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164 Background: Supporting emotional, psychological, financial and spiritual well-being of patients has been shown to have a positive impact on quality of life and patient experience. Social workers in our outpatient cancer center are responsible for completing new patient assessments at the start of chemotherapy treatment to provide early access to psychosocial support services. Assessments are to be completed within three weeks of the patient’s first chemotherapy treatment. Connecting with patients early in the care experience allows social workers to proactively assist with education, support and link patients to vital resources. Methods: Completed assessments were tracked and from October through December 2017. The social workers leveraged the use of data analytics and a team based approach to increase the number of new patient assessments completed within the first 3 weeks of chemotherapy. Weekly 30-minute huddles were held using problem solving methods, including brain storming, cause and effect diagrams, force ranking, and polling. Results: A team identified 39 potential causes to why 65.14% of patients were not receiving assessments within the first 3 weeks of chemotherapy treatment. Potential causes were grouped and themed. Work prioritization, inconsistent methods of identifying patients receiving chemotherapy for the first time, and lack of visual management to monitor progress of this metric were identified as key objectives for improvement. Countermeasures were developed and implemented; a dashboard was created to analyze the first time treatment assessment completion percentages by disease group and standardizing the process of notifying social workers of patients in need of an assessment. Social worker assessment completion rates improved from 34.78% (December 2017) to 75.35% (April 2018). Conclusions: This project demonstrates the value of utilizing problem solving, visual management, and data analytics for continuous quality improvement projects related to clinical care and processes. Cross-disciplinary collaboration should be explored with the use of visual tools and other resources to facilitate communication that is understood by all disciplines.

83 Background: Delirium is a common neuropsychiatric condition associated with increased morbidity and mortality, length of hospitalization, and distress. The prevalence of delirium in cancer ranges from 10% to 30% in hospitalized patients and up to 85% in terminally ill cancer patients. Rates of delirium on Cleveland Clinic’s inpatient oncology units were lower than expected. Our goal was to integrate mental health professionals into the care team to assist with better recognition and management of delirium. Methods: Education was developed for a range of caregivers, including physicians, nurses, and advanced practice providers. It was facilitated by a psychiatrist, psychologist, and clinical social workers, and included proper identification of both hyper- and hypoactive delirium through use of the Brief Confusion Assessment Method (bCAM) and use of a delirium order set to treat and manage patients identified as positive for delirium. An important component of this education included a proper assessment and comparison of patients’ current mental status compared to their true baseline prior to hospitalization. Additional integration directly into the care team included participation of the psychiatrist, psychologist, and clinical social workers into each team’s multidisciplinary rounds to facilitate discussions around delirium and its appropriate management, and separate targeted rounding which included one-to-one education with front-line caregivers. Results: During the first year of integration, substantial improvements were noted. The percentage of patients identified as positive for delirium through bCAM screening increased from 3.4% to 15.8% after 12 months, and utilization of the delirium order set increased from 11.1% to 58.3%. Additionally, the average nursing unit length of stay (LOS) for delirium-positive patients decreased by more than 2 days compared to baseline. Conclusions: Integration of mental health providers into the care team to assist with recognizing and managing patients with delirium and to provide direct education to front-line caregivers has helped to rapidly improve delirium identification and management for oncology inpatients.

171 Background: Due to complexity of disease and treatments, oncology patients have among the highest hospitalization rate, especially towards End of Life (EOL). In our cancer institute, just 6% of all discharged patients accounted for >40% of unplanned readmissions, and continue to be highest risk of future admissions, ICU stay, ED visits, overuse of chemotherapy and under use of hospice care. We hypothesized that developing individualized care plans (ICP) for this high-utilization group will provide guidance in the complex care they require to reduce unnecessary and aggressive medical services. Methods: An Interdisciplinary Care Team (ICT) was created consisting of palliative medicine and oncology physicians, social workers, care coordinators, and nurses. On a bimonthly basis, patients with at least two unplanned hospital readmissions over the last 60 days were identified. ICPs were created using a team-based approach with parallel input from patient’s primary outpatient providers. Results: A total of 36 patients, 226 hospitalizations, and 163 ED visits were evaluated over a 6-month period, with an average number of hospitalizations of 1.08 per patient month (ppm). After implementation of ICP, hospitalizations decreased to 0.23 ppm, with an average length of stay decrease from 7.17 to 4.06 days per admission. Average ED visits decreased from 0.58 to 0.34 ppm, and the average number of unplanned readmissions decreased from 0.43 to 0.13 ppm. Of the 10 patients expired since creation of ICP, 8 utilized hospice care, while 2 patients died in an ICU. Average time to death from creation of ICP was 72 days among this cohort, while time to death from last exposure to chemotherapy was 58 days. Conclusions: Creation of individualized care plans for high-utilizing cancer patients decreased number of hospitalizations, ED visits, unplanned readmissions, and length of stay. A dedicated focus from a team of experts, beyond disease biology, on a unique patient situation may result in improved patient experience with decreased aggressiveness of care at EOL and overall resource utilization.