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Location: Marriott Marquis
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PQA 09 - PQA 09 Hematologic Malignancies and Digital Health Innovations Poster Q&A

3456 - Should We Enter Orders and Prescriptions at Consult Time

Tuesday, October 1, 2024
4:00 PM – 5:00 PM ET
Location: Hall C

Screen: 19

M. Manning1, J. Liu2, B. J. Sintay1, J. S. Moody1, and D. Wiant1; 1Cone Health, Greensboro, NC, 2North Carolina School of Science and Mathematics, Durham, NC

Purpose/Objective(s): Accurate and timely orders and prescriptions (ORx) are essential for an effective radiation treatment. Insurance authorization, scheduling, and planning all depend on the presence of accurate ORx. Errors and delays in these areas can directly lead to errors and delays in treatment. Placing orders immediately following consult may allow for maximum time to carry out necessary steps with reasonable accuracy. Materials/

Methods: A custom web-based system to create, discretely enter, store, and automatically document ORx was developed. Physicians can create ORx using templates and decision support with only a few mouse clicks. Common regimens can be stored as templates, saving time and improving accuracy. This system allows any member of the department to request changes and logs the details of the changed element. This system has been in use for 5 physicians across 2 departments for the past 4 years. P</span>hysicians entered all ORx necessary for treatment immediately following the initial consult visit, prior to simulation. All changes from January 2021 to June 2023 were analyzed.
Results: A total of 8639 courses of care were reviewed. The treatments were grouped into 9 disease sites: abdomen, brain, breast, extremity, head and neck (HN), pelvis, prostate, spine, and thorax. All ordered dosimetric (dose, fraction, frequency) and imaging (type, frequency, alignment instructions) parameters were reviewed. Less than 5% of the breast, extremity, pelvis, and prostate patients had any dose changes. The remaining sites had dose changes on 10-15% of the cases. Breast, prostate, and HN had imaging orders changed on < 5% of the cases. Abdomen, brain, pelvis, and thorax had imaging orders changed on 10-15% of the cases. While extremity and spine had changes in up to 25% of the cases. Hypofractionated brain and thorax cases with tight dose constraints were the main causes of dose changes. Difficulty imaging spine cases (particularly T spine) and non-standard extremity cases were main causes of imaging changes.
Conclusion: Our results demonstrate that it is possible to quickly enter ORx at the time of consult with an acceptable accuracy using a templated web-based system. In addition, the automated entry and documentation process saves time and effort for physicians, which can reduce stress and burnout. Additional study is needed to better understand the impact of this process on team efficiency, workload and stress. Abstract 3456 – Table 1: Percent of cases that have order changes
Site Total Cases Dose/Fraction (%) Total Dose Dose/Fraction (%) Fractions Dose/Fraction (%) Image Type Dose/Fraction (%) Image Frequency Dose/Fraction (%) Image Alignment Dose/Fraction (%)
Abdomen 254 11 10 6 5 7 5
Brain 607 13 12 7 5 8 4
Breast 2849 3 3 2 4 5 3
Extremity 170 4 4 4 16 20 12
HN 431 11 12 9 3 3 3
Pelvis 999 5 5 4 7 9 6
Prostate 1304 2 2 2 1 0 2
Spine 442 7 7 4 11 16 9
Thorax 1583 16 15 14 6 11 5