Decreasing Time to Initiation of Chemotherapy for Patients Electively Admitted to a Hematologic Malignancy Service

Jose N. Galeas, Stuart Packer, Roy Browne, Susan Sakalian, Adam F. Binder

Research output: Contribution to journalArticle

Abstract

PURPOSE: Delays in initiating elective inpatient chemotherapy can decrease patient satisfaction and increase length of stay. At our institution, we observed that 86% of patients who were admitted for elective chemotherapy experienced a delay-more than 6 hours-with a median time to chemotherapy of 18.9 hours. We developed a process improvement initiative to improve time to chemotherapy for elective chemotherapy admissions. METHODS: Our outcome measure was the time from admission to chemotherapy administration in patients who were admitted for elective chemotherapy. Process measures were identified and monitored. We collected baseline data and used performance improvement tools to identify key drivers. We focused on these key drivers to develop multiple plan-do-study-act cycles to improve our outcome measure. Once we started an intervention, we collected data every 2 weeks to assess our intervention. RESULTS: At the time of interim analysis, we observed a median decrease in time to chemotherapy administration from 18.9 hours to 8.85 hours (P = .005). Median time to laboratory results resulted decreased from 3.17 hours to 0.00 hours. There was no change in time from signing chemotherapy to nurse releasing the chemotherapy. We noted that more providers were signing the chemotherapy before patient admission. CONCLUSION: By implementing new admission workflows, optimizing our use of the electronic medical record to communicate among providers, and improving preadmission planning we were able to reduce our median time to chemotherapy for elective admissions by 53.2%. Improvement is still needed to meet our goals and to ensure the sustainability of these ongoing efforts.

Original languageEnglish (US)
Pages (from-to)e906-e915
JournalJournal of oncology practice
Volume15
Issue number10
DOIs
StatePublished - Oct 1 2019
Externally publishedYes

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Hematologic Neoplasms
Drug Therapy
Outcome Assessment (Health Care)
Process Assessment (Health Care)
Workflow
Electronic Health Records
Patient Admission
Patient Satisfaction
Inpatients
Length of Stay
Nurses

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Decreasing Time to Initiation of Chemotherapy for Patients Electively Admitted to a Hematologic Malignancy Service. / Galeas, Jose N.; Packer, Stuart; Browne, Roy; Sakalian, Susan; Binder, Adam F.

In: Journal of oncology practice, Vol. 15, No. 10, 01.10.2019, p. e906-e915.

Research output: Contribution to journalArticle

Galeas, Jose N. ; Packer, Stuart ; Browne, Roy ; Sakalian, Susan ; Binder, Adam F. / Decreasing Time to Initiation of Chemotherapy for Patients Electively Admitted to a Hematologic Malignancy Service. In: Journal of oncology practice. 2019 ; Vol. 15, No. 10. pp. e906-e915.
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abstract = "PURPOSE: Delays in initiating elective inpatient chemotherapy can decrease patient satisfaction and increase length of stay. At our institution, we observed that 86{\%} of patients who were admitted for elective chemotherapy experienced a delay-more than 6 hours-with a median time to chemotherapy of 18.9 hours. We developed a process improvement initiative to improve time to chemotherapy for elective chemotherapy admissions. METHODS: Our outcome measure was the time from admission to chemotherapy administration in patients who were admitted for elective chemotherapy. Process measures were identified and monitored. We collected baseline data and used performance improvement tools to identify key drivers. We focused on these key drivers to develop multiple plan-do-study-act cycles to improve our outcome measure. Once we started an intervention, we collected data every 2 weeks to assess our intervention. RESULTS: At the time of interim analysis, we observed a median decrease in time to chemotherapy administration from 18.9 hours to 8.85 hours (P = .005). Median time to laboratory results resulted decreased from 3.17 hours to 0.00 hours. There was no change in time from signing chemotherapy to nurse releasing the chemotherapy. We noted that more providers were signing the chemotherapy before patient admission. CONCLUSION: By implementing new admission workflows, optimizing our use of the electronic medical record to communicate among providers, and improving preadmission planning we were able to reduce our median time to chemotherapy for elective admissions by 53.2{\%}. Improvement is still needed to meet our goals and to ensure the sustainability of these ongoing efforts.",
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