Cancer Services, NHS Highland, Inverness, Scotland, UK.
Macmillan Suite, NHS Highland, Inverness, Highland, UK.
BMJ Open Qual. 2020 Oct;9(4). doi: 10.1136/bmjoq-2019-000904.
The demand for systemic anticancer treatment continues to rise due to the increasing numbers being diagnosed with cancer and developments in treatment options. The net result is greater pressure on services and subsequent patient delays. Delays in treatment could decrease the benefit of the therapy and be detrimental to patient experience. Patients with human epidermal growth factor receptor-2 (HER 2) positive breast cancer within Raigmore Hospital waited an average of 41 min from the scheduled appointment time despite the administration of subcutaneous (SC) trastuzumab being scheduled for a 15 min treatment window. Given the frequency of these injections, this was having an adverse impact on patients and services. The aim of this project was for patients with breast cancer to receive treatment within the 15 min window. Lean principles were applied to reduce waste and increase value. Exploration of the problem led to the solution of relocating the administration of SC trastuzumab from the Macmillan Day Bed Unit (MDBU) to the Highland Breast Centre (HBC). Multiple improvement tools and techniques were used to implement the change. Data were collected on the median number of treatment episodes of SC trastuzumab per week at baseline and patient wait from appointment time to treatment completion was calculated at baseline and as an ongoing measure. Patient experience feedback was gathered following relocation of the treatment. Following relocation, the average time from scheduled appointment to discharge was 14 min (66% reduction). Patient experience feedback was positive and identified an unanticipated outcome; the regular Friday afternoon clinic, identified as most efficient for the service, was found by patients to be particularly convenient for their own planning. Through the application of Lean principles, the service was redesigned in a cost neutral way and resulted in a reduction in the wait time for treatment.
由于被诊断出患有癌症的人数不断增加，以及治疗方案的不断发展，对全身性抗癌治疗的需求持续上升。其最终结果是服务压力增大，继而导致患者等待时间延长。治疗的延迟可能会降低治疗效果，影响患者的治疗体验。尽管皮下注射曲妥珠单抗的治疗窗口设定为 15 分钟，但在雷格莫尔医院就诊的人表皮生长因子受体 2（HER2）阳性乳腺癌患者，从预约时间到实际开始治疗的平均等待时间为 41 分钟。鉴于此类注射的频率较高，这对患者和服务都产生了不良影响。该项目的目标是让乳腺癌患者在 15 分钟的治疗窗口内接受治疗。采用精益原则来减少浪费并增加价值。对问题的深入研究得出的解决方案是，将皮下注射曲妥珠单抗的治疗地点从麦克米伦日间病床区（MDBU）转移到高地乳腺癌中心（HBC）。在实施变革过程中，使用了多种改进工具和技术。在基线阶段，每周收集皮下注射曲妥珠单抗的治疗次数的中位数，并计算患者从预约时间到治疗完成的等待时间。在搬迁治疗地点后，收集患者的反馈意见。搬迁后，从预约到出院的平均时间为 14 分钟（减少了 66%）。患者的反馈意见为正面的，并发现了一个意外的结果；患者认为，服务效率最高的周五下午常规门诊，对他们自己的计划特别方便。通过应用精益原则，以不增加成本的方式重新设计服务，减少了治疗等待时间。
