Improving time to first appointment for breast and thoracic medical oncology patients.

195 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 breast and thoracic cancer patients to 7 days or less. Average TTAs were 11.3 days for breast and 10 days for thoracic cancer patients. This initiative was conducted in collaboration with the ASCO Quality Training Program. Methods: Data collection included interviews, surveys, and chart reviews, with input from nurse navigators, schedulers, and social work. Data sources included the new patient unit, navigator and social work databases. Pareto analysis was used to identify key barriers to timely appointments. We chose two interventions that were high impact and relatively easy to implement: increasing tele-visit appointment availability and scheduling provider visits before all work up was completed or resulted. Results: After three Plan-Do-Study-Act (PDSA) cycles, TTA for thoracic cancer patients showed improvement: PDSA 2 TTA 9.1 days, PDSA 2 TTA 7.9 days. For breast cancer patients, similar interventions were not able to improve TTA: PDSA 2 TTA 12.9 days and PDSA 3 TTA 11.7 days. Pareto analysis revealed that delays were often due to patient preference to wait for Oncotype results or patient/ family availability before the initial oncology visit. Review of triple-negative, HER2-positive, metastatic breast cancer, and breast cancer in pregnancy indicated improved TTA for this subgroup: PDSA Cycle 2 TTA was 7.7 days and PDSA Cycle 3 TTA was 5.9 days. Discussion: Improved awareness and adoption of interventions can improve TTA. 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, and re-evaluating the appropriateness of the 7-day TTA metric for hormone positive, Her2 negative breast cancer or chemoprevention patients. Conclusions: TTA for thoracic and some subtypes of breast oncology patients improved. Oncotype or genomic testing for hormone positive breast patients is a vital part of the medical oncology visit where most patients prefer to wait for results and delay TTA.