GME Patient Safety Quality and Innovation Symposium

Issues Addressed/Background

Patients with suspected malignancy are routinely admitted inpatient for diagnostic evaluation for urgent but not emergent workups, utilizing limited inpatient resources. We wondered if some of these workups could be managed outpatient in a timely manner with the right infrastructure. Conventional oncology referral pathways follow a consultation-first sequence; ie patients are seen, then tested, then redirected, which delays diagnosis and consumes limited clinic capacity. The UCSD Suspicion of Cancer (SoC) clinic was designed around an inverted model: physician-led triage occurs right at referral, testing is coordinated before the first visit, and patients who can be safely redirected to disease-specific teams never need an SoC appointment. This report describes operational outcomes over the first four months following clinic launch in December 2025.

Description of the Project

The SoC clinic serves patients with findings suspicious for malignancy without a confirmed site-specific diagnosis. Referrals are restricted to ED providers, inpatient teams, and specialty oncology clinics. The referral order set was kept deliberately simple: two questions asking whether findings are suspicious for cancer and whether a known primary exists, to decrease friction with referrals. Core operational components included mandatory CT chest/abdomen/pelvis for all ED-placed referrals, a target of first patient contact within 1–2 business days, an expedited outpatient biopsy and imaging pathway, and a new patient access supervisor with expertise in scheduling, insurance verification, and records retrieval. Clinic capacity was set at approximately 2 SoC slots per week for now during the initial phase.

Lessons Learned

Between December 2025 and March 2026, 65 patients were referred to the SoC clinic. Of these, 30 (46%) were diverted to disease-specific oncology teams or primary care without an SoC visit, and 16 (25%) completed SoC appointments. The remainder involved insurance denials (n=5), patient refusals or no-shows (n=5), and cases pending or closed for other reasons. Cases were diverted from in-person SoC clinic (to subspecialty oncology clinics) following triaging actions, including the following: ordering additional imaging or other testing, placing IR biopsy referrals via expedited pathways, correcting misdirected referrals, and communicating this directly with patient families. This allowed for SoC staff to contact patients within a few days to begin the urgent outpatient workup and place referrals soon after, thereby decreasing time to workup compared to having to schedule clinic visits and have a formal visit to begin evaluation. 

Recommendations/Next Steps

The most meaningful structural improvement is establishing disease-team liaisons (designated oncologists on each disease team) who are comfortable accepting early referrals based on triage data alone, so patients can bypass the SoC visit when workup already points toward a specific diagnosis. Addressing patient follow-through will require a more active outreach protocol after initial contact, particularly for pre-visit orders. Future data collection should include time from referral to imaging completion, time to diagnosis, and longitudinal tracking of whether the 2-slot-per-week capacity remains appropriate as referral volume grows. Additionally, we would like to eventually open up the clinic referrals to be placed by PCPs and outpatient providers.