Clinical Situation
Bone marrow biopsies often need to be performed expeditiously in order to alleviate patient concerns and quickly determine a diagnosis and treatment plan. However, with increasing subspecialization there are fewer hematology/oncology providers available to perform this procedure.
Literature
Our VA previously addressed this issue by having all bone marrow biopsies performed through Interventional Radiology (IR). The average time from order to procedure, though, was 18.6 days (Arfons LM, AVAHO 2016).
Intervention
A weekly bone marrow biopsy clinic was formed, utilizing a small group (heme/onc physician, nurse practitioner and key nursing staff). In collaboration with pathology, interior design, pharmacy, facilities and environmental services, a standard operating procedure was developed, which included a staffing model, procedural checklist, documentation template, scheduling and ordering system.
Outcomes/Implications
Bone marrow biopsies performed before and after initiation of the bone marrow biopsy clinic were tracked for time from order placement to: procedure being done; diagnosis rendered; and for those whose biopsy result needed therapy, initiation of treatment. From 8/4/2020 to 8/12/2021 there were 140 bone marrow biopsies performed, all through IR. The average time from order to the procedure was 23.1 days; from order to diagnosis was 27.8 days and from order to treatment was 54.8 days. After implementation of the bone marrow biopsy clinic, from 9/8/2021 to 5/25/2022 there have been 61 bone marrow biopsies performed (those ordered through IR were excluded). The average time from order to the procedure was 6.8 days; from order to diagnosis was 11.4 days and from order to treatment was 27.3 days. The differences in the average wait times for all 3 measures (time to procedure, diagnosis and treatment) were highly statistically significant (P < .001 for each), in favor of shorter wait times for those performed in the bone marrow clinic as compared to those done through IR. Implementation of a dedicated weekly bone marrow biopsy clinic significantly reduced wait times for the procedure, diagnosis and treatment initiation. This should be considered at other VA centers to improve the care of our veterans.
