From the 2018 HVPAA National Conference
Arjun Gupta (University of Texas Southwestern Medical Center, Dallas, TX;), Jenny Li (University of Texas Southwestern Medical Center), Bernard Tawfik (University of Texas Southwestern Medical Center), Thao Pham (University of Texas Southwestern Medical Center), Sudarshan Pathak (University of Texas Southwestern Medical Center), Prabhjyot Singh (ASCO), Esmaeil Porsa (Parkland Health and Hospital System), Navid Sadeghi (University of Texas Southwestern Medical Center, Dallas, TX;), Hsiao C. Li (University of Texas Southwestern Medical Center, Dallas, TX;)
Reducing the length of stay (LOS) is a high priority objective for all healthcare institutions. Delays in chemotherapy initiation for planned pre-admissions lead to patient dissatisfaction and prolonged LOS.
To reduce the time to initiation of chemotherapy from patient arrival to Parkland Hospital from a median of 6.2 hours at baseline, to 4 hours over a 6-month period (35% reduction).
A multidisciplinary team was formed as part of the ASCO Quality Training Program. The team identified inconsistency in blood work requirements, poor communication, and non-standard patient arrival times as key delays in the process. Plan-Do-Study-Act (PDSA) cycles were implemented based on identified improvement opportunities. The outcome measure was time from arrival to chemotherapy start. Data were obtained from time stamps in the electronic health record.
The first PDSA cycle included patient reminders to arrive at a specific time, improved communication using a smartphone secure messaging application, and the oncology fellow writing a pre-admit note detailing whether fresh labs were needed on admission prior to starting chemotherapy. Baseline data from 36 patients and post-implementation data from 28 patients were analyzed. Median time from admission to chemotherapy initiation pre-process change was 6.2 hours and 3.2 hours post-change. A sustained shift in the process was apparent on a control chart (Figure 1).
Delays in initiation of chemotherapy can be prevented using classic quality improvement methodology, a multidisciplinary team, and investment in key stakeholders. We aim to further refine our PDSA cycles and to ensure sustainability of change.
Implications for the Patient
We would also like to transfer our learnings to the clinics, and are hopeful other institutions can reduce chemotherapy delays by adapting this process locally.