Understanding workflow of inpatient chemotherapy and developing strategies to improve provider coordination and treatment delivery.

67 Background: Inpatient chemotherapy administration is crucial for many hospitalized patients, yet it involves a multifaceted process requiring seamless collaboration among various healthcare professionals. The absence of a unified workflow for the ordering, verification, and administration of chemotherapy has led to significant delays in patient care and dissatisfaction among care teams. Addressing these challenges presents an opportunity to develop a streamlined process that improves provider communication and promotes efficient patient care. Methods: All patients that received off-floor chemotherapy between April 2023 and April 2024 at the Greenberg Pavillion at Weill Cornell Medicine were identified. Treatment-related cases in Keepsafe (incident reporting system) for these patients were evaluated and categorized. Oncology teams, primary medical teams, oncology pharmacy, and outfield chemotherapy nurse were interviewed to generate a process map of inpatient chemotherapy administration. Specific patient cases were reviewed to identify areas for improvement. Results: There was a total of 398 episodes of chemotherapy administered in 270 unique patients between April 2023 and April 2024 at Weill Cornell Medicine. Out of 14 Keepsafes submitted that were determined to be directly related to the chemotherapy administration process, 3 (21%) were related to poor communication between providers that led to delays in care. Additionally, 6 (43%) were related to discrepancies in documentation, 3 (21%) were related to vascular access, and 2 (14%) were related to hospital protocols. Root Cause Analysis (RCA) and case studies on each related Keepsafe were conducted which revealed several distinct errors that delayed patient care and increased hospital resource utilization. Conclusions: Inpatient chemotherapy is a complex task that requires coordination among multiple healthcare professionals, each with other active clinical responsibilities. Our review revealed several distinct areas for improvement including provider communication and documentation, meeting treatment parameters, patient education on side effects, and understanding the treatment capabilities of different units. These challenges led to delays in patient care, compromised patient safety, and wasted hospital resources. Interdisciplinary meetings to implement these strategies are ongoing, and we anticipate piloting an improved workflow in the upcoming academic year.