218 Background: An oral chemotherapy safety event in 2017 prompted analysis of related workflows utilizing lean quality improvement methodology. Three kaizen workshops utilizing lean methodology with primary objectives to 1) develop safety standards for oral chemotherapy as rigorous as those for intravenous chemotherapy; 2) improve efficiency; and 3) design workflows that enable data collection and process control were conducted. Since 2017, our goal has been to sustain developed workflows to ensure oral chemotherapy patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by all care providers. Methods: After multidisciplinary teams participated in three kaizen workshops to develop workflows, education plans were developed and results were incorporated into the lean management system. The lean production method of Training Within Industry (TWI) was used to train physician, nursing, and pharmacy teams to the workflows. Results were communicated to key stakeholders weekly to monitor progress on workflow creation, spread, and process metrics designed to signal defects in the workflow. When processes were deemed ‘out of control,’ clinical team members provided regular and targeted interventions. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 62 consecutive weeks with 99% reduction in oral chemotherapy defects reaching pharmacy. 86 consecutive weeks with 51% error reduction processing oral chemotherapy though a single EMR workflow. 57 consecutive weeks with 62% error reduction processing oral chemotherapy though a single EMR workflow. No serious safety events have occurred since 2017. Conclusions: Comprehensive quality improvement in our oral chemotherapy process has resulted in sustained safety, efficiency, and a data collection to signal when process defects occur. Multidisciplinary teams utilizing established lean methodology were critical to success.

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e19154 Background: An increasing proportion of advanced cancer patients live longer and seek urgent or emergent care due to complex treatment regimens. Prolonged wait times and excessive cost of care are common deterrents for these patients to seek care in the Emergency Department (ED). Cancer Urgent Care (CUC) was established in February 2019 with the goal to provide timely and specialized care and improve outcomes for symptomatic cancer patients. Methods: CUC is staffed by two advanced nurse practitioners and two registered nurses and operates from 7am till 7 pm, Monday to Friday. Between 2019-2020, 471 patients were seen at the University of Kansas CUC. Visit information including diagnosis, duration of stay and outcome was retrospectively collected and analyzed using the REDcap database. Patient satisfaction and feedback surveys were conducted for each visit. Results: Most common causes for which patients sought care were dehydration 41.6%, nausea or vomiting 25.9%, pain 16.8%, diarrhea 9.8%, fever 9.6%, fatigue 8%, pneumonia 6.4% and sepsis 2.1%. Nearly 34% patients seen had underlying hematologic malignancy, other common disease sites included gastro-intestinal (26.8%), genito-urinary (14.6%) and breast cancer (13%). Average time to patient evaluation was 17 minutes and patients spend a mean of 3.2 hours in the CUC. Escalation of care (ED transfer) was required in 36 patients (7.6%), a majority of which (n = 28, 78%) required inpatient admission. An additional 58 patients (12.3%) required direct inpatient admission while a majority of patients (n = 385, 79.6%) were discharged home from the CUC. Overall patient satisfaction was very high, 68% patient noted that they would have sought care in ED if they were not seen in CUC while 30% patients would have waited for their next clinic appointment to discuss symptoms. Conclusions: Greater than 90% patients seen in CUC had a diagnosis being evaluated under Chemotherapy Measure (OP-35) by CMS. CUC provides a viable mechanism to provide specialized care to cancer patients resulting in improved patient satisfaction. Additional studies are ongoing to evaluate its impact on ED utilization and cost-effectiveness.

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