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Christopher M Parker
OA10 - Sophisticated TNM Staging System for Lung Cancer (ID 136)
- Event: WCLC 2019
- Type: Oral Session
- Track: Staging
- Presentations: 1
- Now Available
- Moderators:Ke-Neng Chen, Pedro Lopez De Castro
- Coordinates: 9/09/2019, 14:00 - 15:30, Toronto (1985)
OA10.01 - Impact of Pre-Ordered Staging Tests on Timeliness of Lung Cancer Diagnosis and Staging: A Quality Improvement Initiative (Now Available) (ID 483)
14:00 - 15:30 | Author(s): Christopher M Parker
Timely care for patients undergoing evaluation for suspected lung cancer (LC) is critical to optimize clinical outcomes and minimize patient anxiety. We identified delays in local LC evaluation pathways and sought to improve the timeliness of care provided by the Lung Diagnostic Assessment Program (LDAP), a rapid assessment clinic. We launched a Quality Improvement (QI) initiative consisting of Standardized Triage Pathways (STP) with pre-ordered staging tests for LDAP-referred patients with a high suspicion of LC and seek to evaluate the impact on timeliness of care.Method
Data were collected retrospectively for all LDAP-referred patients to establish baseline (January - April 2018) and prospectively for improvement (May - October 2018), including: LDAP referral date, triage pathway, pre-ordered tests (PET, CT/MRI brain) including date of completion, and reasons for not completing pre-ordered testing. Mean data are reported, with significance determine by special cause variation using Statistical Process Control (SPC) XbarS charts; unpaired t-tests assess for differences between independent groups.Result
We reviewed 553 consecutive LDAP referrals (185 baseline, 368 post-STP). Compliance with STP and pre-ordered testing for patients with suspicion of LC improved to 100% and 93%, respectively. Post-STP, mean time from referral to PET decreased from 40.5 to 26.0 days, significant by SPC, and was 21.8 days for patients completing pre-ordered testing (p=0.0001). Time from referral to CT/MRI Brain decreased from 35.8 to 19.9 days, significant by SPC, and was 18.5 days for patients completing pre-ordered testing (p=0.0001). While there was a non-significant trend to improvement in time from referral to diagnosis (41.4 to 30.4 days), the improvement was significant for patients completing pre-ordered testing (28.4 days, p =0.0001). Of the 166 (45%) LDAP-referred patients triaged to receive pre-ordered testing, 134 (80.5%) completed pre-ordered tests. Those completing pre-ordered tests experienced more timely care, on average, than those who did not: mean time from referral to PET was 13.9 days faster (p=0.0001), referral to CT/MRI Brain was 15.9 days faster (p=0.0001), and referral to diagnosis was 10.2 days faster (p=0.0004). Main patient barriers to completing pre-ordered testing were preference for physician consultation prior to testing, (10, 31.3%), and barriers regarding travel and cost, (6,18.8%).Conclusion
A standardized triage process with pre-ordered staging tests at the time of LDAP referral is associated with improved time from referral to completion of staging tests and diagnosis. Strategies to improve compliance with pre-ordered testing are ongoing, including collaboration with primary care physicians and nurses to support patients and navigate barriers.
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