Improving Timeliness of Pathology Reporting in the Community Hospital Setting Through Evaluation and Navigating Change

November 2019 Vol 10, No 11
Danielle Brown, RN, BSN, OCN, CN-BN, ONN-CG
Sarah Cannon
Sania Richards, RN, BSN, ONS
Sarah Cannon

Background: Waiting for diagnosis for more than a week can increase anxiety and uncertainty for patients and families because a cancer diagnosis is viewed as a threat to future health and life.1 Pathology results allow patients to move forward with treatment discussions and decisions sooner. According to the College of American Pathologist (CAP), timely pathology reports are one of the most important tools physicians use to adequately manage the quality and safety of patient care. The National Cancer Institute reported in 2010 that pathologists send pathology reports to physicians within 10 days after biopsy or surgery is performed. In reviewing the National Accreditation Program for Breast Centers (NAPBC) in 2017, the benchmark for a breast pathology report is no more than 2 days. CAP also requires the turnaround time for any biopsies at a maximum of 2 business days. Establishing an Oncology Nurse Navigation Program in the community hospital setting raised awareness of delays in patient care due to untimely pathology results. Institutional data were collected and analyzed by navigator and division leaders to identify ways to improve turnaround time.

Objectives: Navigator tracked pathology turnaround time in 2 local facilities (one 221 beds and the other 65 beds), as they share a pathology department, to improve timeliness to care. A timeline of 6 months was used to observe, identify, and address delays, improving timeliness by at least 4 days by June 1, 2019. The goal in doing so was to educate, raise awareness, and have timely pathology that allows for an earlier navigation touchpoint with the patient and healthcare team.

Methods: Systemic review of facilities’ pathology time of reporting and quantitative research (date of surgery/biopsy to date of results input into a manually tracked spreadsheet) were used. Navigator worked with leadership to identify root causes of the issue to improve pathology processing time and raised awareness of identified barriers to timely diagnosis. Directors met in person with facility leadership at both facilities, including the CEOs, CNOs, pathologist, and director of pathology, and also at the division and corporate level and IT monthly with timeliness noted from spreadsheet.

Results: Identified barriers, which included 1 pathologist used for 2 hospitals, cases being sent to academic center across the country for second review, courier service delays, pathologist grossing in-house then sending 2 hours away for blocks to be made, lack of knowledge related to markers/staining needed to proceed, and lack of general facility–led protocols for timely processing. Data at the 4-month mark have shown one facility’s average time to confirm diagnosis improved from 12 days to 4.5 days, and from 5 days to 3.16 days for the second facility.

Conclusion: Verifying pathology reports in a timely manner helps healthcare teams with earlier diagnosis and more effective treatment planning.2 Working with facility leadership to identify potential delays in processing and to implement best practices improved timeliness by 7.5 and 1.8 days, helping to reach our initial timeline goal.

References

  1. Stark DP, House A. Anxiety in cancer patients. Br J Cancer. 2000;83:1261-1267.
  2. Caplan L. Delay in breast cancer: implications for stage at diagnosis and survival. Front Public Health. 2014; 2:87.
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November 2019 Vol 10, No 11
Last modified: November 7, 2019

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