Incorporating EHR-application into care coordination for the timeliness of breast cancer surgery: A quality improvement initiative.

586 Background: Delays in time from diagnosis to treatment of breast cancer patients can have a negative impact on patient outcomes. In June 2022, the Commission on Cancer (CoC) released this measure: For patients with AJCC Clinical Stage I-III breast cancer, the first therapeutic surgery in a non-neoadjuvant setting is performed ≤ 60 days of diagnosis. In 2024, the Cancer Committee at JPS Health Network, a safety-net healthcare system in Tarrant County, Texas, approved a quality improvement project aimed to improve the percentage of patients who received surgery ≤ 60 days. Methods: A multidisciplinary team was formed at the end of 2023, and three levels at which delays occurred were identified:1) Diagnosis (abnormal imaging result) to biopsy 2) Biopsy to consultation with the breast surgeon 3) Consultation to date of surgery. A need was identified to enhance patient tracking. Historically, breast navigator manually tracked patients from biopsy result via Excel spreadsheet. Interventions comprised of :1) Standardization of terminology in radiology reports 2) Consultation with breast surgeon scheduled within a week of referral 3) Surgery date scheduled during the consultation visit 4) Implementation of Epic Compass Rose application: This was developed by Epic electronic health records (EHR) as a case management tool and was repurposed by JPS Information Technology to assist with care coordination. 5) Collaboration with the Health Center for Women – prompt notification of all biopsy proven malignancies to the navigator, 6) Meetings with surgical optimization team to streamline the process for optimization referrals prior to surgery. These interventions started in January 2024, except for Compass Rose, which was implemented in June 2024. Results: From January 2024 to December 2024, 78 patients were included for analysis. 52 out of 78 patients were concordant with the completion of first therapeutic surgery within 60 days (67%; 95% Cl: 56%-77%). This is higher than 2023, where only 14 out of 62 patients were concordant (23%; 95% confidence interval: 12%-33%; Chi-square P-value: <.0001). The median time from biopsy to consultation decreased after implementation of Compass Rose from 20 days (January 1, 2024-June 28, 2024) to 14 days (June 29, 2024-December 31,2024) (Mann Whitney U Test P-value: .03). Reasons for falling out of the 60-day timeline include financial clearance issues, specific requests for surgery dates and patients not being surgically optimized in a timely manner. Conclusions: The quality improvement project was successful in reducing the time to surgery and improving the percentage of patients concordant with CoC metrics at our institution. Care coordination by multiple team members led by the navigator, manual tracking with Excel supplemented by Compass Rose helped achieve this result. Future directions include continued monitoring and constant refining.