Houston, TX, 3 University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX Purpose/Objective(s): We recently instituted a navigation program, led by our breast radiotherapy (RT) specialized advanced practice registered nurses (APRN), to improve utilization of current clinic capacity without reducing patient satisfaction in a large academic breast RT clinic. Primary goals were to optimize the timing and number of visits for each patient starting RT to increase new treatment starts (NTS)/consults utilizing a patient centered approach. Materials/Methods: We hypothesized APRN patient-specific specialized navigation could increase clinic capacity with a budget favorable return on investment (ROI) of at least 10 -fold. An electronic health record workflow was developed to include APRN navigation of new referrals to RT prior to patient scheduling. One additional full time APRN was hired. An APRN reviewed the clinical history for each patient referred, calling patients as appropriate to review patients’ disease-specific information pertaining to RT prior to their visit. When appropriate, secondary referrals were initiated. Optimal scheduling recommendations were relayed to the patient scheduling team and completed. NTS to consult slot ratio (NTS/Consult) was compared from 3/2019-8/2019, the period of navigation in the fiscal year, excluding start up time, to the same period the prior year. No significant changes to staffing or process occurred during this time frame, excluding one provider taking on an administrative role (this provider’s data are excluded). Results: Documentation of navigation was completed as time allowed for 159 patients representing <10% of total referrals from 1/2019-12/2019. From the initiation of documentation, 38 no shows were averted, 27 received information that led to reduced out-migration, 146 patients were scored as needs addressed. NTS/Consult was 56% vs 71% baseline vs. navigation timeframe, P Z 0.001. NTS/clinical full time equivalent (cFTE) increased 6% for the full fiscal year (9/2018-8/2019), resulting in a conservative increase in gross patient revenue of $1,445,260 per cFTE. Thus, for an estimated maximum annual salary investment of $150,000 in a clinic of 4.0 cFTE the ROI Z 37.8 exceeding the hypothesized minimum return on investment. Overall patient satisfaction scores showed improvement during this time period. Conclusion: For breast radiotherapy patients, the time interval from diagnosis to radiotherapy is highly variable and can lead to unnecessary and/or duplicate visits. Patient-specific provider-level APRN navigation produced a meaningful reduction in no shows and out-migration while optimizing scheduling and increasing the capacity for radiotherapy con- sults without producing an added burden to faculty providers. Other nursing and scheduler script or algorithm-based navigation efforts have been unsuccessful. Provider level knowledge of expected radiotherapy recommendations and regimen were thought to be critical to patient safety and coordination of care. Current financial estimates are likely conservative. Author Disclosure: B. Camacho: None. D. Johnston: None. B. Rhodes: None. K. Doughtie: None. G.G. Fleming: Employee; United Surgical Partners International. S. Pham: None. S.E. Todd: None. R. Ghafar: None. A.C. Koong: Stock; Arravive, Inc. M.P. Mitchell: Practical Radi- ation Oncology. K.E. Hoffman: Research Grant; Varian Medical Systems, Jansen Pharmaceuticals. Consultant; Vanderbilt University. W.A. Wood- ward: Honoraria; Genomic Health, Inc. Speaker’s Bureau; Genomic Health, Inc. Advisory Board; Epic Sciences; ASTRO. 