Implementation of an expedited cancer workup clinic for uninsured patients at a metropolitan safety net hospital.

1573 Background: Timely evaluation of patients with suspected cancer is essential; yet delays in diagnosis and treatment remain common in safety-net health systems, particularly for uninsured or underinsured patients. Such delays are associated with advanced stages of disease at the time of diagnosis and increased mortality. While inpatient evaluation can facilitate multidisciplinary coordination, it is associated with higher costs. Outpatient delivery models designed to expedite cancer workups have been demonstrated to reduce time to diagnosis and number of hospitalizations. We describe outcomes from an Expedited Workup Clinic (EWC) in a large Los Angeles County safety-net hospital. Methods: The EWC was designed to coordinate outpatient imaging, biopsy, and oncology specialty referrals for vulnerable patients with suspected malignancy. All patients were uninsured and lacked a primary care provider. Referrals originated from the Emergency Department (ED), Urgent Care, or inpatient admissions. We retrospectively analyzed outcomes from 2022 to 2025 using real-world data extracted from the Electronic Health Record. Results: 255 patients were referred to the EWC encompassing 153 men (60%) and 102 women (40%). 155 patients (60%) were Hispanic/Latino, with other represented ethnicities including 28 (10.9%) Asian/Pacific Islander, 22 (8.6%) Black/African American, and 14 (5.5%) White/Caucasian. Spanish was the preferred language of 150 patients (58.8%). The majority of patients (87.9%) were referred from the ED with a median time to first EWC appointment of 11 days (IQR 7-14). From the first EWC appointment, the median time to imaging was 6 days (IQR 1-14), to biopsy was 21 days (IQR 12-54), and to initiation of oncologic treatment was 51 days (IQR 34-83). 92 patients (36.1%) ultimately had a negative malignancy workup, and 38 patients (14.9%) were lost to follow-up. Among patients with confirmed malignancy, the most commonly identified primary sites were colorectal (19.2%), lung (10.6%), hematologic (9.6%), pancreatobiliary (9.6%), prostate (6.7%), head and neck (6.7%), hepatic (6.7%), renal (4.8%), gynecological (3.8%), melanoma (3.8%) and breast (3.8%). Conclusions: The EWC demonstrates the feasibility of providing timely malignancy evaluation for high-risk, uninsured patients within a resource-limited setting. These findings support the use of an outpatient rapid evaluation clinic, while surfacing opportunities for improvement including reducing the number of patients lost to follow-up. Further evaluation of cost-effectiveness and access barriers may continue to strengthen the design of rapid workup clinics meant to serve our most vulnerable patients.