Presenter: Bryna Delman Ewachiw, PharmD, BCOP, Johns Hopkins Bayview Medical Center, Baltimore, MD
Co-Authors: Gillian Pullido, MHA, Johns Hopkins Medicine, The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Baltimore, MD; Adwoa Nyame, PharmD, Johns Hopkins Bayview Medical Center, Baltimore, MD
BACKGROUND: Managing oncology clinic throughput with persistent postpandemic staffing constraints and a lack of resources continues to pose challenges to an already-busy outpatient oncology model. A multidisciplinary group of oncology providers, pharmacists, nurses, and support staff embarked on a quality improvement initiative to improve clinic throughput using a scheduling template software program that was established at other oncology clinics within the health system. Before implementing this software program, patients had their laboratory, provider, and treatment visits all scheduled on the same day, which led to bottlenecks and patient care delays in the phlebotomy area, the infusion room, and the oncology pharmacy but only at certain points of the day.
OBJECTIVES: The primary objective was to measure the schedule template compliance rate before and after the intervention, with 85% as the goal. The secondary objective was to measure the rate at which a patient’s laboratory visits were decoupled from their treatment dates before and after the intervention.
METHOD: Sidney Kimmel Comprehensive Cancer Center (SKCCC) at Johns Hopkins Bayview Medical Center is an academic ambulatory oncology clinic that is primarily focused on the treatment of thoracic malignancies for the Johns Hopkins Health System. From January 2022 through April 2022, the patients’ laboratory, provider, and treatment visits were on the same day, and appointments were scheduled by assigning patients to an infusion chair by the scheduling team without a standardized approach. Using a templated schedule software program, which went live in April 2022, patient treatments were scheduled according to the length of the treatment, and all new patients were required to get blood work done before their treatment visit. Standardized patient education and signage reminded patients to have their laboratory work done before their treatment visit. The multidisciplinary group met every week to develop the scheduling templates based on clinic volumes, staffing, and treatment time lengths. The oncology pharmacy team provided scheduling recommendations based on pharmacy technician resources, pharmacy hours, and chemotherapy admixture processes. The scheduling software program set a benchmark target of 85% compliance with the schedule template before and after the go-live date.
RESULTS: The mean schedule template compliance rate before we implemented the software was 70% compared with 80% 6 months after the program was used. Regarding laboratory and treatment decoupling, the rate was 40% before the scheduling software was implemented compared with 25% after the software was implemented.
CONCLUSION: Incorporating a standardized template for scheduling improved the oncology pharmacy workflow throughput, with enhanced distribution of treatments and the decoupling of laboratories and treatment visits in an outpatient oncology center.
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