Opportunity

When abnormalities are found in a patient’s breast scans, further imaging and sometimes biopsy are required for diagnosis. As the demand for breast biopsies at Penn Medicine has risen, so has time to biopsy – the amount of time between abnormality detection and biopsy completion. As a result, patients may look to other health systems for faster care.

In addition, time to biopsy currently varies by race, insurance type, and practice location in a way that perpetuates health inequities.

Intervention

With support from the Nudge Unit, a team of researchers at the University of Pennsylvania developed default conditional orders to make the breast evaluation pathway more efficient and reduce the need for patient, provider, and staff action. In this workflow, mammogram screening orders are automatically linked with orders to perform additional imaging and biopsy if results indicate that a patient is at high risk for breast cancer.

Impact

An eight-month pilot demonstrated that time-to-biopsy dropped by 13 additional days with the default three-step order in place for the Department of Obstetrics and Gynecology. This difference was in comparison to the time-to-biopsy for patients of primary care clinicians, who had the three-step order available but not as a default. The reduction in time-to-biopsy was seen across racial groups. 

The three-step order has since been implemented as a default across the health system, driving rapid adoption and further reductions in time-to-biopsy. After one year, the average for time-to-biopsy for OB-GYN patients had fallen from 72 days to under 24 days.