Postoperative sore throat (POST), although a minor complication, remains a source of postoperative morbidity. We compared the efficacy of dispersible aspirin gargle to benzydamine hydrochloride (a topical nonsteroidal anti inflammatory drug) gargles for prevention of POST. We enrolled 60 consecutive female patients, 16-60 yr of age, ASA physical status I or II, undergoing elective modified radical mastectomy under general anesthesia in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly divided into 3 groups of 20 subjects each: Group 1 (C) mineral water; Group 2 (AS) tab aspirin 350 mg; and Group 3 (BH) 15 mL of benzydamine hydrochloride (0.15%). All the medications were made into 30 mL of solution. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anesthesia. Grading of POST was done at 0, 2, 4, and 24 h postoperatively on a 4-point scale (0-3). Aspirin gargles reduced the incidence of POST for 4 h whereas benzydamine hydrochloride gargles reduced POST for 24 h. POST was more severe in the control group at 0 and 2 h (P < 0.05). Aspirin and benzydamine hydrochloride gargles significantly reduced the incidence and severity of POST (P < 0.05).

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235 Background: Physician burnout affects over 50% of physicians in the US and is related to the high workload and loss of anonymity. The result is physical exhaustion, moral distress, and increased rates of suicide. At our institution, burnout was identified in 42.1% of providers & 55.6% of staff surveyed using AMA/ASCO burnout questionnaires with treatment delays in the infusion center (IC) implicated as the biggest culprit. Methods: We tracked causes of delay in starting chemotherapy in the IC and utilizing Pareto Chart identified that over 80% of delays were due to missing chemotherapy orders on the day of IC appointment. Process flow charts for providers noted significant variations in practices. Retrospective chart review, 6/21/2019 to 8/30/ 2019, revealed that an average of 13.18% of patients scheduled to receive chemotherapy at the IC had missing orders on the day of the infusion, resulting in up to a 111-minute delay in starting chemotherapy. We set out to sustainably decrease the number of missing chemotherapy orders in the IC by 50%, decreasing the resultant stress on providers and IC nurses. Results: Four interventions were implemented over 2 plan-study-do-act (PDSA) cycles and resulted in decreasing the average number of missing orders on the day of IC appointment to 7% achieving our aim (Table). To ensure sustainability of results, we continued the interventions and maintained faculty engagement via periodic updates. Sustainability analysis revealed that the median number of patients with missing orders between 12/2/2019 and 2/28/2020 remained at 5% effectively achieving our goal. The effects of this intervention on physician/staff burnout will be reassessed after 1 year of intervention implementation using the same AMA/ASCO burnout questionnaires. Conclusions: Systematically standardizing a process achieves a sustainable impact, promotes a more effective workplace environment and decreases burnout on physicians and staff. [Table: see text]

e19246 Background: Physician burnout is affecting over 50% of physicians in the US alone and is related to the high workload, loss of anonymity and a sense of powerlessness in the face of multiple bureaucratic hurdles. The result is physical exhaustion, moral distress, high turnover and increased rates of suicide. Methods: The faculty and staff at Washington Cancer Institute (WCI) were surveyed using AMA/ASCO burnout questionnaire to identify burnout rates. A brainstorming session with staff captured the perceived causes of burnout in a fishbone diagram, and the most prominent cause was noted to be pertaining to delays in the infusion center (IC) related to chemotherapy orders. We tracked causes of delay in starting chemotherapy from 7/23/19 to 8/7/19, and utilizing a Pareto Chart identified that over 80% of the delays were due to missing chemotherapy orders on the day of IC appointment. Process flow charts were developed for all provider teams at WCI noting variations that may be leading to delays. The aim was to decrease the number of missing chemotherapy orders for patients coming to the IC by 50%, decreasing the resultant stress on providers and IC nurses. Results: By retrospective chart review, 6/21/2019 to 8/30/ 2019, an average of 13.18% of patients scheduled to receive chemotherapy at WCI IC had missing orders on the day of the infusion, which resulted in up to a 111-minute delay in starting chemotherapy. This, in turn, resulted in stress/burnout among 42.1% of providers and 55.6% of supportive staff. To remedy the problem, we implemented 4 interventions over two plan-do-study-act (PDSA) cycles. In the first PDSA cycle the process was standardized to obtain necessary labs 48 hours prior to IC appointment and review and sign orders by 2 pm the day prior to IC appointment. Email notifications were also sent to all providers and nurse navigators regarding missing orders 48 hours prior to IC appointment. In the second PDSA cycle we continued with the previous interventions in addition to addressing pharmacy related delays in releasing premedication if dose adjustments of chemotherapy are needed. In the time period of 10/2/2019 to 11/11/2019, two PDSA cycles were implemented and resulted in a decrease in the average number of missing orders on the day of IC appointment to 7% achieving our aim. Conclusions: Using a systems approach to standardize the process promotes a more effective environment in the work place and decreases burnout on physicians and staff.