High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is frequently performed in patients with hematologic malignancies. ASCT can result in significant nausea, pain, and discomfort. Supportive care has improved, and pharmacologic therapies are frequently used, but with limitations. Music has been demonstrated to improve nausea and pain in patients undergoing chemotherapy, but little data are available regarding the effects of music therapy in the transplantation setting. In a prospective study, patients with lymphoma or multiple myeloma undergoing ASCT were randomized to receive either interactive music therapy with a board-certified music therapist or no music therapy. The music therapy arm received 2 music therapy sessions on days +1 and +5. Primary outcomes were perception of pain and nausea measured on a visual analog scale. Secondary outcomes were narcotic pain medication use from day -1 to day +5 and impact of ASCT on patient mood as assessed by Profile of Mood States (POMS) on day +5. Eighty-two patients were enrolled, with 37 in the music therapy arm and 45 in the no music therapy arm. Patients who received MT had slightly increased nausea by day +7 compared with the no music therapy patients. The music therapy and no music therapy patients had similar pain scores; however, the patients who received music therapy used significantly less narcotic pain medication (median, 24 mg versus 73 mg; P = .038). Music therapy may be a viable nonpharmacologic method of pain management for patients undergoing ASCT; the music therapy patients required significantly fewer morphine equivalent doses compared with the no music therapy patients. Additional research is needed to better understand the effects of music therapy on patient-perceived symptoms, such as pain and nausea.

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80 Background: Reducing length of stay (LOS) is an important initiative for hospitals for both clinical and financial reasons. Patients who are hospitalized for extended lengths of time may be more susceptible to hospital-acquired infections and other complications. Reducing LOS can also decrease cost of care and allow for more streamlined patient throughput. Our institution sought to evaluate opportunities to reduce LOS for our medical oncology patient population. Methods: Several interventions were implemented to streamline discharge planning. The structure of rounding was evaluated and standardized on each inpatient oncology unit to ensure that it was multidisciplinary and occurred each day at an established time. A process was established for Advanced Practice Providers (APPs) to write prescriptions the day before discharge (delivered directly to the bedside), and for APPs to begin discharge of patients early the following morning with use of a new discharge checklist. Standardized workflow was also created for instances where prior authorizations were required for prescriptions. We partnered with our Home Care providers to streamline the process for patients anticipated to be discharged to that service. Partnership was also established with physical therapy (PT) to avoid ordering low-value consults and to provide enhanced education to nursing staff about early patient mobility. Another project is being piloted to move lab draws six hours earlier the night prior to discharge. This provides the medical team additional time to assess and treat based on lab results if the patient required blood product transfusions or electrolyte replacement prior to discharge. Results: Implementation of interventions began throughout the first several months of 2019. Each of the first four months of 2019 saw consecutive improvements in both observed average LOS and LOS observed-to-expected ratios. Overall, a 2% decrease was seen in both of these metrics when comparing January to April 2019 to the 2018 baseline. Conclusions: Implementing several interventions to streamline workflows and processes leading up to a patient’s discharge can be effective in reducing both overall LOS and LOS observed-to-expected ratios.

High-dose chemotherapy followed by autologous stem cell transplant (ASCT) is frequently performed in patients with hematologic malignancies. ASCT can result in significant nausea, pain, and discomfort. Supportive care has improved and pharmacologic therapies are frequently employed, but with limitations. Music therapy has been demonstrated to improve nausea and pain in patients undergoing chemotherapy, but little data are available in the transplant setting. We present Results from a randomized study of music therapy in patients undergoing ASCT. Patients with lymphoma or multiple myeloma undergoing ASCT were randomized to receive either interactive music therapy (MT) with a board-certified music therapist or no music therapy (No MT). The MT arm received two music therapy sessions: the first occurring as close to Day +1 as possible, the second occurring 48-96 hours later (listed as Day +1 and Day +5). Primary outcomes were perception of pain and nausea, measured on a visual analog scale which ranged from 0 to 10 (0 = no nausea, 10 = worst nausea). These were measured before and after the first music therapy session or at comparable interval for No MT patients and on days +5 and +7. Secondary outcomes were narcotic pain medication use, with pain medication doses converted to morphine equivalents and assessed daily from Day -1 to Day +5. Mood disturbance assessed by Profile of Mood States (POMS). POMS has six scales: depression, vigor, anger, tension, confusion, and fatigue. Categorical variables were compared between arms using Chi-square test, continuous variables were compared using Wilcoxon rank sum test. Repeat measures analysis of variance was used to compare outcomes between study arms over time. Eighty-two patients were enrolled: MT 37 patients, No MT 45 patients. MT arm had more African American patients (16% vs. 2%, p = 0.02), but otherwise patient characteristics in terms of age, gender, disease type, and preparative regimen were balanced. (Table 1). There was no difference in nausea between MT and No MT arms for Days 1 and +5, however, by Day +7, the MT arm had more nausea than the No MT arm (mean score 2.1 vs. 1.1, P=0.03). Although there was no difference in pain between MT and No MT patients, MT patients required significantly less morphine equivalent over the 7 study days (median 24mg vs 73mg, p =0.03). (Figure 1 and 2). There was no difference between arms for depression, vigor, anger, tension, confusion, or fatigue. In conclusion, despite having similar pain scores between both groups, the patients who received MT required significantly less narcotic pain medication use. Future study will focus on impact of music therapy on pain. Table 1 Patient characteristics Figure 1 Pain assessment Figure 1. Pain assessment Figure 2 Narcotic medication use Figure 2. Narcotic medication use Disclosures: Duong: Celgene: Honoraria, Research Funding. Off Label Use: Approved in the US but not in Europe. Hill:Celgene: Honoraria, Research Funding.

56 Background: Oncology Advanced Practice Providers (APPs) have not been optimally trained to care for each other’s sub specialty of patients. In times of high census and/or short staffing, inpatient APPs are left to care for and manage high volumes of acutely ill patients. This is concerning for patient safety, burning out as well as dissatisfactions when vacation and meetings are denied because there is no backup coverage available. Methods: In order to minimize the use of overtime pay, physician moonlighting pay and additional positions in times of short staffing, we proposed to cross train experienced APPs to see if the staffing needs could be met. The disease groups consisted of transplant, leukemia and lymphoma. Each disease group has a lead APP involved in the strategic planning and implementation process. They were instrumental in working through and identifying risks and benefits of this training plan and were the first to be trained, as to lead by example. Buy in from APPs was achieved by promoting the flexibility of scheduling that would result from having more coverage. Some were also motivated to add to their skill set by learning how to care for a new disease group. Results: The APPs felt comfortable taking patients after around 2 training shifts. They felt the patients were more alike than different and the workflow for most job duties were identical, and enjoyed working with fellow oncology APPs they hadn’t interacted much with. Cross training was proposed to add a financial benefit to our institution. Key metrics we monitored were productivity and supplemental pay. The financial savings from avoiding supplemental overtime or fellow moonlighting wages for 2018 was $8,540, and $14,640 for quarter1 2019. The APPs had no decrease in productivity to date, and no decrease in quality metrics and no adverse events related. Conclusions: Cross training as a means to reduce short staffing financial burdens while advancing the scope of practice of APPs is a safe and possible alternative to adding positions, or paying overtime/moonlighting pay. Training of cross covering APPs was not overall a major constraint. Buy-in from leadership as well as APPs is instrumental in not only initiating a cross training program, but maintaining it as well.