Healthcare Network Research Articles

Implementing a Hospital-Wide Programme Using iPARiHS to Prevent and Manage Incontinence-Associated Dermatitis and Improve Hospital-Acquired Pressure Injuries.

To outline the implementation of a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Services framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries. This is an empirical research study using mixed methods. The study, conducted across surgical, medical and critical care wards between June and October 2023, aimed to address knowledge gaps, enhance clinical practice and evaluate the effectiveness of interventions. The implementation strategy included education modules, engagement of staff through focus groups and targeted interventions such as individualised toileting plans and structured skin care regimens. Data collection involved audits, incident reporting and clinician knowledge surveys. Findings indicate a reduction in hospital-acquired incontinence-associated dermatitis and pressure injuries postimplementation, with observed improvements in clinician knowledge. However, challenges including workload, skill mix and resource limitations were identified as barriers to implementation. The sustainability and scalability of the programme were emphasised, with ongoing monitoring and evaluation essential for long-term success. This study underscores the importance of evidence-based interventions, interdisciplinary collaboration and leadership support in improving patient outcomes and reducing healthcare costs associated with preventable skin injuries. Further research is needed to assess implementation in community settings and scale up interventions across healthcare networks. Analysing a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Service framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries, could help identify the challenges for delivering patient-centred care. No patient or public involvement. To describe the implementation study, we referred to the StaRI Guideline. This intervention study was applied to the whole population and was therefore not a trial and did not require trial registration. The study was considered low risk and the Human Research Ethics Application (HREA) was approved.

GLP-1 Receptor Agonists Confer No Increased Rates of IBD Exacerbation Among Patients With IBD.

In patients with inflammatory bowel disease (IBD), multimorbidity with obesity and type 2 diabetes is common and increasing. Glucagon-like peptide 1 (GLP-1) receptor agonists are increasingly being prescribed for patients with IBD, yet their impact on patients with IBD is largely unknown. We aimed to assess the impact of GLP-1 receptor agonists on the course of IBD. We identified all IBD patients prescribed GLP-1 receptor agonists at a large academic healthcare network between 2009 and 2023. We analyzed demographics and IBD characteristics in the year pre- and post-GLP-1 receptor agonist prescription and matched them to non-IBD controls. Our primary outcome was IBD exacerbation in the year following GLP-1 receptor agonist initiation, measured as a composite of IBD-related hospitalization, corticosteroid prescription, medication escalation or changes, or IBD-related surgery. Secondary outcomes included change in metabolic risk factors. Overall, 224 patients met inclusion criteria. At GLP-1 receptor agonist initiation, the median age was 54 years, 63% were female, 77% were White, and median BMI was 33.2kg/m2. Compared to the 12-month period prior to GLP-1 receptor agonist initiation, in the 12 months post-GLP-1 receptor agonist initiation, there was no change in rates of IBD exacerbation, IBD-related hospitalization, steroids prescription, medication escalation or changes, or IBD-related surgery. There was a significant decrease in BMI in the year following GLP-1 receptor agonist initiation (median BMI 33.5 vs 31.6kg/m2, P < .01), with rates of decrease comparable to non-IBD matched controls. In patients with IBD, GLP-1 receptor agonists are effective for weight loss and associated with few episodes of disease exacerbation.

Influence of socioeconomic aspects on morbidity and mortality rates from COVID-19 in the state of Tocantins, Brazil

This study aimed to analyze the spatial correlation of COVID-19 with social vulnerability indices in the state of Tocantins. Methodology: An ecological and cross-sectional study was conducted, analyzing the temporal evolution of the pandemic using the local bivariate Moran's index and the Kernel intensity estimator for COVID-19 cases in Tocantins from 2020 to 2022. Results: The northern region of the state showed the highest concentration of cases and deaths, a concerning fact given the high social vulnerability of most municipalities in this region. Conclusion: The study identified a positive spatial correlation between the incidence and mortality rates of COVID-19 and the social vulnerability index of the municipalities. These findings highlight the need to strengthen preventive measures and expand the physical, technological, and human resources of the healthcare network, especially in areas serving populations with higher vulnerability and traditional communities. This is particularly relevant as the disease also affects more isolated areas, impacting indigenous, riverside, and quilombola populations.

