- Design
- Quality improvement before-and-after study, multisite health system
- Population
- 70,823 diagnostic breast imaging examinations, 2023-2025
- Primary outcome
- Completion within 3 weeks of order
- Effect
- 57.4% to 65.3%; median 18 to 14 days
After a safety event analysis, a multisite US health system introduced a scheduling guideline in August 2024 requiring high-priority diagnostic breast imaging to be completed within three weeks of the order. High priority covered a new breast or axillary mass, new nipple changes or unilateral discharge, new skin dimpling, and new symptoms during breast cancer treatment. The before-and-after study (JACR, 5 October 2026) included 70,823 examinations.
Completion within three weeks rose from 57.4% to 65.3%, and median time to completion fell from 18 to 14 days. Before the guideline, symptomatic patients were worse served than asymptomatic ones (49.5% vs 61.3% within three weeks). Afterwards, high-priority examinations reached 61.1%.
The point is that symptomatic women had been waiting longer than women recalled for routine reasons, an inversion of clinical priority that a simple rule partly corrected. Uncontrolled before-and-after designs can be affected by other changes over the same period, and four in ten high-priority patients still waited more than three weeks.
- Define high-priority breast indications explicitly - new mass, nipple change, unilateral discharge, skin dimpling
- Set a time target for those indications and track completion against it
- Check whether symptomatic patients in your service wait longer than asymptomatic ones
- Ask referrers to state the symptom on the request so it can be triaged
Why it matters
Without a rule, women with worrying symptoms were waiting longer than women without them.
Don't overread it
Uncontrolled before-and-after data on timeliness - it does not show earlier cancer diagnosis or better outcomes.
The statistics, in plain English
The improvement from 57.4% to 65.3% is statistically clear given the large numbers, but this is a before-and-after comparison without a control group, so some of the change could reflect other factors such as staffing.
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