Yao LuoFollow

Date of Graduation

Spring 5-17-2018

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Cathy Coleman

Second Advisor

Mary Seed


The Clinical Nurse Leader as Outcomes Manager: Optimizing Screening Mammography in an Outpatient Breast Center


This clinical nurse leader (CNL) practice improvement project was conducted in an outpatient breast center that is part of a community safety-net hospital. The patient population consists of a large proportion of disadvantaged, low income, low English literacy, and high-risk women over 445 years of age. Recent observations and baseline data from the breast center and the mobile mammography van indicated that five to eight radiologic views were taken during a routine mammogram in a subset of screening patients which exceeds the standard set of four views (craniocaudal and mediolateral oblique views). Additional mammographic images can waste resources, expose patients to unnecessary radiation, decrease patient satisfaction, and inhibit efficient workflow. A root cause analysis further revealed there was a lack of consistency in positioning techniques and an opportunity for improvement in technologist education and training.

The objectives of this project were to create a long-term teaching and learning plan to help technologists identify their individual learning needs, address challenges related to knowledge and skills, reduce unnecessary film images, and promote optimal screening mammography. An integrated interprofessional training program plan (including one mammography screening case review and feedback session with a breast imaging radiologist) was introduced to the outpatient breast center. Comparative data on the number of routine screening mammographic views were collected and analyzed one week after the training session. A post-meeting evaluation questionnaire was also conducted to collect attendees’ feedback on this activity. Results showed there was a 10% decrease in additional screening mammographic views over a 7-day period post-training. Technologists also experienced high overall satisfaction with this training activity. Consistent and standardized film images are crucial for radiologist interpretation and quality assurance. By teaching enhanced mammography positioning techniques, better images can be achieved by the technologists, as well as increasing the positive predictive value of mammography and ensuring quality for all patients.