Quality improvement project to optimize the management of immune-related toxicity in hospitalized patients receiving immunotherapy.

475 Background: As part of the 2024 Quality Training Program (QTP) held in Madrid, we developed a quality improvement project aimed at enhancing the management of immune-related adverse events (irAEs) in patients requiring hospitalization. The increasing use of immune checkpoint inhibitors has shifted the pattern of oncology admissions, with a notable rise in hospitalizations due to irAEs. Our objective was to reduce irAE-related hospital admissions by at least 15% through structured intervention using QTP methodology. Methods: We conducted a retrospective review of all hospital admissions from March to May 2024, identifying those due to irAEs. A baseline stratification by toxicity type was performed. Using a cause-effect diagram and Pareto analysis, the primary contributing factors were identified as suboptimal pre-treatment evaluation and inadequate clinical management of irAEs. A process flowchart revealed three potential intervention points: (1) oncologist training in irAE management, (2) pre-treatment immunology consultation, and (3) emergency department staff education. A prioritization matrix indicated that implementing an immunology consultation was the most feasible and impactful intervention. Prospective data were collected from September to November 2024, during which all patients scheduled for immunotherapy were referred to a dedicated immunology consult to assess toxicity risk via clinical and laboratory parameters. Results: Baseline data showed 30 irAE-related hospitalizations out of 577 immunotherapy treatments. After implementing the intervention, admissions slightly decreased to 27 out of 597 treatments. (See table). Conclusions: Although the 15% reduction target was not achieved, a modest decrease in irAE-related admissions was observed. Contributing limitations included a short intervention period and the absence of a standardized immunology consultation protocol. Future cycles of Plan-Do-Study-Act (PDSA) should focus on refining the consultation process and exploring complementary strategies such as emergency department staff training. Immune-related toxicity admissions before and after intervention. Month Total IT Treatments Total Oncology Admissions IT-Related Admissions March 183 97 10 April 193 102 11 May 201 83 9 Pre-intervention Total 577 282 30 September 198 104 9 October 203 121 8 November 196 92 10 Post-intervention Total 597 317 27