Collaborative model between breast surgery and genetic counseling reduces wait times and increases pretesting genetic counseling volume.

Due to limited certified genetic counselor resources as well as increasing referral volumes, long wait times for genetics appointments were negatively impacting timely patient care at our institution in 2018. Using existing staff resources, we designed and implemented a collaborative workflow that integrated pretest genetic counseling and consent by our breast clinic physician assistant during either initial high-risk clinic appointment or as part of the new breast cancer diagnosis work-up. After 6 months of using the new model, wait times for pretest genetic counseling for new patients with breast cancer decreased from 116 to 13 business days, and we saw an increase in genetic counseling volumes of nearly 30%. There were no errors or discrepancies in test selection or testing criteria in the 62 patients seen by the physician assistant for pretest counseling. Barriers to the new workflow included a low completion rate of a preappointment survey used to generate the patient pedigree, which required significant effort at the appointment to manually gather this information. Although this workflow was highly successful at the time, it was ultimately discontinued due to internal staffing changes and updates to national guidelines for genetic testing. However, implementing this model illustrates a practical, low-cost way to manage genetic testing referrals in a timely fashion and increase volumes of appropriate testing in a setting with limited certified genetic counselor resources and was highly effective in our institution for several years.