Building an Episode of Care to Reduce Time to Treatment

Patients with incidental findings of lung nodules faced an extended period to undergo evaluation, diagnosis, and treatment. Under the newly designated pathway, lung nodule patients would now have a specified visit type and a care episode created upon presentation to the lung nodule clinic.

In the past, even after providers identified the causes of delay, existing workflows allowed for circumstances where there were no consistent timelines estimated for providers to diagnose and treat patients. The time to determine the cancer staging for patients was extended, and there were many delays in testing and scheduling appointments with no support for providers or patients follow up consistently. Under the modified workflow, each provider will indicate the required testing they would like for the patient to undergo and in what order. This ensures the provider has all the information needed for the patients’ follow-up appointments, enabling them to quickly determine the visit timeline for diagnosis confirmation and treatment planning.

We discovered variations among provider screening methodologies, and scheduling protocols. We ran a three-month pilot study with a dedicated nurse practitioner to follow up on the patients with lung nodules. Through the pilot study, we discovered inconsistencies in patient tracking. Under the lung nodule pathway, we created a schedule template to designate specific visit types (eg, neoplastic nodule visits vs follow-up visits for nonneoplastic lesions) and correlated these visits to the lung nodule report to enhance status reporting for the utilization of visits. The template also ensured follow-up visits for patients with nonneoplastic lesions. Utilizing the pathway, we have demonstrated across two additional three-month cycles that we have significantly reduced time to diagnosis and treatment. Utilizing the pathway, we engaged the Epic team leaders to build an event of discovery of lung nodules, which can be further tracked via the episodes of care. Previously, publications related to time-to-treat were outdated and poorly defined, which can now be accurately defined and tracked for reporting and quality improvement purposes. As a result, we observed that the median number of days from suspicion of malignancy to treatment decreased from 82-46 days (about one and a half months) for early-stage cancer diagnosis (43.9% reduction) and 42-31 days (about one month) for late-stage cancer diagnosis (26.19% reduction).

With reduced time to diagnose and treat, patients got answers and began treatment faster. This also allowed for a better system for tracking patients who only need surveillance. More granular data analysis is underway to identify the effect on time-to-treat based on the severity of cancer diagnosis and patient demographics. In addition, this project has been reviewed by multiple other specialties and will be spread system-wide to allow for better tracking of where patients are in their journey and allow for the patients to have treatment started faster.