Development of a Prompt Radiation Oncology Mediated Palliative Treatment (PROMPT) Program for Handling Urgent Cases at an Academic Hospital.

173 Background: Oncology inpatients frequently need urgent palliative radiation therapy (RT). Evaluating and treating these unscheduled patients adds challenge and stress to all members of the radiation oncology team. To efficiently and compassionately address these situations, and ensure prompt, evidence-based, quality treatment, we developed the PROMPT program. This included scheduling designated consult slots for emergencies, adding flexible CT simulation times, assigning palliative-specific dosimetrists, and engaging support staff to improve workflow. The purpose of this project was to evaluate the PROMPT program with various quality metrics and identify areas for further improvement. Methods: Patient data from inpatient encounters for academic year 2016-2017 (July 1, 2016 to June 30, 2017) were reviewed. The day of the consultation, reason for consult, date of simulations, and dose fractionation were recorded. Time from consult to simulation, and treatment initiation were calculated. Results: A total of 270 inpatient consults (199 new and 71 established) were evaluated. During the inpatient stay, 141 CT simulations and 121 verification simulations were performed. For those treated with palliative intent, 87% were simulated within one day of consult (72% same day, 15% next day). The median time from consult to the start of treatment was 1 day with 56% starting treatment within 1 day and 75% within 3 days. The most common reasons for RT were bone metastases (30%), brain metastases (19%), airway obstruction (15%), soft tissue masses (11%), and spinal cord compression (7%). For bone metastases, the median time from consult to end of treatment was 6 days with hypofractionated regimens being commonly employed in 86% (55% received 20 Gy in 5 fractions, and 31% received single fraction). Of those that started RT as inpatients, 13% stopped prior to completion, usually to enter hospice. Conclusions: The PROMPT program provided rapid identification of patients requiring palliative RT and an effective and efficient path from consultation to treatment. Implementing similar programs at other centers could facilitate improved care of palliative patients.