Streamlined screening cuts wait times

Jennifer Crump

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Ontario program has breast cancer patients going from mammography to biopsy in one day

SAULT SAINT MARIE, ONT. – Physicians here are behind an initiative that has reduced the waiting times for a definitive diagnosis of breast cancer from 107 days to an enviable 18 days.
   A unique collaboration between physicians, specialists, the hospital and public health authorities has led to the creation of the Algoma Breast Health Program (ABHP). What makes their success even more remarkable is that Algoma also boasts the highest recruitment rate for breast screening in the province—easily meeting the 70% goal of the Ontario breast-screening program.
   The high recruitment rate is directly related to the streamlined diagnostic procedures. Dr. Robert D'Ovidio, chief radiologist and medical director for the Algoma Breast Health Program, said the success of the program says a lot about the people involved. Co-operation and the best interests of patient care have taken precedence over personal or professional agendas.
   The system, created by the ABHP, offers a streamlined delivery of service. Patients of screening age can call a central number and come directly in for a mammogram, and patients of non-screening age are referred directly through their physicians. The doctors have agreed not to have the patients return to them prior to taking the next step in obtaining a diagnosis, although they are kept in the loop throughout the process.
   Radiologists have been given the green light to order further testing, including biopsies, without returning the patient to their GP first.
   "There is no ping-ponging of the patient between physician and specialist," said Joe DiAngelo, head of radiology at Sault Area Hospitals. "We can often go from mammography to biopsy in one day."
   A large part of the success of the program is due to its organizational innovations. Incoming patients are triaged. Asymptomatic patients are sent to the group health centre for initial tests, while symptomatic patients are sent directly to Sault Area Hospitals.
   A second, vital innovation is the centralizing of imaging data. Patient history and images are kept a single library and an organized delivery service ensures specialists get immediate access to the distinctive bright pink files. "We no longer have to make 15 calls to track down our histories," said DiAngelo.
   Teamwork, said Dr. D'Ovidio, is the key to the program's success. "People are doing what they should be doing and that is what makes a system efficient."
   Dr. Pat Avery, a general practitioner and the GP representative for the Algoma Breast Health Program agreed. "Our resources are limited so we work together to make things better for the patient. There is no ego-tripping." She added, "The anxiety level of my patients has dropped. It benefits us, it benefits them."
   Dr. Avery is now working on ways of integrating a similar system for PAP screening.
   In the meantime, the Algoma Breast Health Program has recently hired a co-ordinator and Dr. D'Ovidio said staff are hard at work on phase two, which will involve specialists providing streamlined treatment for breast cancer patients, possibly using a clinic system.
   "We believe (this model) could potentially work for other types of diseases processes," he added.