EXPEDITING REFERRAL TO A LUNG CANCER RAPID ASSESSMENT CLINIC THROUGH REGIONAL STANDARDIZATION OF RADIOLOGIST REPORTING

Abstract

SESSION TITLE: Advances in Patient-Centered and Compassionate Care SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Lung cancer (LC) diagnostic pathways are often initiated following suspicious radiographic findings but are prone to delays in coordination of care. We previously demonstrated that a standardized Radiology report recommending referral to a rapid assessment clinic (Lung Diagnostic Assessment Program [LDAP]), led to faster specialist referral and assessment for patients with suspected LC at an academic centre. We spread this initiative to regional community hospitals and report the impact on LC diagnostic milestones. METHODS: Retrospective chart review of all LDAP-referred patients (Jan - Dec 2018), local standardization of Radiology reporting (Jan 2019), spread to 3 community hospitals (Mar 2019), prospective chart review (Jan - Sept 2019 for academic centre, Mar - Sept 2019 for community hospitals). Data include dates of: imaging suspicious for LC, CT chest, specialist referral and assessment, Radiology recommendation, including non-standardized language used for suspected LC. Continuous data are reported as means; unpaired t-tests assess for significance. Categorical data are reported as percentages; chi-squared tests assess for differences. RESULTS: We reviewed 1244 LDAP referrals (697 baseline [Jan - Dec 2018 academic centre, Jan 2018 - Feb 2019 community hospitals]; 547 post-standardization [Jan - Sep 2019 academic centre, Mar - Sept 2019 community hospitals]). Following standardization, the percentage of LDAP-referred patients that had a Radiologist recommendation for referral increased (27.4% to 45.9%, p<0.00001), significant for both the academic centre (50.2% to 61.8%, p=0.006) and community hospitals (12.1% to 35.3%, p< 0.00001). The uptake in standardized Radiology reporting varied across community hospitals (Site A, 6.5% to 42.5%, p< 0.00001; Site B, 30.5% to 22.4%, p=0.31; Site C, 2.0% to 12.9%, p=0.045), significant for Sites A and C. Of all LDAP-referred patients, 2.6% had a CT report with non-standardized language recommending specialist referral for suspected LC, most from Site B (74.2%). Following regional standardization, time to LDAP referral and specialist assessment remained faster (7.5 vs. 15.1 days, p=0.0001; 21.3 vs. 26.5 days, p=0.0004). After standardization, the overall percentage of inappropriate referrals to the LDAP decreased (18.4% to 13.9%, p=0.03), significant for the academic centre but unchanged for community hospitals. CONCLUSIONS: Regional spread of standardized Radiology reporting recommending specialist referral for patients with imaging suspicious for LC led to significant uptake in standardized reporting and a faster time to specialist referral and patient assessment. CLINICAL IMPLICATIONS: Timeliness of care and regional equity in the LC diagnostic process is improved with standardized Radiology reporting. Next steps include a Radiology directed referral process to further improve quality of care. DISCLOSURES: No relevant relationships by Gurmohan Dhillon, source=Web Response No relevant relationships by Genevieve Digby, source=Web Response No relevant relationships by Breanne Golemiec, source=Web Response No relevant relationships by Thomas Howard, source=Web Response No relevant relationships by Monica Mullin, source=Web Response