Impact of multidisciplinary rounds on time to treatment for veterans with lung cancer at a VA medical center.

Abstract

e23281 Background: Delays in initiating lung cancer treatment adversely affect patient outcomes. In late 2024, increasing delays at our center were associated with care coordination gaps during periods of navigator turnover. To address these barriers, weekly multidisciplinary rounds (MDR) were implemented in February 2025. Methods: We conducted a retrospective review of Veterans with newly diagnosed lung cancer who had an oncology consult placed between November 4, 2024, and January 30, 2025. Prior to intervention design, a multidisciplinary root cause analysis using an Ishikawa diagram was performed to identify system-level contributors to treatment delays. The intervention consisted of a weekly, one-hour virtual multidisciplinary round held immediately after thoracic tumor board, involving medical oncology, pulmonary medicine, radiation oncology, surgery, nursing, and care coordination staff. During these sessions, patients were reviewed to identify and address delays in diagnostic completion, consult placement, treatment sequencing, and external referrals, with real-time assignment of next steps and responsible services. Patients treated prior to MDR implementation comprised the pre-intervention group (n = 25), while those managed after MDR initiation formed the post-intervention group (n = 24). For each patient, we calculated the time from diagnosis to first treatment (surgery, systemic therapy, or radiation). Secondary measures included treatment-specific trends and the proportion of patients experiencing prolonged delays (>90 days). Results: Following MDR implementation, the median time from diagnosis to treatment decreased by 6 days, representing an approximately 11% relative reduction. The proportion of patients experiencing prolonged delays (>90 days) decreased from 20% pre-intervention to 13% post-intervention. Treatment timelines became more consistent after MDR implementation, as reflected by a narrower interquartile range. The greatest improvement was observed among patients initiating systemic therapy, while surgical timelines showed modest improvement and radiation timelines remained generally stable. In both periods, the longest delays were primarily associated with cases requiring external referral. Conclusions: Weekly multidisciplinary rounds improved coordination and contributed to more timely and reliable lung cancer treatment at our VA. The intervention lowered the median time to treatment, reduced the proportion of extended delays, and produced the most notable improvement among patients starting systemic therapy. Persistent longer delays were largely related to surgical planning and external referrals, highlighting areas for future workflow improvement. MDR represents a practical, low-resource strategy to enhance lung cancer care delivery for Veterans.