Impact of Electronic Procedural Protocoling on the Timeliness of Pre-operative Breast Localization Procedures

Abstract Objective : To evaluate the impact of a new electronic procedural protocol on start times of pre-operative breast localization procedures. Methods : This HIPAA-compliant, Institutional Review Board-exempted, quality improvement initiative was performed at a large tertiary academic center. In May 2018, an electronic version of the pre-procedure protocol for breast localizations was created within the electronic health record; prior to this time, the protocol was completed manually on a paper form. Mean time between: 1) appointment time and procedure start time, 2) procedure begin-to-end time, and 3) arrival to appointment time were compared for all female patients undergoing pre-operative breast localization procedures during four-month periods pre-implementation of the electronic procedural protocol (January-April 2018), and post-implementation (June-September 2018), excluding the May 2018 implementation month. Statistical analysis was done by two tailed t-test and statistical process control (SPC) charting. Results : Pre-implementation, 427 procedures were performed, and post-implementation 409 procedures were performed. Three pre-implementation cases performed more than 3 hours prior to appointment time were excluded (presumed to be rescheduled cases). Mean time between appointment time and procedure start time decreased from 2.7 minutes after to 5.6 minutes before appointment start time, an 8.3-minute improvement (p=0.0001), with sustained improvement by SPC analysis. Mean time for procedure length increased by 4.7 minutes (p=0.001). There was no significant difference in mean time of patient arrival to appointment time pre- and post-implementation. Conclusion : Implementation of an electronic protocol process for pre-operative breast localizations was associated with a significant and sustained reduction in time between appointment time and procedure start time.