Reducing the wait time to initiate inpatient chemotherapy at Lyndon B. Johnson Hospital.

Authors

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Andrew James Wiele

University of Texas MD Anderson Cancer Center, Houston, TX

Andrew James Wiele, Trung Nguyen, Onyebuchi Ononogbu, Kristyn-Mae Russo, Phat Le, Tejal Amar Patel, Hilary Y. Ma, Alyssa G. Rieber

Organizations

University of Texas MD Anderson Cancer Center, Houston, TX, Lyndon B. Johnson Hospital, Houston, TX

Research Funding

No funding received
None

Background: Delays in initiating inpatient (inpt) chemotherapy (chemo) for planned admissions can decrease patient (pt) satisfaction and increase length of stay and healthcare costs. Our center, a community public teaching hospital, lacked clear standard operating procedures for scheduled chemo admissions, resulting in significant delays. We developed a process improvement initiative to reduce the pt wait time from admission to chemo administration (time to chemo [TTC]). Methods: A multidisciplinary team was formed to clarify workflows and identify root causes prolonging wait times for pts admitted to the inpt chemo unit. We implemented two Plan-Do-Study-Act (PDSA) cycles over a 6-month period. First, in early March, we collaborated with pharmacy and nursing to standardize the inpt chemo operating procedures and extend pharmacy’s evening hours for chemo preparation (prep) from 7pm to 9pm. Second, in early June, we implemented a Pre-admission Checklist that was visibly displayed in clinic for fellows to review with faculty, and began discussing pts scheduled for admission during the daily, multidisciplinary huddle that already occurred on the inpt chemo unit. Using the electronic medical record and available time stamps, baseline data was collected from November-December 2019, post-intervention data for PDSA cycle 1 was collected from March-April 2020, and data collection for PDSA cycle 2 is ongoing. Results: Root cause analysis identified late afternoon admissions and PICC line placements as two main sources for TTC delays. Hospital procedures also limited inpt PICC line placement between 8am-4pm and inpt chemo prep between 7am-7pm. Baseline data revealed 77.4% (24/31) of pts were admitted between 3pm-10pm, the median TTC was 20.4 hrs, and 6.5% (2/31) of pts had chemotherapy initiated within 12 hrs of admission (TTC < 12). Additionally, 56.5% (26/46) of pts had PICC lines placed during their admission, but 69.2% (18/26) of the pts with PICC lines were eligible for outpatient port placement according to institutional intravenous (IV) access guidelines. After PDSA cycle 1, median TTC decreased by 10% to 18.4 hrs, and 33.3% (5/15) of pts had TTC < 12. Conclusions: After standardizing inpt chemo procedures and extending chemo prep times, PDSA cycle 1 resulted in a 10% reduction in TTC and a 26.8% increase in the rate of TTC < 12. Although admission times cannot be controlled at this time, the impact of improving pre-admission planning, and specifically addressing IV access, for PDSA cycle 2 is currently being evaluated and will be reported at the time of abstract presentation.

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Abstract Details

Meeting

2020 ASCO Quality Care Symposium

Session Type

Poster Highlights Session

Session Title

Poster Highlights B: Quality Improvement

Track

Health Care Access, Equity, and Disparities,Technology and Innovation in Quality of Care,Cost, Value, and Policy,Patient Experience,Quality, Safety, and Implementation Science

Sub Track

Quality Improvement Research and Implementation Science

Citation

J Clin Oncol 38, 2020 (suppl 29; abstr 210)

DOI

10.1200/JCO.2020.38.29_suppl.210

Abstract #

210

Abstract Disclosures

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