Columbus (Ind.) Regional Hospital in 1995 built the Breast Health Center to offer improved mammography screening. While women liked the state-of-the-art facility, focus group research showed the 256-bed hospital was still losing patients because of the center's slow pace, lack of coordination and an overall perception of poor quality.
A random sample of patient charts in 1999 showed the average time lapse from identification of an abnormal result to diagnosis was about 25 days. While this lag did not pose a significant medical risk, patients found the wait intolerable and unnecessary, the focus group research showed.
Since January 2000, the hospital has reduced the wait time to about two days. Women with an abnormality are called at home and scheduled the next day for testing. From 1999 to 2002, the number of mammography patients rose to 8,696 per year from 7,347, and the facility's scores from Press Ganey Associates, a patient-satisfaction survey firm, have been in the 90s for two years.
These improvements have helped the hospital earn the Spirit of Excellence Award for Quality. Judge Carol Berster, chief executive officer of Hollidaysburg, Pa.-based Presbyterian Homes in the Presbytery of Huntingdon, praised Columbus for "trying to look at what the patients needed, not necessarily what the facility needed. If I had to wait 24 days to find out (test results), I'd be a little nervous myself."
Columbus' prior procedures had been scrutinized for years, but some physicians and radiologists had resisted changing their scheduling routines, says Deana Tuell, nurse manager at the health center. She remembers a conversation that helped break the philosophical logjam. "One of the (male) surgeons said, `This is a slow-growing disease. It doesn't matter,' " Tuell says. "One of the female surgeons said, `How would you feel if this was testicular cancer you were waiting on?' "
Radiologist Martha Dwenger and surgeon Rick Shedd took up the cause as "physician champions" and member turnover on the hospital's board brought in more sympathetic ears, says Doug Leonard, the hospital's CEO. "The resistance was noticeable but not formidable," he says. "It was mostly the primary-care doctors who resent the self-referrals. They saw that was a small concession to make."
Dwenger says radiologists balked partly because it meant spending time at an outside facility, which complicated staffing. "It's been busy enough that we've worked out the hours," she says. "There was a little bit of hesitancy to put someone at an outside facility, particularly for (mammography), which doesn't reimburse well and is a high-litigation area. It's basically a money loser. But it's important."
Among the key changes were the creation of a "nurse navigator" who serves as a case manager for each patient and a switch to having radiologists perform biopsies in some cases and then meet with each patient in person to explain the findings. "If you have to wait to get on the surgeons' schedule, it takes a lot more time," Tuell says.