Today, I am going to focus on pathologists.
In our quantitative and qualitative research we discovered that there were a lot of calls, emails, and reports being sent between the pathology department and physician offices, clinics, hospitals, and patients.
Some of the calls were to see how long it would take to get a pathology report, others were to get more information on the diagnosis, sometimes calls were made because a report or information was not received, and yet others inquiries were to ensure that the summary and pathology slides were ready for that weeks cancer conference or multidisciplinary conference.
The insight we took from this was that there are a lot of touches being made that may not necessarily add any value to allowing a pathologist to complete their work, to getting information back to other physicians, nor does it relay any information back to the patient. We also realized that many physicians did not have a good grasp on the work pathologists performed.
The most important insight for pathology: When a patient is waiting to hear if they have or do NOT have cancer, you CANNOT speed up the time it takes a biopsy or a tissue sample to be prepared, stained, analyzed, and read by a pathologist. There are protocols set by the College of American Pathologists which dictate best practices, guidelines, and consistency for pathology.
I repeat, “No matter the number of people that need to know if they do or do NOT have cancer, you CANNOT speed up the time it takes for pathology to be performed.”
In looking through the CAP guidelines we sat down with pathologists to understand how they performed worked today, and how we could improve their work tomorrow.
All with the common goal to get an answer to a patient in a timely fashion on whether they do or do NOT have cancer.
In discussing the results and findings with the pathologists we thought of an easy solution: defining the types of tests that they performed, when each test was needed, and the length of time it took to perform the test and get a response.
By mapping out the types of tests and the time it took to perform, we were able to share this information with the other team members. We made sure to educate and follow up with additional information with the primary care physicians, surgeons, medical oncologists, internal medicine physicians, and other healthcare practitioners.
We developed an agreement with the care team members specific to pathology. Part of the agreement was that the physician that performed the biopsy would take the “leadership” role in communicating the results to the patient.
Part of the “leadership” role was not just communicating the result of cancer or NO cancer, but to also educate the patient on how long it takes to get an answer. If it took more than 24 hours (1 business day) then there were also follow up calls to the patient and family to reduce anxiety, answer any questions, and to let them know that someone was focused on their care and getting them an answer.
If there was a positive finding that the patient does have cancer, that information would also be shared upstream with other members of the care team. We would have results sent to navigators, surgeons, medical oncologists, radiation oncologists, and integrative medicine physicians.
When you send information in both directions you are able to get the information to the patient in a timely manner. You are also preparing the rest of the care team for a patient that is just being informed that they have cancer. The flow of information allows the team responsible for producing that care for a patient with cancer to define the choices for care, the information to understand those choices, and to create a summary for the patient and their family.
We also worked with the pathologists on speaking to the patients directly. The pathologists and the care team decided that each patient would get a single sheet of paper. On the sheet of paper would be the category of cancer they had, say “pancreatic cancer.” It would then list the stage of their cancer, along with a simple description of what T-N-M meant. (find more about staging at ACS) It would include a diagram of where the tissue was taken, along with a color picture of the pathology slide(s). It would also include a 1 paragraph summary from the pathologist. At the very end it would have the reading pathologists name, along with a contact number in the event that the patient wanted to speak to the pathologist.
We incorporated the same process for specialty molecular diagnostic pathology testing as well. With the advancement in molecular markers there are some tests that need to be sent out to specialty labs. Things such as EGFR, KRAS, BRAF, ALK 1/2, etc. are special tests that only a few labs perform. We were able to work with the labs to develop a way to place the same information into our summaries to share with patients.
There were a lot of great results due to the work. There happened to be less calls inquiring about pathology tests. The number of calls about a lost report were almost completely eliminated. We were able to reduce anxiety, the number of patients lost to competitors, improve communication with patients, and improve the time to get an answer to a patient.
We were able to get teams to discuss treatment options and care plans in real time, before most meetings, and found that changes in care occurred less often due to incomplete information. We could also measure in reduction of costs, less side effects, adherence to treatment guidelines, and improved survival rates.
We were able to free up more time for pathologists to attend multidisciplinary meetings, perform educational talks within the community, and more time to read pathology.
Pathology moved from being a hidden department in the basement that no one understood their pictures, to a department that was at the forefront of making a decision on whether a patient has or does NOT have cancer.
We took a microscopic story and shared the macroscopic importance in its message.
Knowing if you have or do NOT have cancer changes entire worlds.
As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek