Enhancing screening for nutritional causes of anemia in hospitalized patients with cancer.

367 Background: Anemia in patients with cancer has been associated with lower quality of life, diminished performance status, and potentially even delays in chemotherapy. Multiple professional societies, including the NCCN and ESMO, recommend routine testing for iron deficiency and iron replacement if deficiency is identified. The aim of this quality improvement project was to increase testing for nutritional causes of anemia, especially iron deficiency, among patients admitted to the onco-hospitalist teaching service at MD Anderson Cancer Center. Methods: A process map was constructed to identify pitfalls with the current process for identifying and ordering testing for nutritional (iron, B12, and folate deficiency) causes of anemia. The primary intervention for our Plan-Do-Study-Act (PDSA) Cycle was creating and implementing an electronic medical record smart phrase to be included in each note prompting consideration of reversible causes of anemia and whether testing was ordered in the last 6 months or needs to be ordered. Education was also provided to residents regarding reversible causes of anemia and appropriate studies to order. Fliers describing the intervention and the recommended testing algorithm were placed in the resident workroom. A retrospective chart review of all patients admitted to the onco-hospitalist teaching service from August 2023 to February 2024 was employed to collect pre- and post-intervention data, and a run chart was created to plot rates of screening over time. Results: Of the pre-intervention cohort (n=263) from August to December 2023, 196 (74.5%) were identified as having anemia; of these patients, 109 (55.6%) underwent screening for nutritional causes of anemia during the admission. After our intervention was implemented, of all patients admitted to the service (n=186), a total of 156 (81.7%) were found to have anemia and 116 (74.3%) were screened for reversible causes of anemia. Almost all reversible causes of anemia were found to be secondary to iron deficiency. Conclusions: Our data shows that anemia is prevalent in our patient population yet inconsistently evaluated at baseline. At the same time, a combination of smart phrase utilization and education successfully increased rates of screening from 55.6% to 74.3% of patients admitted to the onco-hospitalist teaching service. One potential future endeavor is addition of a smartphrase to the admitting H&P templates to prompt teams to consider reversible causes of anemia, especially iron deficiency, during the admission.