Hospital Network Centralization of Primary Total Joint Arthroplasty Is Associated With Reduced Early Complication Rates But Not Reduced Readmission or Reoperation Rates: A Retrospective Database Study

Background: Hospital networks centralize primary total joint arthroplasty (TJA) within their existing systems to develop specialized service lines with higher surgical volumes to reduce adverse events. It is not known what role hospital network centralization has had on primary TJA outcomes. Purpose: We sought to determine whether the degree of hospital network centralization for primary TJA is associated with (1) 90-day postoperative complication rates, (2) 90-day hospital readmission rates, or (3) 1-year revision rates. Methods: We conducted a retrospective database study of Medicare Part A beneficiaries who underwent inpatient primary TJA for osteoarthritis in 2016 and 2017 ( n = 523,142 patients); individual hospital-level characteristics and hospital networks were also identified ( n = 360 unique networks, n = 3339 hospitals). Patients having surgery at a hospital that was not a member of a health care network were excluded ( n = 163,998 patients) because we wanted to examine only the role of network structures on outcomes; this resulted in a cohort of 359,144 patients. Hospital network centralization, which was defined as the percentage of total network cases performed at the highest volume hospital and categorized into quartiles (eg, lowest 25% of networks by concentration, 26%–50% of networks by concentration, etc). Primary outcomes included postoperative 90-day complications, 90-day readmissions, and 1-year revisions. Multivariable logistic and linear regressions evaluated associations of hospital network centralization with outcomes and controlled for relevant patient-level and hospital-level covariates, including hospital network volumes. Results: Odds of 90-day complications were lower in the most centralized hospital networks than in least centralized networks (odds ratio [OR] = 0.85; 95% confidence interval [CI]: 0.75, 0.95). Degree of centralization was not associated with readmissions or 1-year revision rates. Non-modifiable patient and individual hospital characteristics appeared to have a greater association with complications, readmissions, and early revision rates than hospital network centralization or volume. Conclusion: This retrospective database study found that increased centralization of primary TJA within a hospital network was associated with lower 90-day complication rates but not with 90-day readmission or 1-year revision rates. This suggests that structural changes within hospital networks may be beneficial to reduce early complications in this patient population. In addition, our findings suggest that risk adjustment in assessing non-modifiable patient and hospital risk factors may be important when assessing TJA outcomes.

Smart Green Cotton Textiles with Hierarchically Responsive Conductive Network for Personal Healthcare and Thermal Management.

Whereas cotton as an abundant natural cellulose has been widely used for sustainable and skin-friendly textiles and clothes, developing cotton fabrics with smart functions that could respond to various stimuli is still eagerly desired while remaining a great challenge. Herein, smart multiresponsive cotton fabric with hierarchically copper nanowire interwoven MXene conductive networks that are seamlessly assembled along a 3D woven fabric template for efficient personal healthcare and thermal comfort regulation is successfully developed. The robust hierarchically interwoven conductive network was "glued" and protected by organic conductive polymer poly(3,4-ethylenedioxythiophene) along a 3D interconnected fabric template to enhance interfacial adherent and environmental stability. Benefiting from the robust multiresponsive hierarchically interwoven conductive network, smart cotton fabric exhibits real-time response to various external stimuli (light/electrical/heat/temperature/stress), and the details of human activities can be accurately recognized and monitored. Furthermore, the porous structure of 3D smart fabric induced strong capillary force and confinement to phase change materials PEG, which exhibits a wide range of phase transition temperatures for efficient thermal comfort regulation. After further encapsulation with transparent fluorosilicone resin, the smart cotton fabric exhibits excellent self-cleaning performance with water/oil repellent. The smart multiresponsive cotton fabrics hold great promise in next-generation wearable systems for efficient personal healthcare and thermal management.

OA17.04 Implementation of a Natural Language Processing (NLP) Model to Detect Incidental Lung Nodules in a Nationwide Health Care Network

OA17.04 Implementation of a Natural Language Processing (NLP) Model to Detect Incidental Lung Nodules in a Nationwide Health Care Network

The clinical and genetic spectrum of paediatric speech and language disorders.

