Association of Inpatient Radiation Oncology Consult Timing with Length of Hospitalization and Opioid Utilization

Abstract

<h3>Purpose/Objective(s)</h3> Inpatient providers responsible for placing radiation oncology inpatient consult requests (ICR) during hospital admission may not be as aware of potential indications for palliative radiotherapy as are radiation oncologists. We hypothesized that earlier ICR was associated with reduced length of hospitalization (LOH) and daily opioid usage (DOU). We also hypothesized that placement of ICR later in the week was associated with increased LOH. <h3>Materials/Methods</h3> Inpatients who received ICR at a tertiary academic center were identified using call logs from the radiation oncology on-call pager. Consecutively evaluated patients from July 2020 - March 2021 were selected for retrospective cohort analysis. Timing of ICR by pager notification, including day of week, was recorded. LOH was determined using dates of admission and discharge. ICRs were categorized into early in week (Monday-Wednesday) vs. later in week (Thursday-Sunday). Home and hospital opioid regimens were recorded and converted to morphine milligram equivalents (MME) for calculation of change in DOU. It was noted if ICR was for malignant spinal cord compression (mSCC) or if patients ultimately received same-day simulation and delivery of first treatment fraction ("sim & treat"). Patients receiving elective ICR for heterotopic ossificans prophylaxis were omitted for time-to-event analyses. Multivariable linear regression assessed associations between time-to-event predictors with outcome variables, including LOH and DOU. <h3>Results</h3> 270 patients were reviewed. 79 (29.3%) ICRs were for pain, 113 (41.9%) for neurologic compromise (e.g., headache/sensorimotor deficits), 31 (11.5%) for thoracic symptoms (e.g., dysphagia/dyspnea), 20 (7.4%) for bleeding, 10 (3.7%) for obstructive symptoms (e.g., bowel obstruction/urinary retention), and 26 (6.3%) for elective indications. 47 (18.0%) received ICR for cord compression and 130 (49.8%) received same-day sim & treat. Controlling for timing in week of ICR and mSCC/same-day treatment, each additional day from inpatient admission to ICR was associated with 1.3 days longer LOH (95% CI: .98-1.57, p<0.0001), and ICRs placed later in the week were associated with 2.3 days longer LOH (95% CI: .43-4.25, p=.02). mSCC was independently associated with longer LOH (OR: 3.95; 95% CI: .76-7.13, p=.004). A trend towards significance was observed for association of longer LOH with increase in DOU (6.0 mg/day increase in MME; p=.06). <h3>Conclusion</h3> Later ICR during admission and timing of consult in week are associated with longer LOH. The latter may reflect reduced availability of departmental personnel and resources. Informing inpatient providers of common treatment indications and encouraging earlier ICR placement may mitigate delays in ICR while potentially preventing increases in DOU, with further data and validation for this needed.