1 The University of Texas MD Anderson Cancer Center, Houston, TX.
2 University of California Irvine Medical Center, Orange, CA.
J Oncol Pract. 2019 Jun;15(6):e576-e582. doi: 10.1200/JOP.18.00541. Epub 2019 Apr 16.
Long wait times at chemotherapy infusion centers adversely affect patients' perception of quality of care and result in patient dissatisfaction. We conducted a quality improvement initiative at a busy community hospital to improve infusion center efficiency and reduce patient wait time, while maintaining patient safety and avoiding chemotherapy waste.
We used a coordinated and collaborative effort between providers, infusion center nurses, and pharmacists to ensure completion of orders, review of laboratory data, and prepreparation of chemotherapy 1 day ahead of each patient's scheduled infusion center appointment. Monthly Plan-Do-Study-Act cycles were conducted for 6 months beyond the pilot month to refine and sustain the intervention.
The average patient cycle time, measured as time from patient check-in to check-out from the infusion chair, decreased from 252 minutes to 173 minutes in the last 4 months evaluated (30% decrease) after the intervention. Similarly, the average chemotherapy turnaround time, measured as time from chemotherapy request by nursing to pharmacy delivery, improved from 90 minutes to 27 minutes after the intervention (70% decrease). Infusion center capacity was unaffected by the intervention. The cost of wasted chemotherapy was minimal after the first postintervention month. Surveys revealed extremely high patient and employee satisfaction with the new system.
A strategy involving prepreparation of chemotherapy on the day before the scheduled infusion is feasible to implement at a busy community hospital infusion center and is associated with significant improvement in infusion center efficiency as well as patient and employee satisfaction.
化疗输注中心的长时间等待会影响患者对护理质量的感知，并导致患者不满。我们在一家繁忙的社区医院开展了一项质量改进计划，以提高输液中心的效率，减少患者的等待时间，同时保持患者的安全并避免化疗药物的浪费。
我们的做法是，让提供者、输液中心护士和药剂师协调合作，确保在患者预约的输液中心治疗日前一天完成医嘱、审查实验室数据并预先准备化疗药物。在试点月之后的 6 个月内，每月进行计划-执行-研究-行动循环，以完善和维持干预措施。
干预措施实施后，评估的最后 4 个月中，患者的平均周期时间（从患者登记到从输液椅上登记的时间）从 252 分钟减少到 173 分钟（减少 30%）。同样，从护理部门向药房发出化疗请求到化疗药物送达的平均化疗周转时间（从化疗请求到化疗药物送达的时间）从 90 分钟缩短至 27 分钟（减少 70%）。输液中心的容量未受干预措施的影响。第一个干预后月份过后，浪费的化疗药物成本微乎其微。调查显示，新系统受到患者和员工的高度满意。
在繁忙的社区医院输液中心实施化疗前一天预先准备化疗的策略是可行的，与输液中心效率的显著提高以及患者和员工的满意度的提高相关。
