HCP-03: NEWLY DIAGNOSED SINGLE BRAIN MASS – IMPLEMENTATION AND PERFORMANCE OF A HOSPITAL-WIDE MANAGEMENT PATHWAY

BACKGROUND: Prior to 2012 there was no standardized admission protocol at our institution for patients presenting with a single brain mass. The service to which they were admitted, specialty consultations requested, and diagnostic testing employed varied significantly, both in the emergency department and on the inpatient services. In order to enhance management of this patient population we created and implemented a Single Brain Mass admission protocol. Our goal was to provide specialized care from a single multidisciplinary team from admission to discharge, reduce length of hospitalization, limit unnecessary diagnostic testing, and enhance patient care. METHODS: We reviewed records of 94 patients without a cancer history admitted to our emergency department with a new single brain mass between 12/2010 - 08/2014. Patients admitted prior to the protocol implementation (11/2012) were designated the pre-intervention group (PRE), and those admitted following implementation comprised the post-intervention group (POST). RESULTS: 46 patients were PRE and 48 were POST. When patients discharged to rehabilitation (35/94) were excluded from the analysis, a significantly longer mean length of stay was noted in the PRE compared to POST group (7.37 days versus 4.6 days; P= 0.01). More patients underwent CT scans of the chest, abdomen or pelvis in the PRE compared to the POST group (49% versus 17%, P = 0.001). There was no significant difference in the number of patients discharged to a rehabilitation center (38% in PRE vs. 35% in POST) or diagnosed with a brain metastasis (0.04% for both groups). Length of stay in the emergency room and time to surgery was similar across groups. CONCLUSION: Implementation of a management protocol executed by a single, specialized, multidisciplinary team streamlined the care of patients with a new single brain mass, decreased their average length of stay and reduced unnecessary diagnostic imaging tests.