Optimizing timeliness of first appointment with medical oncology: A quality improvement initiative at Northwell Health Cancer Institute.

Abstract

e23248 Background: As part of the quality improvement initiative , the Northwell Health Cancer Institute aimed to improve the average time to first appointment(TTA)for all new cancer patients to 7 days or less. Breast, Gynecological(gyn), and thoracic cancers were considered for the initial phase since the authors on this study focused on these cancers. Average TTAs were 11.3 days for breast, 6.7 days for gyn, and 10 days for thoracic cancer patients. This initiative was conducted in collaboration with the ASCO Quality Training Program. Methods: Data collection involved interviews, surveys, and information from nurse navigators and schedulers, utilizing sources such as the new patient unit, navigator, and social work database, as well as chart reviews. Priority analysis using Pareto charts identified key barriers to timely appointments, guiding our interventions. We chose two interventions that were thought to be of high impact and relatively easy to implement: opening up tele visit appointments and scheduling provider visits before all work up was completed or resulted. Results: Early results show promising trends, with some reduction in TTA for both breast and thoracic cancer patients, though the aim of statistically reducing TTA to 7 days has not yet been fully achieved. Challenges include patient preference and hospitalization, which are not easily amenable to change. Successes include increased awareness of TTA by the new patient unit and navigation teams leading to 100% collection of reasons behind patient preference as reason for delay compared to < 10% prior to this quality improvement project. Additionally, our interventions led to special cause variation in the direction of TTA improvement, particularly in the thoracic oncology space. Conclusions: Challenges include patient preference and hospitalization , which are not amenable to change. Future steps involve refining data collection templates, addressing specific barriers such as Oncotype testing delays , re- evaluating the appropriateness of the 7- day TTA metric for breast cancer patients, and collecting data for uninsured patients. This project highlights the complexity of reducing TTA due to various patient and systemic factors, with early interventions showing potential for improvement.