Implementing An Early Discharge Initiative For Patients Receiving High-Dose Methotrexate.

90 Background: Over 70% of patients are hospitalized in the first year after a cancer diagnosis. While some admissions are unplanned and potentially preventable, many are planned admissions for intensive chemotherapy. High Dose Methotrexate (HD-MTX) is commonly used for the treatment of osteosarcoma or CNS involvement in lymphoproliferative neoplasms. It is given in the inpatient setting due to monitoring requirements after administration. We postulated that changing discharge criteria for HD-MTX from 0.05 µmol/L to ≤0.1 µmol/L would be feasible and safe, and would reduce length of stay (LOS) for patients receiving HD-MTX. Cost savings were also calculated. Methods: Following an assessment of drivers of LOS amongst patients receiving HD-MTX, we identified discharge criteria as an actionable factor. We developed a workflow to discharge patients with 3 days of oral leucovorin and sodium bicarbonate when MTX level reached ≤0.1 µmol/L. Patient demographics, chemotherapy regimen, cycle, dose, and LOS data were collected for a 7 month period before and a 4 month period after the intervention. Cost savings were estimated based on the daily cost of a hospital bed at the institution. Results: Mean LOS for the pre-intervention and post-intervention group was 4.84 days (n=49) and 3.67 days (n=42), respectively (p=0.007). This resulted in a 24.4% reduction in length of stay. Average reduction in LOS of 1.17 days resulted in a decrease in cost of $1,828.73 per admission, with a 4 months savings of $76, 806.56 and projected annualized savings of $230,419.67. No patient experienced complications because of change in discharge criteria. Conclusions: Liberalizing discharge criteria for HD-MTX is feasible, safe, and cost-effective. Further efforts to reduce LOS for elective chemotherapy admissions or safely transition some of these complex regimens to the home setting are currently underway at our institution.