Improving oncology transfer request timeliness to a tertiary hospital.

48 Background: Cancer patients treated at our regional facilities often need specialized oncology input, especially when a transfer is requested to our tertiary hospital for specialized cancer care. Orlando Health’s tertiary hospital is Orlando Regional Medical Center (ORMC), located in downtown Orlando. Transfers are requested from the system’s 10 hospitals, 9 hospital EDs, and 7 free-standing EDs in the Central Florida area. A transfer order may involve many phone calls between providers before a decision is made to either transfer the patient or discharge the patient with urgent outpatient follow-up. Improvement opportunities were identified in the transfer request process for cancer patients. ORMC, Orlando Health Cancer Institute, and the regional hospitals/EDs collaborated to improve timeliness of medical decision making and transfer request completion for cancer patients being treated at our regional facilities. Methods: In Feb 2023, multidisciplinary stakeholders began to categorize oncologic conditions and emergencies. Each condition was assigned the following guidance (example below): Category 1 = Emergent Transfer (within hours) to our tertiary hospital. Category 2 = Urgent Transfer (< 24 hours) to our tertiary hospital. Category 3 = Urgent Outpatient Evaluation. Recommended Testing/Communication before transfer. An Oncology Institutional Guideline was finalized and distributed to ED, inpatient, and consultant teams in Aug 2023, then revised in April 2024. Guidelines were made available on internal Quality webpage and embedded in Epic transfer order. An Epic report used to obtain baseline mean time (hours) of transfer request completion from a regional facility to our tertiary hospital. Statistical process control (XMR chart, continuous data) was used to monitor the change in outcomes. Results: Baseline transfer request completion time for requests from a regional facility to our tertiary hospital was 28.3 hours in 2022. We reduced mean transfer request completion time to 8.8 hours. Average volume of cancer patient transfer requests is 102 per month. Conclusions: The correct level of care is key to timely and appropriate care of cancer patients. As health systems expand and consolidate, streamlining and triaging the transfer process to tertiary care is essential. We reduced mean time from Transfer Request Start to Completion from 28.3 to 8.8 hours (-19.5 hours), for cancer patient transfer requests from a regional Orlando Health facility to our tertiary hospital. Timeliness of medical decision making for cancer patient transfer requests can be improved with collaboration from the following: disease-specific surgical oncology, medical oncology, radiation oncology, hematology physicians, ED physicians and hospitalists, and administrative patient placement/transfer center support.