2456 Establishing a Benchmark Treatment Termination Rate in a Multicenter Radiation Medicine Department D.C. Ma, 1 P. Gilbo, 2,3 S. Joseph, 1 P. Zuvic, 1 L. Potters, 1 and B.F. Bloom 4 ; 1 Northwell Health, Lake Success, NY, 2 Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, 3 Memorial Sloan Kettering Cancer Center, New York, NY, 4 Department of Radiation Medicine, Hofstra Northwell School of Medicine, Lake Success, NY Purpose/Objective(s): Treatment Terminations (TT) adversely impact the clinical outcomes of patients receiving radiation. TTs are frequently monitored as part of QA metrics in radiation oncology departments, but a benchmark TT rate has not been established. Furthermore, the TT rate for each disease site varies significantly due to differences in treatment duration and toxicity, yet data stratified by disease site is not widely available. We had previously reported a composite annual TT rate of 7.1% in our department from 2013-2016. The aim of this study is to review TT rates from 2017-2019 and to establish a baseline TT rate stratified by disease site. Materials/Methods: Patients with TTs from 01/2017 to 12/2019 in our multi-center department were reviewed. Cases were identified by our chief radiation therapist during routine monthly quality and safety monitoring. TTs were defined as the discontinuation of therapy after CT simulation was completed. All external beam cases treated by our department were reviewed and assigned a disease site based on pre-established treatment directives. TTs in curative cases were stratified by disease site, and TTs in palliative cases were stratified by anatomical location. Results: A total of 8,222 treatments were planned from 2017-2019; 61% of the cases were curative, 34% palliative, and 6% benign. There was a total of 333 TTs during this period, representing 4.1% of all cases; 49.5% of the TTs were curative and 50.5% were palliative. When stratified by intent, the TT rate per new start for curative cases was 3.1%. The disease sites with the highest absolute number of TTs were head and neck (n Z 63), lung (n Z 25), and breast (n Z 17); the disease sites with the highest TT rate were vulva (21.6%, n Z 8), head and neck (7.9%, n Z 63), esophagus (6.9%, n Z 6), and lung (5.8%, n Z 25). The sites with the lowest TT rate were prostate (0.75%, n Z 5) and breast (1.15%, n Z 17). For palliative cases, the TT rate per new start was 6.1%; sites with highest TT rate were spine (18.8%, n Z 30), breast (17.5%, n Z 7), abdomen (11.5%, n Z 11), and thorax (10%, n Z 27). Patients in the curative group has the highest risk of terminating treatment after receiving >75% of the prescribed dose (n Z 49). A total of 93 patients (27%) were scheduled for treatment but received no radiation prior to TT; within this group 50% were curative and 50% were palliative. Reason for TT in this group included: going elsewhere for treatment, changes in goals of care, and progression of disease. Conclusion: TTs have the potential to impact clinical outcomes in both the curative and palliative setting. Establishing a benchmark TT rate for each disease site can help identify opportunities to improve care. While the TT rate in this study cohort has decreased by about 43% compared to prior, there is still a high percentage of patients not completing care. Given the a priori intent of care, TT’s represent substandard opportunities at achieving that intent. Additional analysis is needed to identify the causes for TT’s and to formulate interventions to reduce TT rate. Author Disclosure: D.C. Ma: None. P. Gilbo: None. S. Joseph: None. P. Zuvic: None. L. Potters: RO-HAC members receive an honorarium of $1500 per year. Service on RO-HAC is sponsored by ASTRO and AAPM.; Clarity PSO/RO-ILS RO-HAC. Honoraria; Clarity PSO/RO-ILS RO-HAC. Consultant; Clarity PSO/RO-ILS RO-HAC. Partnership; SRO Health LLC, LPRAD LLC. Board Member; SCAROP. B.F. Bloom: None. 2457 Adverse Events of After-loading High Dose Rate Brachytherapy Reported to the United States Food and Drug Administration (FDA) D. Provenzano, 1 K. Rao, 2 G. Cifter, 1 M. Sarfaraz, 1 H. Aghdam, 1 M. Ojong-Ntui, 1 M. Loew, 3 S. Goyal, 4 and Y.J. Rao 5 ; 1 The George Washington University, Washington, DC, 2 The Johns Hopkins University, Baltimore, MD, 3 George Washington University, Washington, DC, 4 Division of Radiation Oncology, Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC, 5 George Washington University, Department of Radiation Oncology, Washington, DC Purpose/Objective(s): OpenFDA is an open access database maintained by the United States Food and Drug Administration (FDA) that provides information on adverse events related to medical devices, such as high Volume 108  Number 3S  Supplement 2020 Poster Q&A Sessions e203