3704 - Timeliness of In-Patient Radiation Therapy: An Informatics Care Pathway Interval Analysis of Hospital Length of Stay in an Integrated Health System
Presenter(s)
P. Mohindra1,2, R. K. Kyasaram3, K. Bytyci1, A. T. Price1,2, J. Fielden1, L. Allyn1, M. Patel1, K. Stamm1, R. Kashani1,2, A. Baydoun1,2, N. Giffels4, L. McCaulley4, J. Shanahan3, C. I. Wong Ciepiel5, M. Paschall6, and D. E. Spratt1,2; 1Department of Radiation Oncology, University Hospitals Cleveland Medical Center/ Seidman Cancer Center, Cleveland, OH, 2Case Western Reserve University, Cleveland, OH, 3Cancer Informatics, University Hospitals Cleveland Medical Center/ Seidman Cancer Center, Cleveland, OH, 4University Hospitals Cleveland Medical Center, Cleveland, OH, 5Division of Medical Oncology, University Hospitals Cleveland Medical Center/ Seidman Cancer Center, Cleveland, OH, 6University Hospitals Cleveland Medical Center/ Seidman Cancer Center, Cleveland, OH
Purpose/Objective(s):
Hospitalized cancer patients often require urgent radiation therapy (RT), where timely initiation is critical to relieve symptoms and avoid prolonged hospitalization. Multiple patient-level and system-level factors can delay RT start and extend length of stay. This study evaluates system-wide inpatient RT intervals to identify variation and operational bottlenecks, with the objective of establishing baseline performance benchmarks to guide workflow optimization.Materials/Methods:
A systems operations analysis (2023–2025) of in-patient radiation courses was performed within an NCCN-member integrated health system. Cancer informatics–driven queries across the cancer registry, the EPIC, Mosaiq® and Medlever, Inc systems identified patients who underwent RT simulation during an inpatient admission. Descriptive analyses summarized demographics, RT characteristics, and yearly trends in RT pathway intervals (admission, simulation, RT dates and discharge) from 2023 to 2025. Inter-quartile ranges (IQR) are reported due to the expected noise inherent to large operational datasets.Results:
We identified 277 courses of in-patient RT simulation between 2023–2025. Patient demographics and RT details included in Table 1. Over the three years, median hospital LOS reduced a day per year from 16 days (IQR 10-23) to 14 days (IQR 8-20). Through this period, the median admission to simulation interval also reduced from 4 days (IQR 2-6) to 3 days (IQR 2-6). Proportion of patients with simulation > 10 days from admission reduced from 13.8% to 10.7%. Overall simulation-to-RT start interval was short (median 2 days; IQR 1–4), with proportion of patients starting RT within 2 and 4-days of simulation increased from 46% and 68% to 56% and 85%, respectively. Median LOS was 12 days when RT began <2 days after CT sim vs 16 days when =2 days (IQR 8–18 vs 11–25). RT start after discharge decreased (5.3% to 1.9%) and RT completion after discharge decreased more markedly (28.7% to 15.5%).Conclusion:
In a large NCCN-member integrated health system, inpatient RT pathways were characterized by efficient simulation-to-treatment initiation with year-over-year improvements. Delays persisted between admission to simulation interval and proportion patients completing RT during hospitalization. These trends identify key opportunities for targeted workflow optimization and development of escalation triggers to reduce avoidable inpatient days. Table 1: Patient Characteristics, RT Parameters| Domain | Variable | Summary |
| Demographics | Median age (range) | 66 (26–95) |
| Sex distribution | Male 51%; Female 49% | |
| Race | White 74%; Black 20% | |
| Radiation Treatment | Predominant modality | 3D-conformal (87%) |
| Other modalities | IMRT/VMAT/Conformal 7%; SBRT 4%; SRS 1%; CSI <1%; Implant <1% | |
| Median Dose, Gy (range) | 20 (3–45) | |
| Median Fractions (range) | 5 (1–15) | |
| Median Dose per fraction, Gy (range) | 4 (1.5–20) |