Optimizing workflow for OncotypeDx result turnaround time from surgery to report at safety net hospital.

Abstract

317 Background: OncotypeDx test has been widely used for breast cancers patients with early-stage (I-IIIa), hormone-receptor positive, HER2-negative disease. It predicts the benefit of adjuvant chemotherapy in addition to hormone therapy. Delivering OncotypeDx results in a timely manner is important to inform treatment decisions. As a quality improvement project, we implemented a strategy to reduce the Turn Around Time (TAT) from breast surgery to OncotypeDx report at Bellevue Cancer Center, the tertiary referral center of the NYC Health and Hospitals System. Methods: The primary measure was TAT from surgery to receiving OncotoypeDx result in electronic medical record (EMR). We compared TAT before and after implementation of the strategy. The historical control was from 5/2021 through 3/2022, while the group after strategy implementation was from 6/2023 to 1/2024. The strategy revolved around streamlining the identification of eligible patients by collaborating with the breast surgery team, creating and utilizing a smart phrase in the EMR. It also involved ordering OncotypeDx by closely communicating with the pathology department, obtaining insurance approval by working with the OncotypeDx vendor, and tracking OncotypeDx results. The above process was done by a breast surgery provider that offered real time updates in the EMR. Results: The patient groups were similar both before and after implementing the strategy, including patient number (26 and 27 respectively) and patient mean age (61 and 59). The majority of both groups were minority patients (77% and 81%). We found that a higher percentage of patients were from Medically Underserved Areas and Populations (MUA/P) in the group after strategy implementation (35% and 56%). Our strategy reduced the average TAT from 56 days to 30 days. Conclusions: We developed a strategy to optimize the OncotypeDx workflow in a large safety net health system despite an increase in patients from MUA/P. Initiating ordering of OncotypeDx by breast surgery along with communication with pathology and the vendor significantly reduced TAT. EMR integration with OncotypeDx vendor would be the next step to further improve the process. Before Strategy Implementation (n=26) After Strategy Implementation (n=27) Patient Mean Age 61 59 Race (%) White 27 18.5 Hispanic 39 44.4 Black 7 25.9 Asian 23 11.1 Other 4 0 Ethnicity (%) Hispanic 39 44.4 Non-Hispanic 61 55.6 Underserved Area and Population (%) 35 56 Health Professional Shortage Area (%) 50 59 Non-English Speaking (%) 50 40.7