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Comprehensive breast center boosts process of care for reconstruction patients

Article-Comprehensive breast center boosts process of care for reconstruction patients

Recently released results of a new study suggest that the integration of breast-cancer care facilities with breast-reconstruction centers improves process of care.

“Processes outcomes for breast reconstruction—related to access, efficiency and sustainability—have not been well described,” write the authors, all Columbus, Ohio, plastic surgeons and colleagues in the division of surgical oncology at The Ohio State University. “These processes are likely to be impacted by the centralization of breast-cancer care into comprehensive breast centers.”

The objectives of the study, which focuses on the comprehensive breast center (CBC) the surgeons opened in their Columbus-area hospital, were to define measures for breast-reconstruction processes of care and determine a breast center’s effect on these measures.

The study involved all patients evaluated for postmastectomy breast reconstruction between 2009 and 2013, which was from two years before to two years after the CBC opened. The authors reviewed and compared all consultation, surgical and financial data from the two periods. A total of 614 patients and 750 patients were treated before and after, respectively, the authors opened their CBC.

Between the two periods, the internal referral rate for postmastectomy reconstruction increased from 27.1 percent to 46 percent. The delay between surgical oncology and plastic-surgery consultation decreased from 10.5 days to 3.6 days, as did the delays between plastic-surgery consultation and surgery for both autologous (from 45.1 to 32.6 days) and implant-based reconstruction (from 34.9 to 25.5 days). Finally, the immediate breast-reconstruction rate increased from 40.1 percent to 52.7 percent, including autologous reconstruction (from 13.1 percent to 20.8 percent).

“Access to breast reconstruction at our institution improved significantly after our CBC opened, with significant increases in internal referral rates and immediate reconstruction rates,” the authors write.

In transitioning their facility, the authors employed a strategy that included the following, as described in their study:

  • Created a clinic schedule whereby a plastic surgeon conducted a breast-reconstruction clinic every day a breast-surgical oncology clinic occurred.
  • Scheduled all breast reconstruction in afternoon blocks, with the majority of new patient slotted later, to maximize the number of new consultations with patients that were seen by surgical oncologists earlier in the day.
  • If a surgical oncologist requested a same-day consultation, an immediate phone call between clinics was made to initiate timely staffing adjustments.
  • Clinic schedules were designed such that new consultations—including same-day—could be evaluated by the plastic surgeon, whereas mid-level practitioners and nurses concurrently performed other clinic activities.
  • If a same-day consultation was requested but not feasible, the patient was scheduled with another plastic surgeon based on assessment of next available surgery dates compatible with the surgical oncologist.

The study appears in the November 2014 issue of Plastic and Reconstructive Surgery.

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