Team ICE(Improve Cycle Efficiency)

Future Work

• Clinic scheduling• Infusion staffing model• Pharmacy improvement

Immediate Risk

• Electronic chemotherapy ordering (Beacon) Implementation

System Challenges

• Infusions were scheduled by starts per half hour. Pharmacy was limited by how many doses they could mix at any one time

• Patients were more likely to be scheduled for chemotherapy in the AM because of long infusion times

• Multiple secretaries scheduling, each with their own definition of exceptions

• Nurses bringing patients into infusion room based on when they received their orders, not their appointment times

• Pharmacy mixing based on when they received the orders, not patient’s appointment time

• Inconsistent adherence in using ARIA to check patients in and out of the infusion room

• IV access variation from 0 minutes to 30 minutes on average, resulting in delays starting chemotherapy

Team Members:Bradley Arrick Thomas HenryCorey Beaudry Lori JakubowskiMartha Brown James NeilsenDavid Crosby Deborah ScribnerDavid Fittro Sara SimeoneMarc Gautier Laura UrquhartDaryl Gwilt Karen Wertman

Changes Implemented

• Infusions scheduled to doses per half hour, instead of starts per half hour

• Infusion scheduling limited to 4 secretaries

• Implemented standard 90 minute gap between start of provider visit and infusion appointment time

• Patients brought into infusion room only within 15 minutes of their appointment time

• Pharmacy only mixing according to patient’s infusion appointment time

• Conducted a thorough review of infusion durations. Based on analysis, were able to shorten infusion durations by an average of one hour

• Will implement IV access workflow change

Ongoing Data Monitoring

Background

There is an interdependence between infusion and clinic scheduling as 70% of infusion visits come from a provider visit on the same day. Schedules for these patients:

• were unreliable• exhibited a high level of

variation• had extended wait times• had uneven resource

utilization

There is data that suggests a predictable and steady increase in volume of patients requiring infusion services over time. Increased volumes would not be achievable without creating a safe, efficient, and reliable system.

• schedule performance (+/- 15 min), as measured by check-out time from infusion, was averaging 13%

• schedule performance (+/- 30 min), as measured by check-out time from infusion, was averaging 27%

• average modified length of stay (MLOS) was 200 minutes.• whole visit time –

actual infusion time = modified LOS

Infusion Schedule – Before Changes

Infusion Schedule – After Changes

Data – Before and After