- Design
- Before-and-after quality improvement study
- Population
- 70,823 diagnostic breast imaging examinations in a US multisite system
- Primary outcome
- Completion within 3 weeks of order
- Effect
- 57.4% before vs 65.3% after; median time 18 to 14 days
After a safety event, a US multisite health system required that high-priority diagnostic breast imaging be completed within three weeks of the order. High priority covered a new breast or axillary lump, new nipple changes or single-duct discharge, new skin dimpling, and new symptoms during breast cancer treatment. The quality improvement study compared 34,101 examinations before with 36,722 after implementation.
Completion within three weeks rose from 57.4% to 65.3%, and median time to imaging fell from 18 to 14 days. Before the rule, symptomatic patients were less likely than asymptomatic ones to be imaged on time (49.5% vs 61.3%); afterwards, 61.1% of high-priority examinations were done within three weeks.
The gains were real but modest, and a third of patients still waited longer. The value is in the explicit list of symptoms that should jump the queue, which any department can adopt.
- Define a short list of symptoms that make diagnostic breast imaging high priority: new lump, nipple change, single-duct discharge, skin dimpling.
- Set and audit a target time from request to imaging for that list.
- Ask referrers to state the symptom on the request so it can be triaged correctly.
- Recognise that symptomatic patients were the ones waiting longest before the rule.
Why it matters
Without an explicit rule, symptomatic women waited longer than asymptomatic ones for diagnostic imaging.
Don't overread it
A before-and-after study cannot exclude other changes over the same period, and it did not measure stage at diagnosis.
The statistics, in plain English
Completion within three weeks rose by about 8 percentage points. With tens of thousands of examinations, even small differences reach P < 0.001, so the clinical value lies in the size of the change, not the P value.
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