Reduced wait times for molecular-biomarker testing among patients with advanced lung cancer using parallel sample processing and closed-loop communication: the Continuous Oncopanel and ALK Status Tracking (COAST) Project.

Background: Given how crucial molecular-biomarker testing is to treatment decisions for advanced non-small cell lung cancer (NSCLC), guidelines recommend a turnaround time (TAT) of 14 calendar days from receiving specimen to test result, and 3 days to receive a specimen from outside pathology lab. Current TAT for molecular-biomarker testing in British Columbia (BC), Canada frequently exceeds these recommendations. Thus, we launched a quality improvement (QI) initiative to improve TAT of molecular-biomarker testing.

Methods: We assembled a multidisciplinary team to identify areas contributing to delays in molecular-biomarker testing. We designed and conducted three Plan-Do-Study-Act (PDSA) cycles. Cycles 1 and 2 involved changing requisition delivery method from fax to email between BC Cancer Vancouver Centre (BCCV) and two outside hospitals with the highest volume of specimens. Cycle 3 introduced parallel processing of specimens at BCCV pathology lab and concurrent molecular-biomarker testing. TAT was evaluated before and after these process changes along with staff satisfaction via survey.

Results: The average TAT from test request to specimen received by BCCV was reduced from 6.4 days prechange to 4.6 days postchange. The TAT from specimen receipt by BCCV to report availability was reduced from a median of 22-16 days. Report availability for initial medical oncology consultation increased from a median of 13%-29%. The staff satisfaction survey revealed an enhanced experience with the new process, particularly for our nurse navigator.

Conclusion: The TAT for molecular-biomarker testing is an ongoing and complex challenge for healthcare systems worldwide. This QI project is a step towards addressing province-wide reduction in wait times for molecular-biomarker testing results in BC. We continue to explore further ideas to improve workflow metrics and patient care among patients with advanced NSCLC.