Successful Implementation of a Multidisciplinary Chemotherapy Efficiency Initiative at a Community Hospital

Parkes, Amanda; Nusrat, Maliha; Tomasso, Pamela Maree Di; Davis, La Toya; Ogbonnaya, Sunny; Iwuorie, Martina; Patel, Shilpa J.; Abraham, Thega Grace; Mack, Rita; Bhadkamkar, Nishin A.; Ma, Huaxian; Nazario, L. Arlene; Ramondetta, Lois M.; Rosenstock, Aron S.; Rieber, Alyssa G.

doi:10.1200/jop.18.00541

Cited by 6 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 Other previously published efforts to reduce wait times include preparing chemotherapy before arrival, implementing programs to improve clinic communication, establishing fast-track clinics, and reducing laboratory turnaround time. [4][5][6][7] Using the Model for Improvement Framework, 8 our specific aim was to decrease wait times by 20% for patients not requiring laboratories on the day of treatment for a period of 6 months without increasing overall wait times, affecting safety, or increasing cost of care.…”

Section: Introductionmentioning

confidence: 99%

Reducing Infusion Clinic Wait Times Using Quality Improvement

Plourde

Varnado

Gleaton

et al. 2020

JCO Oncology Practice

View full text Add to dashboard Cite

PURPOSE: Long wait times are a common occurrence for chemotherapy infusion patients and are a source of decreased patient satisfaction. Our facility sought to decrease outpatient infusion clinic wait times by 20% using the Model for Improvement, quality improvement tools, and Plan-Do-Study-Act cycles. METHODS: A multidisciplinary team was formed to address clinic wait times. Patient interviews, time studies, process mapping, brainstorming sessions, affinity diagrams, fishbone diagrams, and surveys were used to define the problem and to develop an intervention. Wait times from check-in until medication administration were analyzed using statistical process control charts. Our Plan-Do-Study-Act cycle led to the addition of a “fast-track” clinic title for patients not waiting for laboratory results on the day of treatment and changes in clinic communication. The fast-track clinic signaled for those patients to have priority for vital sign collection and earlier notification to pharmacy to begin preparing medications. RESULTS: Baseline wait times for patients not requiring laboratories on the day of treatment averaged 1 hour and 33 minutes. After intervention, using statistical process control charts, a shift was observed with a new average wait time of 1 hour and 12 minutes (a 23% decrease). Wait times for patients requiring laboratories on the day of treatment did not change significantly. CONCLUSION: Implementation of a fast-track clinic title and improving communication resulted in a significant reduction in wait times for patients not requiring laboratories on the day of treatment. Future efforts will focus on sustainment and improving wait times for all patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Reducing Infusion Clinic Wait Times Using Quality Improvement

Plourde

Varnado

Gleaton

et al. 2020

JCO Oncology Practice

View full text Add to dashboard Cite

show abstract

“…The application of this methodology comprehensively identified and addressed aspects of the chemotherapy scheduling, ordering, preparation, and administration processes that were leading to delays. These issues have also been identified in other studies [3,[17][18][19][20][21]. Our approach is unique in that it holistically incorporates proposals to address these issues by staff with front-line knowledge of the problems, and with the ability to assess the feasibility of proposed solutions.…”

Section: Discussionmentioning

confidence: 90%

Reducing Chemotherapy Waiting Times in the Ambulatory Setting of a Tertiary Cancer Centre Using a Design Thinking Approach

Jen,

Chan,

Lee

et al. 2023

Cancers

View full text Add to dashboard Cite

Introduction: Chemotherapy is complex. We hypothesized that a design thinking approach could redesign preparatory processes and reduce wait times. Methods: A multidisciplinary process mapping exercise was undertaken to understand the current processes, followed by proposing and testing solutions. Proposals were selected based on desirability and feasibility. These focused on starting the morning treatments on time and scheduling pre-made regimens in these slots. The primary outcome measure was the time from the appointment to starting treatment. Treatments in the post-intervention study group were compared against a historical control group. Results: The median time to start morning treatment decreased by 46%, from 83 min (with an interquartile range 50–127) in the control group to 45 min (with an interquartile range of 24–81 min) in the study group (p < 0.001). This translated into an overall improvement for the day, with the median time to start treatment decreasing from 77 min (with an interquartile range of 40–120 min) to 47 min (with an interquartile range of 20–79 min) (p < 0.001). Pre-makes increased by 258%, from 908 (28.5%) to 2340 (71.7%) regimens (p < 0.001). The number of patients starting treatment within an hour of their appointment increased from 1,688 (32.8%) to 3,355 (62.3%, p < 0.001). Conclusion: We have shown that a data-driven, design thinking approach can improve waiting times. This can be adapted to improve other processes in an empathetic, sustainable manner.

show abstract

“…1 There have been other reports of improving wait time through premixing chemotherapy. 26,27 At our center, we tried premixing select, low-cost, sequential-day, chemotherapy doses for 4 weeks. The core members voted to stop this intervention because of limited staffing and difficulty in identifying appropriate patients.…”

Section: Discussionmentioning

confidence: 99%

Improving Outpatient Infusion Clinic Wait Times at a Comprehensive Cancer Center

Hashemi‐Sadraei

Sasankan

Crozier

et al. 2021

JCO Oncology Practice

View full text Add to dashboard Cite

PURPOSE: Many factors contribute to long wait times for patients on the day of their chemotherapy infusion appointments. Longer wait time leads to nonoptimal care, increased costs, and decreased patient satisfaction. We conducted a quality improvement project to reduce the infusion wait times at a Comprehensive Cancer Center. METHODS: A multidisciplinary working group of physicians, infusion center nurses, pharmacists, information technology analysts, the Chief Medical Officer, and patient advocates formed a working group. Wait times were analyzed, and the contributing factors to long wait time were identified. Plan-Do-Study-Act cycles were implemented and included labeling patients ready to treat earlier, loading premedications into the medication dispensing system, increasing the number of pharmacy staff, and improving communication using a secure messaging system. The outcome measure was time from patient appointment to initiation of first drug at the infusion center. The secondary outcome measure was patient wait time satisfaction on the basis of Press Ganey score. RESULTS: Postintervention, the mean time from appointment to initiation of first drug decreased 17.6 minutes ( P < .001; 95% CI, 16.3 to 18.9), from 58.1 minutes to 40.5 minutes (43.5% decrease). Patient wait time satisfaction score increased 8.9 points ( P < .001; 95% CI, 6.0 to 11.82), from 76.2 to 85.1 (11.7% increase). CONCLUSION: Exploring real-time data and using a classic quality improvement methodology allowed a Comprehensive Cancer Center to identify deficiencies and prevent delays in chemotherapy initiation. This significantly improved patient wait time and patient satisfaction.

show abstract

Successful Implementation of a Multidisciplinary Chemotherapy Efficiency Initiative at a Community Hospital

Cited by 6 publications

References 17 publications

Reducing Infusion Clinic Wait Times Using Quality Improvement

Reducing Infusion Clinic Wait Times Using Quality Improvement

Reducing Chemotherapy Waiting Times in the Ambulatory Setting of a Tertiary Cancer Centre Using a Design Thinking Approach

Improving Outpatient Infusion Clinic Wait Times at a Comprehensive Cancer Center

Contact Info

Product

Resources

About