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OBJECTIVES To explore the feasibility of a nurse-driven telephone triage intervention to improve the symptom experience of patients with cancer receiving treatment in the ambulatory setting. SAMPLE A SETTING 90 patients in three ambulatory centers (breast, head and neck, and sarcoma) receiving active treatment at a National Cancer Institute-designated comprehensive cancer center. METHODS A VARIABLES Patients received 4-18 triage calls from a nurse during a period of as many as six months dependent on their diagnosis and treatment. Feasibility was defined as the completion of 70% of triage calls. Symptom experience was measured using the MD Anderson Symptom Inventory. RESULTS The overall call completion rate was 78%. Interference (p = 0.002) and severity (p < 0.001) scores were significantly different among patients in the three centers and gradually decreased over time. IMPLICATIONS FOR NURSING Outcomes suggest that a telephone triage intervention is feasible to support patients receiving treatment. Future research can evaluate whether proactive triage affects symptom intensity during the course of the treatment trajectory.

Ethical challenges are inherent in oncology clinical practice. Ranging from transitions in care to code status and treatment decisions, these ethical challenges can have an acute effect on nurses, with well-established connections to moral distress and other psycho-emotional sequelae. The availability of a nurse ethicist can provide invaluable resources to support nurses in awareness of ethical challenges and support for ethical decision making in practice.

Quality improvement strategies can be used to modify existing health care processes to reduce patient wait times. We undertook a quality improvement project to reduce the time between new patients' initial visits and the finalization of their treatment plans. Initiation of treatment of new patients at the MD Anderson Sarcoma Medical Oncology Clinic can take up to 2 weeks from their initial consultation. Treatment delays result in increased costs and anxiety for the patient, adversely affecting the quality of care provided. We performed detailed process mapping and a cause-and-effect analysis to identify and prioritize opportunities for improvement. Process improvements addressed 2 key causes of delay to develop a finalized treatment plan: (1) insufficient data for decision making at the time of new patient visit and (2) delays in obtaining diagnostic imaging. After implementing our process improvements, the median time to develop a treatment plan decreased by 89% from 70.5 to 7.6 hours. Our process changes involved minimal additional work and had the secondary outcome of resulting in time savings for the clinic team.

e18191 Background: Excessive pt wait time can have negative effect on clinic work flow and on pts/ providers satisfaction. Increasing pt volume and limited clinic capacity can lead to long wait times for pts. The purpose of this two-part study was to evaluate the impact of Room Pooling Model (RPM) instead of Room Allocation Model (Part 1) and Electronic Health Record (EHR) on pt wait times in clinic and pts’/providers’ satisfaction (Part 2). Methods: The time studies and pts’/providers’ wait time satisfaction surveys were carried out over 2 weeks before (baseline) and 8 weeks after the implementation of RPM (Part 1), prior to the new EHR system, and 6 months after the implementation of EHR (part 2). All times of when pts, mid-level providers (MLP), and doctors (MDs) entered and exited the exam rooms were collected for 887 pts seen during the clinic. Data was analyzed using JMP and SAS. Results: As described earlier (ASCO 2016, abst 6595), the RPM was associated with increase in the proportion of pts seen by MDs within 30 min from the time roomed in the exam room and improvement in pts’/provider’s satisfaction. Post EHR, there were delays with decrease in the proportion of pts seen within 30 min from the time roomed in. Although the pt satisfaction did not change significantly, the number of times MDs had to wait for an open exam room increased from 8% (5/65) to 24% (14/59, p=0.01). The impact of RPM and EHR on pt times are shown below. The delays to see MDs after EHR were associated with longer time spent with the nurse (from median 4 to 7 min) and delays in seeing MLPs (from 11 to 18 min). Conclusions: These findings indicate that RPM can improve pt wait times. During initial stages of EHR implementation, the increase in pt wait time and reduced clinical efficiencies can be related to learning, and adapting to the new system. These data can be useful to design interventions that can target the areas of delays such as training and redesigning workflow to improve the clinical efficiency. [Table: see text]

194 Background: Growth in patient (pt) volume and limited clinic capacity can lead to long wait-times and pt/provider dissatisfaction. We have previously shown that the room pooling model, can reduce pt wait-time in the exam room, improve room utilization, and pt/providers satisfaction (ASCO 2016, Abstract 6595). One of the important goals of adopting electronic health records (EHR) is also to increase the clinical efficiencies, productivity and quality of care. The purpose of this study was to evaluate the impact of implementation of EHR on pt wait-time in the exam room and satisfaction in the Sarcoma Center. Methods: The time studies and pt and provider wait-time satisfaction surveys were carried out over 2 weeks prior to (baseline) and 6 months after the implementation of EHR. All times of when pts, mid-level providers, and doctors (MD) entered and exited the exam rooms were collected for a total sample size of 578 pts (300 before, 278 after) seen during the clinic hours and analyzed using JMP and SAS. Results: The proportion of pts seen within 30 minutes (Min) by MDs from the time pts roomed into exam room decreased by about 32% [from 53% (148/280) to 36% (94/259), p = 0.0001] post implementation of EHR. The median time for pts in the exam room waiting for MD increased (p = 0.0001) from 30 min (range: 0-126 min) to 40 min (range: 0-121 min). Although, the pt satisfaction did not significantly change [increase from 8% (23/278) to 12% (31/267) in the number of pts that were not satisfied to little-satisfied, and decrease from 92% (255/278) to 88% (236/267) in pts that were moderately to very-satisfied], the number of times MD had to wait for an open exam room increased from 8% (5/65) to 24% (14/59, p = 0.01). The delays to see MDs were associated with longer time spent with the nurse (from median 4 to 7 min), followed by delays in seeing Mid-level provider (from 11 to 18 min). Conclusions: These findings indicate that in the initial stages of implementation of EHR, the increase in pt wait-time and reduced clinical efficiencies can be related to the learning of and adapting to the new system. Attempts targeted to the areas of delays (such as training and redesigning workflow) may reduce the pt wait-time and improve the clinical efficiency.

6595Background: The growth in patient (pt) volume and limited clinic capacity can lead to long wait times and pt/provider dissatisfaction. The room allocation model (RAM), where fixed rooms are all...

127 Background: Treatment of new patients at the MD Anderson Sarcoma Medical Oncology Clinic can take up to 1 to 2 weeks from their initial consultation depending on the information available for review. Treatment delays can result in poor patient outcomes, adversely affecting the quality of care provided. There are numerous processes involved in the development of a treatment plan that could be improved to reduce the time to finalization of treatment plan. Methods: We undertook a quality improvement project involving key clinic and administrative team members. We performed detailed process mapping and developed a cause and effect diagram to identify and prioritize opportunities for improvement. We measured the time in hours from the patient’s initial appointment to finalization of a treatment plan. Baseline data (before process improvement implementation) was collected retrospectively through chart review. Post-implementation data was collected prospectively. For process improvement, we focused on two deficiencies that were regarded as the key causes of delay to develop a finalized treatment plan (1) insufficient data for decision making at the time of new patient visit, and (2) delays in obtaining diagnostic imaging. Results: Due to insufficient data for decision-making available at the time of initial consultation, the median time to develop a treatment plan is 72 hours. After initiating process improvement, the median time to develop a treatment plan decreased to approximately 7 hours. Conclusions: Improving the quality of data available for the medical oncologist prior to initial consultation greatly enhances the rapid development of finalized treatment plan. Availability of an early treatment plan improves patient outcomes, diminishes patient anxiety, and decreases the costs incurred by the patient awaiting a treatment plan at a specialized oncology clinic.