3291 - Optimizing Inter-Facility Patient Transfers for Radiation Therapy in an Integrated Health System

12:45pm - 02:00pm PT

Hall F

Screen: 5

POSTER

Presenter(s)

Pranshu Mohindra, MD, MMM - University Hospitals Seidman Cancer Center, Cleveland, OH, Cleveland, OH

P. Mohindra^1,2, M. Patel¹, K. Bytyci¹, K. Stamm¹, J. Fielden¹, A. T. Price^2,3, R. Kashani^2,3, L. Allyn¹, D. E. Spratt^1,2, and R. Zuhour^1,2; ¹Department of Radiation Oncology, University Hospitals Cleveland Medical Center/ Seidman Cancer Center, Cleveland, OH, ²Case Western Reserve University, Cleveland, OH, ³Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH

Purpose/Objective(s):

Multiple factors, including logistics, access, and patient/provider preferences, influence treatment location for radiotherapy (RT) patients. Within our integrated health system's six radiation oncology locations, patients seen for consultation can be transferred for treatment to another location. We implemented a standardized inter-facility transfer process to optimize patient experience, quality, and operational efficiency. Herein, we aim to quantify utilization of inter-facility patient transfers and evaluate clinical team compliance with the operational workflow.

Materials/Methods:

In this quality improvement audit, anonymized clinical operations and quality tracking data from simulation and treatment planning directives were analyzed. Data was abstracted from a clinical learning health system (LHS) designed using the Medlever, Inc. (Mountain View, CA) platform. All locations use the same electronic medical record, radiation oncology information system and treatment planning software. In addition to triggered transfer workflow within the LHS, clinical teams were required to email a standardized transfer communication template with clinical summary, relevant dates, treatment intent/ urgency, modality/ dose-fractionation and needed care coordination. Compliance to triggering accurate transfer workflows and use of email templates is reported.

Results:

During the study period (09/2023-12/2024), 2940 unique patients were registered into the LHS of whom, 467 patients (16%) had different simulation and treatment locations. Excluding 64 patients simulated at a different facility for motion management without actual transfer, 403 patients (13.7%) were transferred between providers and locations. Treatment intent of the transferred patients were definitive (36%), adjuvant/neoadjuvant (30%), palliative (24%), or for salvage (5%) radiation. Motion management was utilized in 18% of patients, 14% had a history of prior radiation near the current target, and 10.6% were planned to receive systemic therapy with RT. Treatment modalities included IMRT/VMAT (36%), 3D (33%), and SBRT (29%). Radiation was delivered over a median of 10 fractions (range, 1-35). A small proportion (3%) started RT emergently/urgently.

Clinical team's compliance to using a standardized email communication template was 59%, whereas accuracy of triggering appropriate workflows within the learning health system platform was 80% (OR 2.8, p<0.001).

Conclusion:

Patient transfers within our integrated health system were utilized for 13.7% of patients, across varied treatment intents and modalities. Compliance with using the learning health system to initiate transfer workflow was > 2.5 times higher than email communication. The gaps identified in this quality improvement study have informed revisions to optimize the transfer process. A new version of the learning health system is pending deployment, and its effectiveness will be compared with these current benchmarks.