Reducing infusion wait time at a comprehensive cancer center: a quality improvement program evaluation
Yakowec, Jing Jing
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INTRODUCTION: Inefficiencies in health systems waste resources and reduce quality of care. At Dana Farber Cancer Institute, the majority of patient complaints centered around wait times often due to suboptimal workflows. To reduce infusion wait time (IWT), three initiatives were piloted on one outpatient clinic floor: 1) premixing qualified chemotherapy drugs during off-peak hours of day, 2) sharing late sign data with providers to encourage them to sign medication orders as soon as patients were seen in exam, and 3) moving a pharmacist physically closer to providers on the exam side to support the medication verification process. The goal of this study was to evaluate the three improvement initiatives and assess their impact on IWT. METHODS AND MATERIALS: The baseline period was September–December 2017 and the implementation period was January–September 2018. The three initiatives were implemented in a staggered fashion within the implementation period. IWT was defined as the later of infusion appointment or check-in time to first infusion medication administration time, and the 75th percentile was used to monitor change. Process metrics were also defined and monitored for each improvement initiative. A unique SQL code was written to pull and merge data tables from the electronic medical record (Epic) and real-time locating system (RTLS). Tableau and SAS were used to clean, analyze, and visualize time series data. RESULTS: The 75th percentile IWT decreased from baseline 80 minutes to 68 minutes once all three initiatives were implemented. Moving the pharmacist closer to the exam side where providers signed their medication orders shortened the 75th percentile medication order verification time by 15 minutes (38% reduction) for the gynecology cancer group. Provider late order signing percentages also significantly decreased from 24% to 13%. A higher percentage of qualified premix orders were prepared during off-peak hours (from 78% to 91%) and before the infusion appointment time (from 43% to 87%). Feedback from frontline staff regarding the initiatives were extremely positive. CONCLUSION: Reducing chemotherapy infusion wait time is possible at a comprehensive cancer center. More efficient workflows can translate to patient satisfaction, reduce cost, and improve the quality of care.