Speech and language disorders are known to have a substantial genetic contribution. Although frequently examined as components of other conditions, research on the genetic basis of linguistic differences as separate phenotypic subgroups has been limited so far. Here, we performed an in-depth characterization of speech and language disorders in 52 143 individuals, reconstructing clinical histories using a large-scale data-mining approach of the electronic medical records from an entire large paediatric healthcare network. The reported frequency of these disorders was the highest between 2 and 5 years old and spanned a spectrum of 26 broad speech and language diagnoses. We used natural language processing to assess the degree to which clinical diagnoses in full-text notes were reflected in ICD-10 diagnosis codes. We found that aphasia and speech apraxia could be retrieved easily through ICD-10 diagnosis codes, whereas stuttering as a speech phenotype was coded in only 12% of individuals through appropriate ICD-10 codes. We found significant comorbidity of speech and language disorders in neurodevelopmental conditions (30.31%) and, to a lesser degree, with epilepsies (6.07%) and movement disorders (2.05%). The most common genetic disorders retrievable in our analysis of electronic medical records were STXBP1 (n = 21), PTEN (n = 20) and CACNA1A (n = 18). When assessing associations of genetic diagnoses with specific linguistic phenotypes, we observed associations of STXBP1 and aphasia (P = 8.57 × 10-7, 95% confidence interval = 18.62-130.39) and MYO7A with speech and language development delay attributable to hearing loss (P = 1.24 × 10-5, 95% confidence interval = 17.46-infinity). Finally, in a sub-cohort of 726 individuals with whole-exome sequencing data, we identified an enrichment of rare variants in neuronal receptor pathways, in addition to associations of UQCRC1 and KIF17 with expressive aphasia, MROH8 and BCHE with poor speech, and USP37, SLC22A9 and UMODL1 with aphasia. In summary, our study outlines the landscape of paediatric speech and language disorders, confirming the phenotypic complexity of linguistic traits and novel genotype-phenotype associations. Subgroups of paediatric speech and language disorders differ significantly with respect to the composition of monogenic aetiologies.

Early Lessons From Working With Local Partners to Expand Private-Sector Health Care Networks in Burundi and Mali.

The private health care sector is an important source of service delivery in low- and middle-income countries (LMICs). Yet, the private sector remains fragmented, making it difficult for health system actors to support and ensure the availability of quality health care services. In global health programs, social franchising is one model used to engage and organize the private health care sector. Two social franchise networks, ProFam in West Africa and Tunza in East and Central Africa, provide health care through branded networks of facilities. However, these social franchise networks include a limited number of private health care facilities, and in fragile contexts, like Burundi and Mali, they have faced challenges in integrating with national health systems. The MOMENTUM Private Healthcare Delivery (MPHD) project in Burundi and Mali sought to expand the number of health facilities it engaged beyond the existing ProFam and Tunza networks. The expansion aimed to help improve service quality in more private facilities while advancing localization and reducing fragmentation for improved stewardship by health system actors. MPHD achieved this expansion by removing barriers for private health facilities to join inclusive, nonbranded networks and engaging local partners to build and maintain these networks. We share lessons learned regarding the growing role of local organizations as actors within mixed health systems and provide insights on strengthening stewardship of the increasingly heterogeneous private health care delivery sector in LMICs, particularly in fragile settings.

Trends over time in oral anticoagulation and stroke rates in atrial fibrillation: A community-based study

ObjectivesOver the last decade, direct oral anticoagulants (DOAC) have become preferred over warfarin for stroke prevention in atrial fibrillation (AF). The objectives of this study were to quantify the shift over time from warfarin to DOACs and parallel changes in ischemic and hemorrhagic stroke rates in AF. Materials and methodsThis community-based retrospective study was undertaken within a single integrated health care network from 2011 to 2021. Changes over time in warfarin and DOAC use were quantified by year, both overall and stratified by CHA2DS2-VASc score. Ischemic and hemorrhagic stroke rate changes over time were evaluated by Poisson regression. Stroke rates were evaluated in different time eras: 2011–2015 and 2016–2021. ResultsAmong 31,978 AF patients followed an average of 5.5 years, any OAC use increased from 50.2 % (2011) to 59.4 % (2020) (p < 0.001). Warfarin use decreased from 49.3 % to 30.8 %, while DOAC use increased from 2.0 % to 30.8 % (both p < 0.001). In 2020, patients with CHA2DS2-VASc 0–1 and 2–5 were more likely to use DOACs than warfarin (18.6 % vs. 6.7 %; 33.0 % vs. 28.2 %), whereas in CHA2DS2-VASc 6–9 DOACs were used less frequently (30.0 % vs. 40.8 %). Ischemic stroke rates significantly increased by 19 % (95 % CI: 7 %, 32 %) from 2011 to 2015, but significantly decreased by 18 % (10 %, 26 %) from 2016 to 2021. Hemorrhagic stroke rates stabilized in 2016–2021 (+3 %; −18 %, 30 %) after increasing in 2011–2015 (+36 %; 4 %, 78 %). ConclusionImprovements in ischemic and hemorrhagic stroke rates coincided temporally with increased uptake of OACs and a shift toward increased uptake of DOACs relative to warfarin.

