A rapid molecular testing quality initiative to reduce targeted treatment delays in hospitalized patients with new advanced non-small cell lung cancer (aNSCLC).

497 Background: Targeted therapies have transformed advanced non-small cell lung cancer (aNSCLC) treatment, yet timely molecular testing remains inconsistent. This is particularly challenging for hospitalized patients. We had observed numerous hospitalized patients with driver mutation-positive aNSCLC succumbing to their disease before treatment initiation, highlighting a critical missed opportunity. A Pareto analysis identified delayed molecular testing—often postponed until hospital discharge—as the primary barrier, compounded by logistical and insurance-related obstacles. Given the baseline overall survival (OS) of approximately 2.2 months for aNSCLC diagnosed in acutely ill hospitalized patients, this quality improvement (QI) initiative aimed to implement rapid molecular testing to expedite diagnosis and prevent treatment delays. Methods: During the first Plan-Do-Study-Act (PDSA) cycle, inpatient oncology teams at two tertiary care academic hospitals expedited molecular testing using liquid biopsy (Biodesix IQ Lung, 3–5 day turnaround) and an in-house tissue-based gene panel (Point Solid, 10–14 day turnaround) for patients with aNSCLC. Oncology fellows received training and collaborated with pathology for this project. The primary goal was universal liquid biopsy for all patients with new aNSCLC seen by oncology consult teams. Time to treatment initiation (TTI), testing concordance, outcome measures, and barriers were also captured. Results: Over 6 months, 66 new aNSCLC cases were identified through the pathology database. Of these, 18 patients (61% male, median age 70) were evaluated by the oncology consult teams, and all (100%) underwent liquid biopsy, successfully achieving the primary objective. However, this represented only 27.3% of all newly diagnosed aNSCLC patients during that period, highlighting a gap in testing accessibility. These findings informed the next PDSA cycle, which aims to expand molecular testing beyond oncology consult patients for broader implementation and earlier intervention. Of the 18 tested, actionable mutations (AM) were detected in 8 patients (44%), with 5 (62.5%) receiving targeted therapy, 80% of whom were started on treatment while hospitalized. Average TTI was 21 days (range: 9–49) for targeted therapy. Liquid and tissue-based testing showed 100% concordance. Efficacy data was not yet mature. Conclusions: The first PDSA cycle successfully implemented rapid molecular testing for hospitalized oncology consult patients, demonstrating its feasibility and impact on timely treatment initiation and outcomes. Future cycles will expand testing beyond oncology consult patients and involve broader subspecialty engagement to improve coordination, expedite diagnosis, and optimize survival outcomes to close this gap in care for hospitalized patients.