Emergency Department identifying care for patients with breast abnormalities

Special program provides referrals for unfunded, at-risk population.

A UT Health San Antonio-University Health System collaborative program that coordinates care of patients who come to the emergency department with breast concerns will be formally evaluated, thanks to a recently awarded grant of $49,965.

The support is from the DxQI Seed Grant Program, an initiative of the Society to Improve Diagnosis in Medicine. The purpose of the grant is to assess the effectiveness of the Emergent Breast Abnormality Care & Evaluation program (EmBrACE), which the two partner institutions implemented in 2017.

EmBrACE aims to meet the diagnostic needs of underserved patients, decrease the time it takes for them to be referred to and begin lifesaving care, and align them with financial resources.

“This is just one of many examples of the incredible service our two organizations in partnership provide our community,” said Emily Volk, MD, senior vice president of clinical services at University Health System.

Ensuring decisions are made

Under the EmBrACE pathway, patients are first evaluated in the emergency department or urgent care to determine if they are safe to be managed outpatient or they require hospital admission. Patients who are cleared to go home are referred within 24 to 48 hours to a University Health System clinic for primary care follow-up, initial intake and screening. The next goal is to complete a second appointment for a comprehensive breast workup within seven days.

Patients diagnosed with cancer who need evaluation by the surgical oncology team are referred to the Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. The Mays Cancer Center is the region’s only National Cancer Institute-designated Cancer Center.

The EmBraCE program has already evaluated and identified care for more than 150 women.

“A lot of these patients have tried to access other community health resources prior to coming to us,” said Tatiana C. Emanuel, DMSc, PA-C, of the Department of Emergency Medicine in UT Health San Antonio’s Joe R. and Teresa Lozano Long School of Medicine. She is the EmBrACE architect and grant co-leader.

“Every woman who comes to the emergency department is hoping to have her issue addressed in a timely manner. This can be a scary time,” Dr. Emanuel said. “Without a well-defined and inclusive process, these patients could be discharged with generic follow-up instructions but not have funding or access to seek outpatient services. Through EmBrACE, we are initiating the evaluation and quickly connecting these patients to lifesaving care.”

Reduces cost

EmBrACE prevents unnecessary hospital admissions to perform diagnostic and consult services that could be performed outpatient. “This reduces cost to the patient and the health system,” said Christina Bird, DO, associate professor of emergency medicine in the Long School of Medicine and medical director for the University Hospital Emergency Department. The team is also investigating other diagnoses that could benefit from a similar pathway.

Most of the patients who go through the EmBrACE pathway are unfunded and underserved, said Bradley Goettl, DNP, assistant professor of emergency medicine in the Long School of Medicine. Dr. Goettl said University Health System deserves “enormous credit” for identifying funding options to help many of the patients receive services. “This truly speaks to the organization’s mission,” he said.

Options include grants, Medicare/Medicaid, CareLink and other financial assistance programs. “We have a group of care coordinators who work very closely with these patients, and we found that many patients are eligible for funding,” Dr. Goettl said. “They just aren’t aware of that.”

The seed grant will help the group improve the process and “understand where the kinks are” in serving these patients, Dr. Bird said.

Dedicated providers

The EmBrACE team from UT Health San Antonio and University Health includes Christina Bird, DO, FACEP, Emergency Department project co-lead; Tatiana C. Emanuel, DMSc, PA-C, project co-lead; Bradley Goettl, DNP, assistant professor of emergency medicine; Ismail Jatoi, MD, PhD, chief of the Division of Surgical Oncology, Long School of Medicine; Deborah Seigler, MPAS, PA-C, faculty associate in surgical oncology; Kenneth Kist, MD, breast imaging director in the Department of Radiology, Long School of Medicine; Liem Du, MD, medical director of the Ambulatory Connections Clinic at University Health System; and Emily Volk, MD, senior vice president of clinical services at University Health System.

The DxQI Seed Grant Program is an initiative of the Society to Improve Diagnosis in Medicine with support from the Gordon and Betty Moore Foundation.


The University of Texas Health Science Center at San Antonio, also referred to as UT Health San Antonio, is one of the country’s leading health sciences universities and is designated as a Hispanic-Serving Institution by the U.S. Department of Education. With missions of teaching, research, patient care and community engagement, its schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have graduated more than 37,000 alumni who are leading change, advancing their fields, and renewing hope for patients and their families throughout South Texas and the world. To learn about the many ways “We make lives better®,” visit http://www.uthscsa.edu.

The Long School of Medicine at The University of Texas Health Science Center at San Antonio is named for Texas philanthropists Joe R. and Teresa Lozano Long. The school is the largest educator of physicians in South Texas, many of whom remain in San Antonio and the region to practice medicine. The school teaches more than 900 students and trains 800 residents each year. As a beacon of multicultural sensitivity, the school annually exceeds the national medical school average of Hispanic students enrolled. The school’s clinical practice is the largest multidisciplinary medical group in South Texas with 850 physicians in more than 100 specialties. The school has a highly productive research enterprise where world leaders in Alzheimer’s disease, diabetes, cancer, aging, heart disease, kidney disease and many other fields are translating molecular discoveries into new therapies. The Long School of Medicine is home to a National Cancer Institute-designated cancer center known for prolific clinical trials and drug development programs, as well as a world-renowned center for aging and related diseases.

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University Health System is San Antonio’s only locally owned health system and the only academic medical center in South Texas. Its University Hospital serves as the region’s Level I trauma center for adults and children, and is the only area hospital to be state-designated at the highest level for both its Maternity Center and Neonatal Intensive Care Unit. Outpatient care is provided through a comprehensive network of urgent, primary and specialty care centers. For more than 100 years, University Health has been committed to delivering compassionate, culturally competent and high-quality health care, based on a strong foundation of outcomes‐based research and innovative teaching. Learn more at UniversityHealthSystem.com.



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