RESUMEN
INTRODUCTION: Medical imaging (MI) is a critical service that underpins the care journey for many who enter the healthcare system. The subspecialty of Breast Imaging (BI) represents a complex and multi-modality MI setting with a well-defined role in the healthcare system. BI holds great potential as a setting to consider opportunities for a medical radiation technologist's (MRT) current role to be modified and leveraged to fulfill novel and advanced roles to optimize patient-centered service. METHODS: This study was conducted in three interrelated BI clinics, all at large urban academic hospitals with a common operational infrastructure. It involved three phases; (i) mapping processes and workflows in BI (ii) identification and characterization of care delivery problems (CDPs) within these process maps, and prioritization of opportunities where task shifting might leverage enhanced knowledge, skills, and judgement of MRTs to optimize care. The PEPPA framework - a systematic planning tool for the development and implementation of advanced practice nursing (APN) roles5 - was used, with the first five of nine steps considered in scope for this pilot project. RESULTS: Twelve distinct BI processes were identified and mapped as swimlane charts; a single clerical workflow leading up to patient check-in to the BI department, and 11 subsequent clinical processes. Each map included swimlanes for MRTs, radiologists, and clerical staff, as relevant, and included processes ranging from routine mammogram and ultrasound orders to stereotactic-guided core biopsies and rapid diagnostic workflows. Across the maps, 9 CDPs were identified; scheduling, radiologist availability, incorrect orders, and coordination of externally-acquired imaging and consults. The inpatient process map had the most instances of CDP identified, and the radiologist availability CDP was flagged most frequently across processes. Characterization of the root causes of each CDP led to common reflections on team and task factors, including inefficiencies in communication or division of responsibilities, or availability of resources or team members to support workflows. Consultations based on the resultant maps and CDPs led to identification of the following potential advanced roles for MRTs; review and decision-making relating to imaging acquired externally prior to patient appointments, exam ordering and protocoling in defined scenarios, and task-shifting of certain clinical procedures such as breast screening ultrasounds and contrast-enhanced mammography. CONCLUSION: Advanced practice for MRTs holds great potential to address system inefficiencies in breast imaging, if approached systematically and with the primary objective to optimize care. Future work will consider trial and evaluation of pilot roles that incorporate advanced opportunities identified in this project.