Quantum image encryption protocol for secure communication in healthcare networks

Quantum image encryption protocol for secure communication in healthcare networks

Long-lifespan, biodegradable, self-disinfecting, and gas-sensing electronic mask with a Janus-structured all-natural fiber network for personal healthcare

Conventional disposable surgical masks have become an integral part of our daily lives, however, present a limited filtration efficiency, brief operative lifespan, and inability to degrade naturally, bringing a heavy burden to the environment. Moreover, these masks cannot efficaciously eliminate bacteria, potentially causing secondary and cross infections among users, thereby failing to curb the spread of infectious diseases. Herein, a fire-new, long-lifespan, biodegradable, self-disinfecting, and gas-sensing electronic-mask is nano-engineered with a Janus-structured all-natural fiber network (SA-CPN) constructed from animal-collagen and plant-fibers. SA-CPN demonstrates exceptional filtration performance (99.9%) for PM2.5 and maintains outstanding filtration efficiency after 10 test-cycles or 32 h in high-humidity conditions. SA-CPN exhibits robust antibacterial origins for extended periods, with antibacterial rates of 98.30%, 99.36%, and 98.11% against P aeruginosa, S aureus, and E coli, respectively, and can effectively filter airborne bacterial aerosols. Moreover, SA-CPN achieves real-time detection of ammonia concentrations, effectively identifying ammonia levels in exhaled human breath and external environments, and monitoring the human respiratory rate, potentially identifying underlying health conditions. The directional water vapor transmission capability of SA-CPN improves comfort when wearing. Notably, SA-CPN can fully biodegrade within 5 h under enzyme action. The proposed multifunctional electronic mask, featuring biocompatibility, biodegradability, self-disinfection, and ammonia sensing capabilities, holds significant promise in personal medical protective equipment for health monitoring and disease prevention.

Physical Restraint Use in Hospitalized Patients: A Study of Routinely Collected Health Records Data.

The use of restraints in hospitalized patients is associated with physical and psychological adversity for patients and staff. The minimization of restraint use is a key goal in the hospital setting. Reaching this goal requires an accurate assessment of existing patterns of use across clinical settings. This study reports the rate of physical restraints among patients hospitalized within a multi-entity healthcare network along with stratification by care context, diagnostic, and demographic factors, and examines the sensitivity and specificity of ICD-10 code Z78.1 "physical restraint status" for defining physical restraints relative to electronic health record (EHR) documentation. The EHR was used for a retrospective analysis of all adults hospitalized between 2017 and 2022. Hospitalized adults. Patient demographics, structured diagnostic information, care area, length of stay, and in-hospital mortality, Z78.1 coding for physical restraints, restraint documentation in orders and flowsheets. Among 742,607 hospitalizations, 6.3% (n=47,041) involved the use of physical restraint based on coding or EHR documentation. Treatment in the intensive care unit (ICU) included restraint in 39% of encounters whereas treatment outside the ICU included restraint use in 1.3% of encounters. Besides critical illness, demographic factors including increasing age (adjusted odds ratio (aOR)=1.21 [1.19-1.23]), male gender (aOR=1.56, [1.52-1.60]), unknown race (aOR=1.27 [1.19-1.35]), and preferred language other than English (aOR=1.24, [1.18-1.29]) were associated with higher odds of restraint utilization. As compared to EHR orders or documentation of restraint, the ICD-10 code for physical restraint had a sensitivity of 1.5% and a specificity of 99.99%. Among adults admitted to acute care hospitals, clinical, demographic, and operational factors were associated with increased odds of restraint, with care in the ICU associated with greatly increased odds of restraint. Research into restraint utilization using coded administrative claims data is likely limited by the sensitivity of physical restraint coding.

Survey of the endoscopy workforce’s perception of sustainability

ObjectiveThe National Health Service is a significant contributor to greenhouse gas emissions, with endoscopy ranking as the third highest contributor of waste in healthcare. We aimed to ascertain the endoscopy...

