Managing Patient Flows in Radiation Oncology - Reworking Existing Treatment Designs to Prevent Infections During the COVID-19 Pandemic at a German University Hospital

Abstract

Purpose Implementing active Patient Flow Management practices in a large University Hospital Radiation Oncology Department to prevent nosocomial infections of patients and personnel during the COVID-19 pandemic, while safely enable continuation of essential therapies and optimizing infrastructure utilization.Patients and methods Year-to-date intervention analyses of calender weeks 12 to 19 comparing years 2019 and 2020 inpatient and outpatient procedures evaluating active patient flow management effects on overall treatment and facility capacities while analysing COVID-19 nosocomial infections.Results Implementing changes in active patient flow management first visit overall appointment compliance maintained above 85.5%. Appointment reduction of publicly insured patients by 10.3% daily (p=0.004) significantly increased downstream planning CT appointment scheduling (p=0.00001) and performing (p=0.0001) resulting in absolute 20.1% (p=0.009) increment of CT performance. Daily treatment inception was significantly increased by absolute 18.5% (p=0.026). Hypofractionation and acelleration was significantly increased (p=0.0043). Integrating strict testing guidelines, distancing regimen for staff and patients, strict hygiene regulations and precise appointment scheduling, no SARS-CoViD-2 infection in 164 tested Radiation Oncology Service inpatients was observed.Conclusion In times, where medical infrastructure capacities are shortened and resources reduced, controlling infrastructural time per patient, optimizing facility utilization, personnel workload and machine occupancy rates during therapy evaluation, planning and irradiation in the inpatient and outpatient setting can help increasing appointment compliance and securing time for quality management. Avoiding recurrent and preventable exposure to health care institutions has potential health benefits and might avert nosocomial infections during a pandemic such as the current COVID-19 pandemic enabling Radiation Oncologists continue essential treatments safely.

Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review

“…Another type of protocol that was developed during this time were safety protocols to ensure patients and staff remained safe from the COVID 19 virus. With the implementation of safety protocols for in-person visits, it was found that patients were more likely to stay on treatment regimens with the extra layer of protection these protocols provided [14,27,34,41]. Lastly a protocol theme was identified surrounding how to evaluate staffing levels to ensure that areas in high need of staff were assisted by areas with a lighter workload.…”

“…For healthcare staff taking care of patients in the ambulatory setting, education and training pertained to learning new protocols and guidelines, providing education to patients, learning new technology platforms, and conducting research. At times, each day brought new requirements, warranting the creation of new protocols, methods and learning modules for safe patient care [14,15,20,32,39]. For those ambulatory settings conducting care virtually, new technology tools were implemented, requiring training of staff on how to use the new tools, such as Zoom and Microsoft Teams [15,23].…”

Effect of Body Mass Factors on Setup Displacement in Gynecologic Tumors and Subsequent Effect on PTV Margins

“…Otherwise, expanding the target volumes may be necessary, especially where daily imaging is not practicable, which is the case in settings with reduced resources or high patient flow or particular circumstances, such as the coronavirus disease 2019 pandemic. 14 …”