BOSTONFaced with increasing patient care needs for chemotherapy, a team of nurses and administrators at Roswell Park Cancer Institute (RPCI) performed a study to identify challenges to the current system and develop methods to improve patient flow.
"There is a series of cascading issues that are increasing the need for access to our chemotherapy services," Debra Smith, RN, nurse manager, Chemotherapy and Infusion Center, RPCI, said at the 31st Annual Congress of the Oncology Nursing Society (abstract 181). "We have increasing numbers of patients who are requiring chemotherapy due to new faculty, changes in reimbursement, and enhanced clinical trial offerings."
Baseline data, including appointment distribution, availability of resources, obstacles to on-time starting, and patient preferences, were collected in February 2005; interventions were planned and implemented during April, May, June, and July; and data collection was repeated in February 2006 to assess the effectiveness of the interventions.
At the time of the study, the Chemotherapy and Infusion Center offered services 7 days a week in 38 treatment chairs. The physical capacity was defined as 38 chairs times 13 hours a day, or 494 possible treatment hours. Baseline utilization was 51% of capacity. The goal was to achieve 85% of capacity (420 hours).
Marcia Gruber, RN, vice president for therapeutic services at RPCI, described some of the interventions. "We adjusted staff start times, offered free-parking incentives to patients for appointment times after 4 PM, and put a blood draw site in the Chemo Center," she said. After 6 months, these interventions allowed RPCI to achieve utilization of 76% of physical capacity (375 hours).
"We were pleased to find that we could increase utilization in our high-traffic chemo-infusion clinic without compromising our excellent record of patient safety," Ms. Smith said. "Although we were able to treat an average of 16 additional patients each day, we did experience some additional wait times for our patients, due primarily to patients arriving late, unanticipated patient illness, and nurse vacancies." One major outcome of this research was the decision of RPCI to open a suburban chemotherapy office to help manage patient needs and decrease wait times. "We evaluated patient addresses, and since the majority live in the northern suburbs, we have selected a location in this part of our catchment area," Ms. Gruber said. "This new center will open in 2006 and is expected to improve the efficiency of care delivery for our patients."