| Sumario: | Significance & Background: Timely initiation of post-operative radiation therapy (PORT) is critical for improving outcomes in patients with head and neck cancer. National guidelines recommend starting radiation within six weeks after surgery; delays are associated with decreased local control and survival. Baseline data revealed variation in timelines and equity of access to PORT, with some patients experiencing delays due to referral bottlenecks, inconsistent communication, and lack of centralized tracking. Addressing these barriers was identified as a quality improvement (QI) priority. Purpose: The purpose of this QI project was to reduce time from surgery to PORT by implementing standardized workflows, optimizing multidisciplinary communication, and creating real-time patient tracking systems to ensure timely and equitable treatment initiation. Interventions: A nurse navigator-led workflow was deployed to track all post-surgical patients requiring PORT in a centralized dashboard. Standardized communication regarding adjuvant radiation needs was integrated into provider documentation via an electronic health record (EHR) smartphrase. EHR functionality was enhanced to ensure consult/referral orders were functioning correctly and queryable for reporting. Early initiation of dental clearance and multidisciplinary referrals to medical and radiation oncology were incorporated into the standard process. A custom EHR report was developed to monitor PORT status, flag patients at risk for delay, and prompt timely referrals. Results: Following implementation, measurable improvements were observed in both treatment timeliness and equity. The percentage of patients starting PORT within six weeks of surgery increased compared to baseline, with reductions in variation across demographic and clinical subgroups. Real-time tracking allowed for proactive intervention in cases at risk for delay, reducing last-minute scheduling barriers. These changes were successfully transitioned into standard workflows, ensuring sustainability. Discussion: This nurse navigator-driven QI initiative demonstrated that standardized communication, proactive coordination, and integrated EHR tools can significantly improve the timeliness and equity of PORT initiation. Centralizing oversight with a dedicated nurse navigator allowed for real-time barrier resolution and strengthened multidisciplinary collaboration. The sustainable workflows developed through this project have become part of routine operations, supporting continued monitoring and iterative refinements. This model may be adaptable to other cancer care pathways where timely initiation of adjuvant therapy is critical to patient outcomes.
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