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.

82 Background: Comprehensive, coordinated care is a key driver of care transformation within the Oncology Care Model. Care coordination provides deliberate, organized, patient centered care initiatives aimed to improve care transitions, patient education, patient engagement and quality of care throughout the care continuum. Methods: Specialty care coordinator nurses were a part of our heath system’s model of care but over the course of our participation in the OCM we have implemented care coordination in our regional locations across 15 additional sites of care. Standardized templates for initial and follow up education were created for oral and parenteral therapies with an emphasis on symptom management education. A patient education tool was developed through a partnership with nursing, pharmacy and physicians across disease groups to outline when a patient should contact their physician or RN care coordinator with symptom issues. Targeted outreach calls and associated documentation templates were created for symptom assessment and adequate follow up. Templates include a pre-chemo orientation call, post treatment follow up phone call within seven days, and post hospital discharge/ED treat and release follow up calls. A team based huddle guideline was developed to provide a means for interdisciplinary communication to assess patients for high risk based upon medical, functional, social, cognitive and behavioral factors that might lead to a hospitalization. Results: Our teams worked closely with EMR specialists and internal data analysts to build appropriate templates and subsequent reports to monitor compliance with documentation, evaluate the number of outreach touch points and effectiveness of interventions on a reduction of hospitalizations and ED utilization. We have noted an a modest decrease in hospitalizations and ED utilization through OCM feedback reports and reconciliation reports. Conclusions: We continue to monitor our monthly hospital admissions and ED utilization across the health system and drill down into the data to determine if there are any opportunities where care coordination outreach and incoming telephone triage could have prevented the admission.