Logistical Assessment of Palliative Radiotherapy Workflow for Hospitalized Patients at a Single Academic Institution

Abstract

Inpatient palliative radiotherapy (RT) delivery is logistically challenging. Patients often present with complex medical and psychosocial issues, and coordination with multiple specialty services is essential to optimize management. Herein, we report on a logistical assessment of our institution’s practice of delivering care to hospitalized patients to identify opportunities for improving efficient, patient-centered care. A retrospective analysis of 76 consecutive inpatient palliative RT treatments from August 2017 to September 2019 at a single academic center was performed. All patients received RT for symptom control. Clinical and treatment characteristics were recorded, as were the timing of consultation, CT simulation, contour session creation, contour approval, plan approval, and treatment delivery. When treatment breaks (1+ days without treatment after its initiation) or delays (defined as 1+ hour delay from scheduled simulation/treatment) occurred, the attributed reasons were aggregated. The most common sites for palliative treatment were the spine (36%), brain (32%), and non-spine bone (8%). Planning techniques included 3D conformal RT for 78%, intensity-modulated RT for 11%, and stereotactic radiosurgery/stereotactic body RT for 12% of the cohort. Median time from consultation to initial treatment delivery was 69 hours, and the time period for each step in the RT workflow is listed in the Table, with the time from consultation to simulation being the longest period. Median simulation and first treatment time stamps were at 12:43 (IQR 10:14-14:50) and 14:57 (IQR 13:23-16:18). 26% of the cohort experienced treatment breaks largely due to ongoing goals-of-care discussions (35%) and medical complications unrelated to RT (25%). 22% experienced delays related to transportation services (29%) and conflicting timing with other physicians delivering care (24%). Although inpatient treatment was initiated quickly for most patients, interruptions and delays were common. Potential intra-departmental logistical changes include scheduling simulations/treatments earlier in the day and/or week to optimize time for treatment planning and delivery, and prioritizing inpatient treatment planning over outpatient planning. Inter-departmentally, earlier goals-of-care discussions and processes to improve coordination with transportation services and multidisciplinary care teams could optimize efficient treatment delivery.Abstract 2462; TableDuration of critical workflow processes to deliver palliative radiotherapyMedian (hr)Interquartile Range (hr)Consult to CT Simulation2210 - 45CT sim to contour session ready for physician input11 - 3Contour session ready to contour approval52 - 21Contour approval to plan approval153 - 30Plan approval to 1st treatment fraction52 - 23Consult to 1st treatment fraction6928 - 144 Open table in a new tab