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SAN DIEGO -- A VA health center successfully streamlined the path to bone marrow biopsy by shifting the procedures away from interventional radiology (IR) to a new dedicated bone marrow biopsy clinic.

The change took almost 5 weeks off the time it took get a patient diagnosed and, if needed, treated, reported Kyle Stimpert, RN, MSN, ACNP, of the Department of Hematology/Oncology at VA Northeast Ohio Healthcare in Cleveland.

While the idea of establishing a new clinic may seem daunting, getting the program up and running did not adversely affect workflow, and has been a valuable team-building exercise, she said in a poster presentation at the Association of VA Hematology/Oncology meeting.

Bone marrow biopsy management in the dedicated clinic reduced diagnosis and treatment delays for patients, and meant they avoided a prolonged visit in the same-day surgery unit, she noted.

"This should be considered at other VA centers to improve the care of veterans," Stimpert said.

She explained that increased subspecialization has resulted in fewer hem/onc providers who are able to perform bone marrow biopsies at her center. As a result, those procedures were handed over to IR. The problem with that set-up was that the average wait time from biopsy order placement to IR was 2.5 weeks, she explained.

So in 2020, Stimpert and colleagues formed a work group with a hem/onc clinical nurse specialist and infusion nurse, along with nursing, pathology, pharmacy, and others. They were able to find a physical space, and put together a comprehensive implementation plan that included a staffing model, procedural checklist, patient education materials, and a patient scheduling ordering system -- all in about 4 weeks. The first bone marrow clinic patient was scheduled in September of 2021.

For the current study, bone marrow biopsies performed before and after the clinic was created were tracked from time of order to when the procedure was done, diagnosis given, and treatment initiated (if applicable). Non-urgent bone marrow biopsies (those ordered weeks to months in advance) were excluded.

In the year before implementation of the bone marrow biopsy clinic (August 2020-August 2021), 140 bone marrow biopsies were performed by IR. In the period after the bone marrow biopsy clinic was implemented (September 2021-August 2022), 89 biopsies were performed at the clinic (those ordered through IR were excluded). Stimpert and colleagues reported the following for pre- versus post-implementation:

• Time from order to procedure: 23.1 days through IR to 7.0 days at clinic, for a reduction of 16.1 days
• Time from order to diagnosis: 27.8 to 11.6 days, for a reduction of 16.2 days
• Time from order to treatment: 54.8 to 20.2 days, for a a reduction of 33.6 days

The differences in wait times were statistically significant (P<0.001) for all three measures in favor of shorter wait times for patients having their bone marrow biopsy done in the clinic compared with IR, Stimpert said, adding that "there were no differences in the category of malignant or benign diagnoses in the pre- or post-implementation groups."

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