October, with smaller events in local communities throughout the year.

As we have become early adopters of new technology, we have taken advantage of our professional experience and developed an educational program to teach visiting physicians the interpretive process of breast MRI. These courses are CMEapproved for category 1 credits. Our fellows spend three and a half days with us and actively read MRI cases with one of eight mammographers. They also review 100 teaching file cases, which include dictated reports for all imaging modalities and pathologies. MRI biopsy techniques are taught, and the fellows attend our weekly tumor board. Fellows are also given the opportunity to view percutaneous procedures and to discuss additional breast center issues with our director.

It is our goal at this time to evolve into the Women’s Institute of Health and Wellness. We are currently seeing more than 60,000 women annually. We know that, although their greatest fear is developing breast cancer, they are much more likely to suffer from some other major illness, such as cardiac disease or lung or colon cancer. If we could identify the specific health risk for each of these women using a brief questionnaire, we could refer them to our clinical staff for further evaluation and appropriate screening studies.

By offering these added services to our patients, we hope to build their confidence in our hospital system. If we succeed, the Women’s Institute will become a gateway to the hospital, and the women we serve today will turn to us for healthcare services for all members of their family. We see this as a new day for the mammographer and the breast care center.