Coordination of radiologic and clinical care reduces the wait time to breast cancer diagnosis

BACKGROUND

In 2009, a Rapid Access Breast Clinic (rabc) was opened at our urban hospital. Compared with the traditional system (ts), the navigated care through the clinic was associated with a significantly shorter time to surgical consultation. Since 2009, many radiology facilities have introduced facilitated-care pathways for patients with breast pathology. Our objective was to determine if that change in diagnostic imaging pathways had eliminated the advantage in time to care previously shown for the rabc.

METHODS

All patients seen in the rabc and the office-based ts in November-December 2012 were included in the analysis. A retrospective chart review tabulated demographic, surgeon, pathology, and radiologic data, including time intervals to care for all patients. The results were compared with data from 2009.

RESULTS

In 2012, time from presentation to surgical consultation was less for the rabc group than for the ts group (36 days vs. 73 days, p < 0.001) for both malignant (31 days vs. 55 days, p = 0.008) and benign diagnoses (43 days vs. 79 days, p < 0.001). Comparing the 2012 results with results from 2009, a decline in mean wait time was observed for the ts group (86 days vs. 73 days, p = 0.02). Compared with patients having investigations in the ts, rabc patients with cancer were more likely to undergo surgery within 60 days of presentation (33% vs. 15%, p = 0.04).

CONCLUSIONS

The coordination of radiology and clinical care reduces wait times for diagnosis and surgery in breast cancer. To achieve recommended targets, we recommend implementation of more systematic coordination of care for a breast cancer diagnosis and of navigation to surgeons for patients needing surgical care.

Paediatric Surgery at a Regional Hospital

Infants and young children are at particular risk from anaesthesia and surgery. Somehave suggested that these patients only be cared for by those with specialty paediatricsurgical and anaesthetic training. In district hospitals and the developing world thisis often not possible. We have undertaken a prospective study to determine the mortalityand morbidity rate for children 0 to 5 years undergoing surgery at Western RegionalHospital (WRH) in Pokhara, Nepal. During 1999 there were 354 patients in this agegroup undergoing surgery. Surgical procedures were done in general surgery (coveringurology, plastics and neurosurgery as well), orthopaedics, ENT and ophthalmology.There were 6 deaths for a mortality rate of 1.7%. Seven patients had in hospitalcomplications and significant management problems were identified in four patients.In conclusion, although there is no dedicated paediatric surgical unit at WRH, childrenundergoing surgery at this hospital have acceptable morbidity and mortality rates.An improvement in timely presentation, diagnosis, treatment and intraoperativemonitoring may further improve these results.

Laparoscopy as a cause of a false-positive Meckel's scan

A new cause of a false-positive result of a Meckel's scan is reported. An 11-year-old girl had a 3-week history of constant right lower quadrant pain that was initially managed by laparoscopic appendectomy. A repeated laparoscopy for persistent pain was nondiagnostic. A missed Meckel's diverticulum was considered as the cause of this pain, which prompted a Meckel scan. This scan revealed a periumbilical focus of activity that was interpreted as a Meckel's diverticulum attached to the anterior abdominal wall by a band. The laparotomy showed no Meckel's diverticulum. The false-positive result of the Meckel scan may be the result of inflammation from the periumbilical laparoscopic port site.