Implementing A One-Day Testing Model Improves Timeliness of Workup for Patients with Lung Cancer

Abstract

Background Patients with lung cancer often experience stressful delays throughout the diagnostic phase of care. To address that situation, our multidisciplinary team created a “Navigation Day,” during which patients partake in a single-day visit that comprises nurse-led teaching, social work, smoking cessation counselling, symptom control, and dedicated test slots for integrated positron-emission tomography and computed tomography (pet/ct), pulmonary function tests (pfts), and magnetic resonance imaging (mri) of the brain. We evaluated the effects of that program on wait times and patient satisfaction.Methods Patients with a suspicion of lung cancer on chest ct imaging referred during 3 time periods were reviewed: 1 year before launch of the Navigation Day, 1 year post-launch, and 2 years post-launch. Patients were further stratified according to concordance of their test date with a Navigation Day date. Mean wait times for pet/ct, pfts, and mri brain were calculated for each group. Patient satisfaction was measured using a standardized provincial survey. The Student t-test and analysis of variance were used to assess for significance.Results After implementation, mean wait times in the first year improved to 9.2 days from 15.5 days for pet/ct (p < 0.0001), to 9.6 days from 15.7 days for pfts (p < 0.0001), and to 10.2 days from 16.0 days for mri brain (p < 0.0001). Patients who used a dedicated test slot experienced the shortest wait times, at 5.8 days for pet/ct, 5.8 days for pfts, and 6.3 days for mri brain (p < 0.0001). Those improvements were sustained at 2 years post-launch. Patient satisfaction in the categories of assistance, emotional support, and clarity remained high post-launch.Conclusions Navigation Day significantly improved the timeliness of diagnostic testing services in patients with suspected lung cancer.

Wait List Strategies for CT and MRI Scans

“…A total of 91 publications were identified and included in this report. Among the Canadian publications, some were from pan-Canadian groups or were relevant to Canada in general 3,8,[10][11][12][13][14][15][16][17][18] ; others were action plans, initiatives, or studies from specific provinces, including British Columbia, [19][20][21] Alberta, 6,22 Saskatchewan, 23,24 Manitoba, 25,26 Ontario, [27][28][29][30][31][32][33][34][35][36][37][38] Quebec, 39 Prince Edward Island, 16 Newfoundland, 40 Nova Scotia, 41,42 New Brunswick, 43 and Yukon. 44 Publications were also identified from Australia, 45,46 China, 47,48 the European Union, 49 France, 50,51 India, 52 Ireland, 53 Israel,…”

“…• assessing workflow to determine potential areas for improved efficiency (e.g., reallocating tasks, simplifying paperwork) 15,73,79 • rapid access or walk-in clinics (eg, receiving diagnostic scans and information on disease stage in 1 setting) 31,53,56,60,80 • using artificial intelligence and/or machine learning (e.g., identify most appropriate procedure, personalize contrast doses, enhance low-quality images so scanning time can be shortened, flag unusual scans) 3,12,49,55,64,67,88,89 • using teleradiology (eg, to allow for remote coverage in areas with a shortage of radiologists so radiologists in other areas can interpret scans) 15,45 • having dedicated adult and pediatric scanners 46 • having dedicated staff to assist with patients (eg, checking protocol, assisting with administration of oral contrast) 96 Decreasing low-value scans…”

A Canadian Perspective on the Challenges for Delivery of Curative-Intent Therapy in Stage III Unresectable Non-Small Cell Lung Cancer

“…Although institutions may share some challenges in achieving timely diagnosis and staging of lung cancer, internal quality assurance studies must be performed at individual centres to ensure their unique challenges are addressed. Several centres in Canada have performed quality assurance investigations of their lung cancer care pathway from onset of symptoms to initial treatment and have published articles detailing strategies that were effective in improving diagnosis time [26,28,[31][32][33]. The most common strategy applied by all centres was the use of centralized referral centres/diagnostic assessment programs and a nurse navigator to help triage patients to the appropriate pathway and coordinate the many investigations needed for diagnosis and staging.…”

“…The most common strategy applied by all centres was the use of centralized referral centres/diagnostic assessment programs and a nurse navigator to help triage patients to the appropriate pathway and coordinate the many investigations needed for diagnosis and staging. Referral programs focused on streamlining diagnostic imaging by scheduling multiple tests on the same day where possible [26,32], improving access to test result reporting [26], pre-ordering or holding designated slots for tests [28,32,33], and triaging testing based on urgency [28,33]. Other strategies focused on education, including increasing awareness of the diagnostic assessment program to the referral base [28], and informing patients of their care path, allowing them to take ownership of their journey [26,32].…”