Electronic protocols save time in breast localization procedures

By Amerigo Allegretto, AuntMinnie.com staff writer

September 9, 2021 -- Switching to an electronic protocol process can improve start times for breast localization procedures by almost 10 minutes, according to research published September 7 in Current Problems in Diagnostic Radiology.

A team from Brigham and Women's Hospital in Boston found that using an electronic protocol rather than a paper form significantly reduces the gap between appointment time and procedure start time. This leads to decreased patient anxiety and improved communication among clinical staff members, they said.

"In our busy breast imaging practice, implementation of an electronic protocol process for breast localization procedures instead of a paper protocol process was associated with a sustained and substantial improvement in start times of procedure relative to scheduled appointment time," wrote first author Dr. Arwa Zagha, now at the University of Pennsylvania, and colleagues.

Breast localizations require multidisciplinary coordination between breast imaging and breast surgery. Planning for image-guided interventional procedures has historically been done manually on paper, but previous research has touted that electronic health records and information technology tools can improve operational efficiency and productivity, patient safety, and quality of care.

In the new study, the researchers wanted to see the impact of their own electronic localization protocol on start times of preoperative breast localization procedures at their breast imaging practice. The protocol was embedded within the electronic health record, making it available across interventional sites within the hospital's health system.

The team looked at data from 427 breast procedures prior to the implementation of the electronic protocol, as well as 409 procedures after implementation.

Time savings from electronic protocol process for breast localization procedures
  Paper protocol process Electronic protocol process
Mean time from appointment to beginning of exam 2.7 minutes after appointment 5.6 minutes before appointment
Mean time from beginning and ending of exam 40.5 minutes 45.2 minutes

The 8.3-minute improvement between appointment time and procedure start time was statistically significant (p = 0.001) and was sustainable. The average time for procedure length meanwhile increased by 4.7 minutes (p = 0.001), but the researchers noted that the postimplementation period for the electronic protocol process occurred at the beginning of a new academic year.

"In the first months of the new academic year both residents and fellows require orientation and more intensive training and supervision in breast procedures, and we believe that's likely to account for increased procedure length in our post-implementation period," the authors wrote.

No significant difference was found in the time of patient arrival to appointment time pre- and postimplementation.

While this amount of time savings seems small, the researchers said such an improvement can reduce wait times for anxious patients, as well as improve workflow for technologists and radiologists performing consecutive interventional procedures throughout the day. It could also be used in large academic centers for trainees rotating on and off clinical services.

"While not directly measured in our study, we would also anticipate reduced error and miscommunication from the electronic workflow, as has been demonstrated by other authors," co-author Dr. Catherine Giess told AuntMinnie.com.

Future analysis of a larger sample size after sustained implementation of the model will show more meaningful results, Zaghal said. Giess added that the hospital is building on this work to improve the operational efficiency of its breast imaging center.

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