Housing instability increases for stimulant-involved overdose deaths after linking surveillance data to electronic health records in Kentucky

BackgroundAccording to the U.S. Centers for Disease Control and Prevention, approximately 10.2 % of fatal overdoses in 2022 were among people experiencing homelessness or housing instability. In the United States, the majority of all drug overdoses now involve stimulants. MethodsWe linked stimulant-involved fatal overdose records occurring between 2017 and 2021 from Kentucky’s Drug Overdose Fatality Surveillance System to the electronic health records (EHR) of the state’s largest safety-net hospital network. We used State Unintentional Drug Overdose Reporting System (SUDORS) definitions of homelessness or housing instability to establish baseline estimates before linking decedents to medical records. After linkage, we augmented SUDORS data with structured administrative billing codes, semi-structured address data, and unstructured clinical notes identifying homelessness from the EHR. ResultsThere were 313 individuals with stimulant-involved fatal overdoses linked to at least one medical encounter in the EHR (2017–2021). Thirty-three individuals (10.5 %) were identified as having unstable housing according to SUDORS. After linkage, 130 individuals (41.5 %) had evidence of housing instability. For this period, these 313 individuals represent 8.0 % of stimulant-involved overdoses in KY or 38.5 % of stimulant-involved overdoses from residents of the primary and secondary catchment area of our healthcare network. ConclusionsThe single-site increase in observed housing instability in stimulant-involved fatal overdoses suggests that increased data linkage between state medicolegal death investigation system and EHRs would significantly improve the public health surveillance of overdoses.

A bilevel hierarchical covering model to protect a healthcare network against failures

A bilevel hierarchical covering model to protect a healthcare network against failures

A-207 Enhancing Healthcare Delivery Network Laboratories: The Role of Third-Party Consultants in Benchmarking and Reviewing RFP Results

Abstract Background Healthcare delivery networks, particularly laboratory services, play a critical role in patient care and diagnosis. However, ensuring the quality and efficiency of these services can be challenging due to the complex and dynamic nature of healthcare systems. Third-party consultants offer valuable expertise in benchmarking and reviewing Request for Proposal (RFP) results, which can improve the quality and cost-effectiveness of laboratory services within healthcare networks. Methods To evaluate the role of third-party consultants in enhancing healthcare delivery network laboratories, the author conducted surveys to 50 laboratory leaders with a 50% response rate and analyzed the following aspects: Benchmarking: Comparing laboratory performance metrics with industry best practices and peer institutions to identify areas for improvement. RFP Review: Utilizing subject matter experts to assess the technical and financial proposals submitted by vendors to ensure compliance with RFP requirements and to identify the most suitable vendor for the network. Emotional Procurement: Minimizing the influence of emotional factors, such as personal relationships or brand loyalty, during the RFP process. Results Improved Quality: 65% said they can save &amp;gt;50 hours of labor utilizing a 3rd party for RFP, thus able to focus on patient results and quality. Cost Savings: 76% of respondents said consultants can help networks reduce expenses and improve their financial performance by 10-20% above and beyond incumbent negotiations. Emotional Procurement Mitigation: While the specific statistics supporting the influence of consultants on mitigating emotional factors in procurement decisions are not readily available, the broader impact of emotions on decision-making is well-documented. Therefore, while direct statistics may be limited, the influence of emotions on procurement decisions is a recognized factor in the field of decision science and consumer behavior. Turn around time: 70% of respondents said utilizing a 3rd party can reduce the turnaround time of a sourcing event from &amp;gt;3 months to &amp;lt; 1months. Conclusions Third-party consultants can provide valuable insights and expertise in benchmarking and reviewing RFP results, leading to several benefits. They can play a crucial role in enhancing healthcare delivery network laboratories by providing valuable expertise in benchmarking, reviewing RFP results, communication and reducing turnaround time. By improving quality, reducing costs, mitigating emotional procurement based on brand loyalty, and enhancing collaboration, consultants can help networks deliver high-quality services to patients and improve their overall performance. Consultants can facilitate more focused communication and partnership development between laboratories, vendors, and other stakeholders, ensuring a seamless transition and optimal performance without scope creep. As healthcare networks continue to evolve and face new challenges, the role of third-party consultants will become increasingly important in ensuring the quality and efficiency of laboratory services, potentially resulting in $100’s of millions in cost takeout across the country.

Quality improvement approach to reduce patient cycle time at a student-run free healthcare clinical network

BackgroundThe University of Florida (UF) Equal Access Clinic Network (EACN) is the largest student-run free healthcare clinic network in Florida. The UF EACN serves those who are underinsured or uninsured...

Transition from paediatric to adult neurological care: What do we know?

