1043 - Department Wellbeing is Improved after a Process Improvement on Call Workflow Optimization

C. C. Baniel¹, A. Ewongwo², J. Frank¹, N. Nand³, J. Lewis⁴, K. McClain³, F. Murray³, H. P. Bagshaw⁴, K. C. Horst⁴, and M. F. Gensheimer⁵; ¹Stanford, Palo Alto, CA, ²Department of Radiation Oncology, Stanford University, Stanford, CA, ³Stanford Health Care, Stanford, CA, United States, ⁴Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, ⁵Radiation Oncology, Stanford University, Stanford, CA

Purpose/Objective(s): Effective treatment of urgent and emergent on-call cases requires teamwork and communication, and is an essential component of all departments. However, characteristics of being on call such as high volume of consults and delays in triage and treatment, can exacerbate provider burnout. Using process improvement methodology, this project aimed to assess and improve provider wellbeing related to being on call. Materials/

Methods: On call pages to the radiation oncology consult pager were prospectively collected for 8 weeks to determine inpatient volume. A 5 question needs assessment survey was sent to all radiation oncology staff to determine stress levels associated with being on call. Free text responses were categorized and a Pareto chart was used to identify vital areas in need of improvement. Key Drivers were determined and an improvement plan was implemented. Wellbeing was measured pre- and post-intervention using a 20 question validated survey on Professional Fulfillment, Work Exhaustion, Interpersonal Disengagement, and Operations Knowledge. Responses were scored from 0-100 and results are reported with descriptive statistics. A Specific, Measurable, Achievable, Relevant, and Time-based (SMART) goal was created to increase department wellbeing scores by 10% from baseline.
Results: Analysis of on-call volume showed a weekly average of 19 unique patient pages. Results from the baseline needs assessment demonstrated a high frequency of stress related to patient triage and disposition, communication, and staffing coverage. Key Driver analysis inspired interventions to improve: Communications, Workflow, and Staffing. Interventions included implementation of a single call pager, staggered resident and attending handoffs to improve patient continuity, and creation of a secure department Inpatient Operations shared folder containing a shared patient list with to-dos. Additionally, the radiation oncology inpatient referral order was revised with the EMR IT team and education was provided to referring services. After implementation of interventions, post-survey results 6 months after baseline survey demonstrated an improvement in department wellbeing by >10% (median 66.5 to 80.5). Scores related to Professional Fulfillment, Work Exhaustion, and Operations Knowledge all improved compared with pre-survey scores. Secondary outcome analysis showed a >25% increase in EMR radiation oncology consult orders. These findings resulted in leadership approval for hiring a radiation oncology APP to cover on call and palliative outpatient services.
Conclusion: The implementation of an improved on-call structure and workflow enhanced employee satisfaction and wellbeing. Interventions guided by a validated wellbeing assessment improved professional fulfillment and efficiency of practice with notable improvement in survey scores. The findings of this project highlight that efficiency of practice remains a cornerstone of provider wellbeing.