Early Implementation Outcomes of a Dedicated, Inpatient Radiation Oncology Consultation Service at a Public Academic Medical Center
Faculty and Abstracts
Purpose: While largely practiced in an outpatient setting, radiation oncology is indicated for inpatients in emergent clinical scenarios (spinal cord compression, bleeding, intractable pain etc). Various institutions have implemented strategies to improve access to inpatient radiation oncology care. Inpatient radiation oncology services have been associated with improved quality of care and cost of admission for symptomatic cancer patients. Our objective was to develop a dedicated radiation oncology inpatient consultation service to facilitate the advancement of a clinical and research program focused on optimizing multidisciplinary cancer care including radiotherapy for admitted patients in a public access hospital. The purpose of the present study is to assess the early implementation outcomes of this service and evaluate the impact on the clinical experience and clinician perception of the quality of care.
Methodology: The inpatient consult service was designed and structured based on evaluation of diverse programs at other institutions. Initial research and development included strategic outreach to institutions with established inpatient service lines and systematic assessment of their program structure and operating procedures. During service development, a dedicated committee then developed standard operating procedures for the new inpatient initiative including workflows, deadlines, strategies for care coordination and hand offs. Consultations were tracked for the duration of the initial pilot phase. Patient and consult specific data were obtained from electronic medical records. Variables for evaluation included consultation details (consulting service, date, reason for consult), patient demographics, hospital admission details, and radiation treatment information. Provider experience was assessed via surveys delivered electronically to clinicians following each week of service.
Results: From March-June 2023, 11 clinical faculty and 8 residents participated on the pilot inpatient service. In this time, 113 consultations were performed, of which 50 (44%) resulted in inpatient simulations for radiotherapy. Many patients were recommended for outpatient radiation or re-evaluation. Only 5 (4%) of consultations resulted in a recommendation against receipt of radiation therapy. Consultation was performed by the second day of admission in 64% of cases. Only 33 (29%) consultations were referred by the solid oncology service and 15 (13%) by the hematologic tumor service which speaks to diversity of referring providers. Regarding provider experience, 87% of residents/APPs and 92% of faculty respondents agreed or strongly agreed that patients would benefit from the change to the new service while 73% of residents/APPs and 75% of faculty agreed or strongly agreed that they would personally benefit (ex. clinic workflow).
Conclusions: Development and initial implementation of the new service model was positively received by clinicians who broadly perceived that the change resulted in improved patient care and improved clinical balance/workflow. Future work will focus on establishing the sustainability of the service as well as developing a prospective registry of patient-reported outcomes among patients with metastatic cancer.
