title: Implementation of a Breast/Reconstruction Surgery Coordinator to Reduce Preoperative Delays for Patients Undergoing Mastectomy With Immediate Reconstruction.
abstract: OBJECTIVE
  Mastectomy with immediate reconstruction (MIR) requires coordination between breast and reconstructive surgical teams, leading to increased preoperative delays that may adversely impact patient outcomes and satisfaction. Our cancer center established a target of 28 days from initial consultation with the breast surgeon to MIR. We sought to determine if a centralized breast/reconstructive surgical coordinator (BRC) could reduce care delays.
  
  
  METHODS
  A 60-day pilot to evaluate the impact of a BRC on timeliness of care was initiated at our cancer center. All reconstructive surgery candidates were referred to the BRC, who had access to surgical clinic and operating room schedules. The BRC worked with both surgical services to identify the earliest surgery dates and facilitated operative bookings. The median time to MIR and the proportion of MIR cases that met the time-to-treatment goal was determined. These results were compared with a baseline cohort of patients undergoing MIR during the same time period (January to March) in 2013 and 2014.
  
  
  RESULTS
  A total of 99 patients were referred to the BRC (62% cancer, 21% neoadjuvant, 17% prophylactic) during the pilot period. Focusing exclusively on patients with a cancer diagnosis, an 18.5% increase in the percentage of cases meeting the target (P = .04) and a 7-day reduction to MIR (P = .02) were observed.
  
  
  CONCLUSIONS
  A significant reduction in time to MIR was achieved through the implementation of the BRC. Further research is warranted to validate these findings and assess the impact the BRC has on operational efficiency and workflows.
authors.affiliation: Brigham and Women's Hospital; and Dana-Farber Cancer Institute, Boston, MA mgolshan@partners.org.
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.affiliation: Brigham and Women's Hospital; and Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Katya
authors.initials: K
authors.lastname: Losk
authors.affiliation: Brigham and Women's Hospital; and Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Mallory
authors.affiliation: Brigham and Women's Hospital; and Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Camuso
authors.affiliation: Brigham and Women's Hospital; and Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Linda
authors.initials: L
authors.lastname: Cutone
authors.affiliation: Brigham and Women's Hospital; and Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Caterson
authors.affiliation: Brigham and Women's Hospital; and Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Bunnell
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D020360:Neoadjuvant Therapy; D016522:Oncology Service, Hospital / Q000458:organization & administration*; D058996:Quality Improvement; D012017:Referral and Consultation; D061665:Time-to-Treatment; D000078329:Workforce