IntroductionHealthcare advances have allowed an increase in the survival of paediatric patients with neurological diseases. As a result, it is increasingly common to find these patients in adult neurology consultations. The aim of this study is to evaluate the current level of consensus on the transition of neuropaediatric patients among neurology and paediatric professionals in the Balearic Islands. Material and methodsWe conducted an observational, analytical, cross-sectional study through an anonymous questionnaire consisting of 27 questions, which was distributed to neurologists, paediatric neurologists, hospital paediatricians, and primary care paediatricians in the healthcare network of the Balearic Islands. It was developed using Google Forms and distributed by the competent professional societies. Consensus was considered to exist for answers with 70% or more agreement. ResultsResponses were received from 58 professionals; 46.6% were hospital paediatricians, 29.9% were neurologists, 13.8% were paediatric neurologists, and 13.8% were primary care paediatricians. Among other issues, consensus was observed on the need for a transition programme for patients with neurological diseases. No consensus was observed regarding the duration of the transition (P=.029) and how long simultaneous follow-up must last after the transfer (P=.09). ConclusionsDue to increased survival rates, there is a need to create transition programmes for paediatric patients with neurological diseases. In our study, more than 70% of professionals believed that it would be beneficial to create such programmes.

Enhancing Smart Healthcare Networks: Integrating Attribute-Based Encryption for Optimization and Anti-Corruption Mechanisms

This study investigates the feasibility and effectiveness of integrating Attribute-Based Encryption (ABE) into smart healthcare networks, with a particular focus on its role in enhancing anti-corruption mechanisms. The study provides a comprehensive analysis of current vulnerabilities in these networks, identifying potential data security risks. An anti-corruption mechanism is designed to ensure data integrity and reliability. The ABE approach is then empirically compared to other prominent encryption algorithms, such as Identity-Based Encryption, Data Encryption Standard, Advanced Encryption Standard, and Rivest-Shamir-Adleman algorithms. These methods are evaluated based on access latency, data transmission speed, system stability, and anti-corruption capabilities. Experimental results highlight the strengths of the ABE algorithm, demonstrating an average access latency of 31.6 milliseconds, a data transmission speed of 3.56 MB/s, and an average system stability of 98.74%. Furthermore, when integrated into anti-corruption mechanisms, ABE effectively protects against data tampering and misuse, ensuring secure data transmission. Compared to alternative algorithms, ABE offers a more efficient, secure, and stable solution for data management within smart healthcare networks, supported by its robust anti-corruption capabilities. This positions ABE as an optimal choice for safeguarding the integrity and security of healthcare data.

Improving distress screening in radiation oncology consultation.

332 Background: Receiving a cancer diagnosis and awaiting initial management recommendations is a stressful time. Distress should be recognized, documented, and treated promptly as part of quality oncologic care. The NCCN Distress Thermometer (DT) is a useful tool for patients to quantify their level of distress. This pilot study assesses the rate of distress screening at a high-volume academic healthcare network, before and after institutional quality improvement (QI) intervention. Methods: All patients seen for Radiation Medicine between 1/1/22 - 12/31/23 were reviewed. Rates of DT documentation at the time of consultation were assessed as the QI metric. Patients seen in 2022 served as a baseline of departmental compliance. The importance of distress assessment was formally introduced to physicians and advanced care practitioners (ACPs) in Q4 2022 during monthly departmental quality reports, with notice that a formal QI metric would be monitored beginning 1/1/23. Chi-square test was used to compare rates of DT documentation. Monthly departmental DT documentation rates were back presented to the physicians and ACPs during quality meetings. Results: 9391 patients were seen for radiation oncology consultation (2022 = 4311; 2023 = 5080). Baseline DT documentation was 51.0%. Initial compliance with the metric was below baseline, at 41.4% for Jan 2023. With continued feedback, education, and goal-setting, rates of DT use continually improved over Q1/Q2 2023 and remained relatively steady through the remainder of Q3/Q4 2023, reaching a monthly high of 89.8%. Overall DT documentation significantly improved for 2023 was 81.4% (χ 2 = 977.9, p &lt; 0.0001). The rates of DT documentation were relatively consistent based on diagnoses codes, though lower amongst consults seen for metastatic disease (84.0% vs 73.4%, χ 2 = 24.28, p &lt; 0.0001). Conclusions: Screening rates at consultation are modifiable and maintainable, but distress management remains a continuous quality improvement project as we explore services to address identified stressors and reassess distress levels at future visits.