Background: Genetic testing has become an important component to determining treatment options. Once ordered, the process involves multiple parties, leading to inefficiencies and potentially a delay in results. This “genetic maze” was identified as an opportunity to streamline the process, allowing for a more consistent workflow with genetic testing.
Objectives: Global aim: Standardize the genetic testing process to create formalized and consistent method once genetic testing is ordered. Specific aim: Decrease turnaround time for test results to avoid delay in care.
Methods: Assessment (current state): Genetic testing ordered and processed by MD nurse. Return fax sent at random requesting additional information before starting genetic testing placed in MD folder to be addressed. Timeliness of response to fax was dependent on provider/MD nurse availability. This process was identified as lacking consistency, which ultimately led to a delay in turnaround time (ie, follow-up appointment being pushed out the day prior to follow-up appointment due to no test results). Process improvements: (1) Created a genetic testing tracking log and checklist allowing for streamlined communication on all genetic tests ordered to avoid delay in process when provider/MD nurse unavailable; (2) Identified point person with each genetic testing company to help expedite process and have regular communication regarding next steps and necessary documentation needed to begin testing; (3) Created genetic testing resource binder outlining steps for completing and submitting REQ form and included patient education material on genetic testing.
Results: Collected data on total number of days for test results (date test was ordered to date when test results were reported to provider), which showed the turnaround time for test results was quicker by 4 days. Before implementation (baseline period: December 2016-March 2017, average number of days for test results was 17 days. Longest time: 30 days; shortest time: 8 days. After implementation (April-July 2017): average number of days for test results was 13 days. Longest time: 21 days; shortest time: 6 days. New current state: All genetic tests ordered are logged into genetic testing spreadsheet for tracking purposes. Nurse navigator notified of genetic test orders to ensure streamlined communication and efficient process. Nurse navigator designated as “assigned delegate” for online portal to expedite access to timely results. Communication pathway created for genetic test results prior to breast surgery to ensure efficient and consistent communication process with interdisciplinary team.
Conclusion: The process with genetic testing has improved after changes were implemented. Limitations: PI focused on BRCA testing only during 8-month period. We have since expanded to track other driver mutations as well as genomic testing. Future work: recollect data and compare after implementation time frame to determine if access to online portal provides additional decrease in turnaround time as this was implemented after initial PI data collected.
