Background: Accurate cancer staging is essential for estimating prognosis, guiding treatment, populating cancer registries, and assessing clinical trial eligibility. Hence, timely staging of new solid oncology patients (NSOP) is an ASCO QOPI priority. At our institution, baseline review of staging documentation revealed fellows staged only 47% of NSOP, generally as unstructured free text. During the 2017-18 academic year, our structured electronic medical record (EMR) staging tool (ST) was used in only 11% of NSOP. We used Quality Improvement (QI) methods to improve structured EMR staging documentation rates of NSOP seen by fellows during the 2018-19 academic year. Methods: A fellow focus group identified poor integration of the EMR ST as root cause of our low staging rates. We set a cumulative goal of 70% structured EMR staging of NSOP within 1 month of initial visit as our target (50% increase from baseline). We incorporated the EMR ST into our visit workflow and used promotional flyers and fellow orientation to introduce our QI initiative. Staging rates were tracked by EMR-generated reports. We used periodic emails and QI-specific boards to disseminate progress among our oncology practices. Fellows were anonymously surveyed for feedback. Results: Over an 8-month period, the cumulative rate of NSOP staging by fellows increased from 47% to 70% (Table). Statistical process control analysis showed special-cause variation in July 2018 (low performance) and December 2018 (high performance). Fellow feedback highlighted the educational value of this QI intervention and identified incomplete workup as a barrier to staging. Conclusions: Our fellow-led QI intervention achieved our goal of leveraging an existing EMR tool to increase staging documentation. In addition, this QI intervention facilitated fellow education and use of data for clinical and research purposes. Future steps include ensuring sustainability and expansion into our hematology clinics.

NSOP = new solid oncology patients; * Baseline includes structured & unstructured data