When Brett Parkinson, MD, was asked to lead the new One Intermountain breast care services team last fall, his number one task was to standardize how we do breast cancer detection and diagnosis across the system. Dr. Parkinson, who’s based at the Breast Care Center at Intermountain Medical Center, brought together all the radiologists who provide breast imaging services for Intermountain patients and as a team they developed a new set of standardized protocols. The new protocols, which were approved unanimously by all participating physicians, were officially implemented throughout Intermountain in January.

“In the past, everyone was doing things in a different way,” Dr. Parkinson says. “We took five months and thoroughly researched each protocol—including looking at research studies and outcomes data and consulting with peers from around the country—to find the best practices. We didn’t just adopt the protocols from Intermountain Medical Center or one of the big hospitals; the new protocols represent the best of what we were doing across the system. In fact, we ended up taking some great ideas from some of the smaller facilities and implementing them systemwide.”

The protocols include standard ways physicians treat various types of patients, such as a pregnant patient, a patient under 30, or a male patient.

Three new processes are being piloted at Intermountain Medical Center:

  • Same-day biopsies. When a mammogram or ultrasound reveals a suspicious mass that warrants a biopsy, whenever possible the care team will perform the biopsy right then as part of the same appointment instead of making the patient come in on another day for the procedure.
  • Breast cancer surgery localization marker placement at the time of biopsy. In the past, the radiologist would place a metallic marker in the tumor at the time of biopsy. If the lump turned out to be cancerous, on the day of surgery the radiologist would use the marker as a guide to place a wire in the breast that would help the surgeon find the tumor. However, beginning last fall Intermountain Medical Center radiologists began placing a special radar-reflecting marker called a SAVI Scout in the tumor at the time of biopsy. Using a special probe in the operating room, the breast surgeon can easily find the marker without needing a wire placed. In addition to saving patients the discomfort of a second procedure to place a wire, they avoid an extra visit to the breast center. The result is a 35 percent reduction in cost—a savings of about $1,600. The SAVI Scout also allows surgeons to make a more accurate incision than with wire localization, which helps save breast tissue.
  • Intraoperative injection of radioactive lymph node-mapping dye. Breast cancer surgery patients require the injection of a radioactive dye in the breast prior to lumpectomy surgery, which will identify lymph nodes in the armpit area that might be cancerous. Until recently in Salt Lake-area hospitals, that injection was performed in the breast care center. The dye is injected into the patient's nipple, which can be very painful. Now the injection is being performed by the surgeon in the operating room just after the patient is put under anesthesia, which eliminates the painful injection and an unnecessary visit to the breast care center.

All the new processes are substantially reducing the time it takes from when a lump is detected to when the patient receives breast cancer surgery or other treatment. The processes also decrease the number of patient visits, reduce patient discomfort, improve quality, and increase affordability.