Optimizing Radiation Oncology Referral Triage Through Referral Coordinator-Led Triage and Workflow Redesign

This quality improvement project aimed to reduce administrative delays and workflow inefficiencies by optimizing the "Referral Triage" process using Lean methodology.

A pilot study was performed on 3 disease sites at a large comprehensive Radiation Oncology Program: Head and Neck (H&N), Breast (Br), and Genitourinary (GU). In the revised workflow, RCs independently completed triage for pilot-eligible cases (defined by referral source, approval likelihood, and site-specific case complexity criteria, see section 1.5) without requiring RO approval to reduce the triage-related email exchange and associated wait time. A comparative analysis between the Pre-Pilot, Non-Pilot, and Pilot groups was performed based on timestamps for key triaging steps and the time between referral to consult. Staff feedback and error data were collected during the pilot period.

A total of 1,255 referrals were analyzed. Time elapsed for triage process was observed to decrease by 75% in H&N, 68% in Br, and 50% in GU pilot groups compared to Pre-pilot groups (with p <0.001 for all sites). This significant difference in triage times suggests that the workflow change has effectively enhanced efficiency of the triage process for all 3 site groups. Staff feedback collected on the pilot was positive with no increase in safety incidents reported. Reduced triage times also enabled earlier communication of consult appointments with patients. The revised process shifted triage burden away from ROs and optimized RCs' work as the latter could complete the triage process without intermissions and workflow interruptions. Review of wait times from referral to consult (R-to-C) between the Pre-pilot vs. Pilot groups showed different trends between site groups (i.e., decrease of 12% in H&N, increase of 7-8% in GU and Br). This suggests that our workflow change did not create any material R-to-C reduction.

Structured triage workflow redesign improved administrative efficiency and reduced triage time with potential enhanced patient experience. Success observed in 3 large disease sites suggests this pilot is scalable and customizable to other high-volume comprehensive radiation oncology settings.