Implementation of a Hospital Pathway for Patients With a Newly Identified Single Brain Mass


Key Points

  • Implementation of the clinical admission protocol reduced median hospital stay, median time to surgery, and use of unnecessary diagnostic tests.
  • No difference in 30-day readmission rate was observed.

In a study reported by Arrillaga-Romany et al in the Journal of Oncology Practice, a team at Massachusetts General Hospital found that implementation of a hospital pathway consisting of a dedicated admission protocol for patients with newly identified single brain masses and no history of cancer resulted in reduced length of hospital stay, time to surgery, and use of unnecessary diagnostic imaging tests.

Study Details

The study compared outcomes prior to and after institution of a clinical admission protocol focused on providing early, specialized, and coordinated multidisciplinary care to patients presenting with a new single brain mass and no history of cancer in order to reduce care variation and improve patient management. Data from 206 patients presenting to the emergency department between January 2010 and May2016 were analyzed, with 96 in the preimplementation group (admitted between January 1, 2010, and November 15, 2012) and 110 in the postimplementation group (admitted between November 15, 2012, and May 1, 2016).

Effect of Implementation

Overall, median length of hospital stay was 6 days in the postimplementation group vs 7 days in the preimplementation group (P = .042), with a more pronounced effect being observed with analysis excluding 66 patients discharged to rehabilitation, skilled nursing, or hospice facilities (median 5 vs 7 days, P = .001). Median time to surgery after hospital admission was 2.7 vs 3.5 days (P = .006). Use of computed tomography scans of the chest, abdomen, and pelvis occurred for 12% vs 47% of patients (P < .001).

No significant difference between postimplementation and preimplementation groups was observed in 30-day readmission rates (12% vs 8%, P = .94). Among 112 patients with glioblastoma, there were no significant differences between groups in median time from admission to start of radiation therapy (4.4 vs 4.7 weeks, P = .26) or in 12-month survival (59% vs 65%, P = .92).

The investigators concluded, “Implementation of a specialized admission pathway for patients with a new single brain mass decreased average length of hospital stay and time to surgery, and reduced unnecessary diagnostic imaging tests in patients with primary brain tumors.”

Isabel Arrillaga-Romany, MD, PhD, of the Stephen E. and Catherine Pappas Center for Neuro-Oncology at Massachusetts General Hospital, is the corresponding author for the Journal of Oncology Practice article.'

Disclosure: The study authors' full disclosures can be found at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.