Oncology Rounds

Facing a backlog of cancer screenings? Here's how to dig out.

by Jacob Dingle and Emily Heuser

To protect their patients and providers, and free up resources for the ongoing Covid-19 crisis, health systems across the United States have all but shut down their cancer screening services.

Unfortunately, this protective effort has long-term consequences for patients: Delayed screenings can lead to cancers being caught at later stages, resulting in worse clinical outcomes.

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As imaging and cancer program leaders work to mitigate these consequences and restart screening services, it's important to keep in mind that tackling the rapidly growing backlog of screenings can lead to bottlenecks at each step of the diagnostic pathway, which could further delay care. Read on for tactics and resources to help your health system avoid these delays by getting patients back in the door and through the screening and diagnostic pathway as safely and efficiently as possible.

End delays as quickly as possible by ensuring patient safety—and communicating to patients that they're safe

The top priority for any health system needs to be ensuring that patients can be safely insulated from the threat of Covid-19. Organizations must confirm that elective procedures can be managed safely before making any move to restart screenings, let alone ramp up procedures further downstream. The sooner organizations can check the patient safety box, the sooner they can cut down the backlog.

Implement these sample safety measures to get patients back in for screening and diagnostic procedures safely:

  • Change walk-in policies to allow screenings by appointment only. Not only will this practice allow programs to better control the physical spacing of patients in the center, but it will also enable programs to prioritize higher-risk patient screenings, which are more likely to require downstream services.

  • Don't schedule appointments too close together. Schedule enough time in between mammograms, biopsies, CT scans, or surgeries to fully sanitize equipment and ensure no contact between patients in the waiting room.
  • Screen patients for Covid-19 symptoms before all appointments. Have staff call patients before their appointments to ask about Covid-19 symptoms and inform them of new safety protocols. Also, perform temperature checks on arrival.

  • Modify how waiting rooms are used or discontinue them altogether. You should consider redesigning the layout to keep chairs farther apart. Another common tactic is having patients wait in their cars prior to appointments, and then calling or texting them when they can enter the facility to reduce time spent in common areas.

However, even when robust safety protocols have been put in place, patients' reluctance to enter a clinical space can delay procedures further. Effective and frequent patient communication is a key factor in overcoming this hesitancy and getting patients in the door.

Use these tactics and resources to assuage patient fears and keep a steady flow of patients coming in for screening and diagnostic services:

  • Survey patients about what would make them feel comfortable coming back in for care. This allows programs to focus on the tactics that make the largest difference to their community.

  • Ensure that your community understands the measures you have put into place to create a safe environment. Use these tactics when developing your Covid-19 messaging strategy.

  • Overcommunicate with patients to ease confusion. Information about new safety practices should be communicated as many times as possible through as many different platforms as possible.

Optimize efficiency and increase capacity to put the backlog to bed sooner and avoid downstream delays

Addressing the screening backlog caused by Covid-19 isn't just about getting patients in the door safely. It's also about getting patients through the screening and diagnostic pathways as efficiently as possible to shorten the total amount of time their screening, diagnosis, and treatment start are delayed. This will allow you to minimize the negative impact on cancer outcomes. However, this is easier said than done: Health systems must now contend not only with evergreen throughput challenges on already strained care pathways, but also with new delays caused by the safety protocols implemented to protect patients and providers against Covid-19.

Implement these tactics to maximize the efficiency of your program and ensure a quicker end to your backlog:

  • Improve your screening and diagnostic processes. The sections on scheduling and streamlining the diagnostic process in our cancer center efficiency toolkit contain helpful resources to identify problems, reduce time to diagnosis, and make the most of your staff's time.

  • Use navigators to keep patients on track. There can be a lot of confusion for patients moving from screening to diagnosis to treatment. Strong patient navigation can grease the wheels of your system while also ensuring patients aren't slipping through the cracks. Learn how OhioHealth and Mickey Health (pseudonym) leverage navigators to guide patients through the diagnostic process, which reduces time to diagnosis. Use our navigation toolkit to make the most out of your patient navigation program.

  • Analyze the impact that Covid-19 has had on your imaging or cancer center's capacity in order to schedule patients appropriately throughout the day. Without understanding the number of procedures that can realistically be scheduled per day, centers face either backups and safety issues due to overscheduling or prolonged delays in reducing the backlog due to under-scheduling. Make sure to consider personal protective equipment shortages, limits on OR time or imaging equipment being used for other service lines, and staffing shortages.

  • Develop a rapid access program. Our Rapid Access Program Guide provides key considerations and program models for reducing the time to first appointment with a cancer care provider once patients have received the necessary screening and diagnostic procedures.

However, getting screening and diagnostic operations back to pre-Covid levels may not be enough to fully combat the backlog, no matter how efficiently done. Use these tactics and resources to increase the capacity of your imaging or cancer center:

  • Extend your imaging or cancer center's hours. Since this has the potential to raise operational costs, be careful to extend hours only at facilities that are facing the largest bottleneck.

  • Provide screening services at alternate sites of care. Consider offering mobile screenings at a convenient location in the community or even in front of your screening facility. Alternatively, work with a community partner to offer screenings on site at one of their facilities, as NorthShore did with Nordstrom. Strategies such as these could be key to managing the backlog by expanding capacity, as well as providing screening for patients who are uncomfortable going to traditional care settings right now.

  • Re-evaluate staffing needs. Determine whether increasing the number of providers or staff would help you see more screening or diagnostic patients. Before hiring staff externally, consider pulling staff from other areas in the health system that don't have as much of a backlog or are still seeing lower volumes because of Covid-19.

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