Impact of a Dedicated Inpatient Radiation Oncology Consult Service on Goal-Concordant Care

Purpose Radiotherapy has an increasing role in the management of metastatic cancers. Integrating radiation with surgical and systemic approaches is complex, and inappropriate management can lead to prolonged hospitalizations inconsistent with palliative goals. An Inpatient Radiation Oncology Consult (IROC) service was created in January 2020 to provide rapid access to specialized care for hospitalized patients. Here we report outcomes of the IROC service, focusing on quality-of-care metrics including hospital length-of-stay (LOS), use of hypofractionated approaches, and treatments for patients discharged to hospice. Methods and Materials We conducted a pre-post observational study to compare inpatient consults placed before ( N = 1,507) and after ( N = 1,509) IROC, from 2019-2021. Continuous variables were analyzed using the Mann-Whitney test and categorical variables using the Fisher's exact test. Results We found that IROC was associated with reductions in hospital length of stay (LOS, mean difference 1.0 days, P = 0.045). Under IROC, inpatient treatment courses were shorter (5.8 v 5.0 days, P = 0.007), in part driven by increased adoption of palliative hypofractionated radiotherapy approaches (74% v 82%, P = 0.001). The reduction in LOS was greatest for patients discharged to hospice (5.1 v 3.7 days, P = 0.036). Conclusions The IROC service was associated with reduced hospital LOS, increased use of hypofractionated approaches and decreased treatments for patients discharged to hospice. Our findings demonstrate the value of a dedicated program addressing radiation delivery to hospitalized patients to improve goal-concordant treatments. The financial impact of reducing low value care is an important subject for future investigations.