A novel “next level of care” protocol can help reduce patient wait times for follow-up services in radiology, according to new research published in JACR.
University of Texas Southwestern Medical Center in Dallas implemented this practice change in breast imaging, bypassing the need for additional exam or biopsy requests. The protocol allows treating providers to delegate certain additional imaging orders (based on radiologists’ recommendations) to qualified, nonphysician personnel. This means patients can receive necessary follow-up care without waiting for an additional order to be placed, experts noted.
Radiologist Jessica H. Porembka, MD, and colleagues assessed the impact of this intervention, comparing data against wait times for thyroid biopsies, where providers do not use the protocol. The average number of days from the diagnostic exam to the completion of a breast biopsy was nine versus 23 in thyroid care. Researchers highlighted a 61% drop in the mean time-to-biopsy rate, with comparable results among different races and ethnicities.
Those involved believe the approach is “reproducible and systematic” and can potentially be applied nationally for any biopsies involving radiologists.
“Next level of care (NLC) protocols can reduce wait times for diagnostic imaging evaluations and image-guided biopsies, helping to address issues of limited supply and availability of providers to place additional orders in a timely fashion,” Porembka, who serves as medical director of both quality assurance and breast imaging at Parkland Memorial Hospital, and colleagues advised, adding that “NLC demonstrates the benefits of radiologist-centric management of patients.”
UT Southwestern first implemented use of the protocol in October 2014. Porembka et al. gave the example of a radiologist recommending a stereotactic biopsy following a diagnostic mammogram. NLC lets the referrer copy the original mammo order and modify it for the follow-up services, without needing to contact anyone. This allows patients to have the biopsy appointment in hand before leaving their original mammography visit.
For the study, researchers retrospectively analyzed two six-month time periods before and after the COVID-19 shutdown. The final sample included 1,114 breast and 154 thyroid patients. Porembka and co-authors highlighted a significantly higher average time-to-biopsy rate for Black thyroid patients when compared to Latinos.
The vast majority of patients (99.6%) had the NLC protocol activated by their treating provider. About 82% of breast patients completed their diagnostic imaging and first biopsy within 14 days versus just 13.2% of individuals assessed for thyroid cancer. Nine breast patients (or 1.6%) included in the study were able to complete both services in the same day.
“While these differences between breast diagnostic evaluations and thyroid US likely reflect several variables, including the individual service’s capacities, differences may also reflect the efficiency of the NLC protocol in breast imaging compared to the process of waiting for a provider to place an order for a thyroid biopsy,” the authors advised. “The NLC protocol is not universally used in breast imaging nationally and could be useful to other imaging centers for both breast and thyroid imaging.”
Read much more in JACR at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.