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New Scheduling at Chemo Infusion Center Improves Efficiency

A new system in which chemotherapy appointments are scheduled throughout the day helps to prevent outpatient infusion facilities from becoming crowded at peak times midday and makes life easier for nurses and patients, a Mayo Clinic study has shown.

Traditionally at infusion centers, schedules accommodate patients’ time preferences, but this results in peak volume at midday and few appointments earlier or later in the workday.

“Most people are not aware of the near-universal phenomenon at infusion centers across the country where the bulk of chemotherapy infusions happen between 10:00 PM and 2:00 PM daily,” commented co-author Alan Bryce, MD, Mayo Clinic Cancer Center, Phoenix, Arizona.

The new model was developed to minimize patient safety violations as well as constraint violations (defined as situations in which nurse availability was below an optimal standard).

The new scheduling “allows the nursing team to maintain optimal and efficient staffing, and it decreases patient waiting times and unanticipated delays,” added co-author Kris Altman, a nurse manager in charge of the chemotherapy unit at the same center.

The study was published online March 29 in JCO Oncology Practice.

Time Preferences

At infusion centers, chemotherapy nurses are required not only at the beginning and the end of each patient visit but also throughout the infusion (which can last several hours) to check on patients and to administered any additional medications that may be needed.

“The ultimate goal [of the new model] was to create a more evenly distributed patient load throughout a clinic day and improve nurses’ satisfaction,” the team commented.

The optimized schedule indeed did lead to less intraday variability in the maximum number of patients who received treatment during each 1-hour segment of the day.

“With the optimal schedule, the average number of patients per hour remained the same at 8.7, but the maximum number of chairs used at one time decreased from 19 to 12,” the authors report.

The new system also led to a 50% improvement over the pre-change schedule in terms of the total number of violations as well as the maximum number of patients scheduled at the same time, from four patients down to three.

Furthermore, a reduction in concomitant treatment start times improved the distribution of effort for pharmacy staff as they prepared treatments for patients. Average chair utilization was also down from 17.3 prior to the scheduling change to 14.1 chairs after implementation, amounting to an 18% improvement.

Importantly from a patient perspective, time to treatment initiation dropped from as much as 40 minutes prior to the scheduling change to 5 minutes on average, the result of improved distribution of pharmacy workload throughout the day.

“The tradeoff was a 5 to 15-minute increase in wait time between provider visits and infusion appointments,” the authors acknowledge.

“But actual implementation thus far has been beneficial for patient flow and positively received by staff and patients,” they conclude.

JCO Oncol Pract. Published online March 29, 2022. Full text

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