Decreasing time to initiation of inpatient chemotherapy at LAC+USC medical center utilizing an admission checklist.

Authors

null

Ronak Patel

Keck School of Medicine of University of Southern California, Los Angeles, CA

Ronak Patel, Victor Chiu, Darcy V. Spicer

Organizations

Keck School of Medicine of University of Southern California, Los Angeles, CA

Research Funding

No funding received
None.

Background: Delays in the initiation of chemotherapy for scheduled inpatient admissions cause excess lengths of stay and shift infusion start times to the evenings when hospital staffing is decreased. We sought to characterize delays in our admission process and assess the feasibility of using an admission checklist to shorten start times in a large academic safety-net hospital. Baseline data for scheduled chemotherapy admissions in July and August of 2017 (n = 25) showed a mean time to chemotherapy initiation of 14.6 hours and mean excess LOS was 0.7 midnights. Significant delays were identified in the time between ordering and resulting of pre-chemotherapy labs (average 2.6 hours), and the time required to obtain imaging to confirm peripheral-inserted central catheter (PICC) position (1.6 hours). Methods: We created a checklist of a standardized admission workflow for physicians, which included moving all pre-chemotherapy labs, pharmacy verification of chemotherapy regimen, and PICC imaging to the outpatient setting. We organized multiple staff in-services to introduce the admission workflow prior to implementation on May 1, 2018. We then performed a retrospective chart review of all scheduled inpatient chemotherapy admissions from May to August of 2018. Results: In the first 2 months after intervention, the mean time to chemotherapy initiation was 8.5 hrs, representing a 42% reduction. In the subsequent 2 months, the mean time to chemotherapy initiation was 11.6 hours, representing a 21% reduction from baseline. Mean excess LOS was 0.4 midnights and 0.5 midnights for those time periods, respectively. For the entire post-intervention group, 7 out of 26 patients obtained pre-chemotherapy labs in the outpatient setting. Conclusions: We observed an initial mean reduction of 6.1 hours in the time to start chemotherapy, as well as a reduction in mean excess length of stay with the introduction of a new admission workflow and admission checklist. We observed incomplete adoption of the checklist, and an increase in time to chemotherapy initiation after the first two months of implementation, suggesting that physician non-adherence represents a significant barrier to maintaining these reductions.

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Abstract Details

Meeting

2019 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B: Patient Experience; Safety; Technology and Innovation in Quality of Care

Track

Patient Experience,Technology and Innovation in Quality of Care,Safety

Sub Track

Standardization Efforts to Improve Safety

Citation

J Clin Oncol 37, 2019 (suppl 27; abstr 262)

DOI

10.1200/JCO.2019.37.27_suppl.262

Abstract #

262

Poster Bd #

G13

Abstract Disclosures

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