Hashemi-Sadraei Neda, Sasankan Shenthol, Crozier Nick, Tawfik Bernard, Kittson Ronald, Abernathy Janet, Lauer Richard, Dayao Zoneddy
Division of Hematology and Oncology, Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM.
JCO Oncol Pract. 2021 Dec;17(12):e1935-e1942. doi: 10.1200/OP.21.00118. Epub 2021 Jun 17.
Many factors contribute to long wait times for patients on the day of their chemotherapy infusion appointments. Longer wait time leads to nonoptimal care, increased costs, and decreased patient satisfaction. We conducted a quality improvement project to reduce the infusion wait times at a Comprehensive Cancer Center.
A multidisciplinary working group of physicians, infusion center nurses, pharmacists, information technology analysts, the Chief Medical Officer, and patient advocates formed a working group. Wait times were analyzed, and the contributing factors to long wait time were identified. Plan-Do-Study-Act cycles were implemented and included labeling patients ready to treat earlier, loading premedications into the medication dispensing system, increasing the number of pharmacy staff, and improving communication using a secure messaging system. The outcome measure was time from patient appointment to initiation of first drug at the infusion center. The secondary outcome measure was patient wait time satisfaction on the basis of Press Ganey score.
Postintervention, the mean time from appointment to initiation of first drug decreased 17.6 minutes ( < .001; 95% CI, 16.3 to 18.9), from 58.1 minutes to 40.5 minutes (43.5% decrease). Patient wait time satisfaction score increased 8.9 points ( < .001; 95% CI, 6.0 to 11.82), from 76.2 to 85.1 (11.7% increase).
Exploring real-time data and using a classic quality improvement methodology allowed a Comprehensive Cancer Center to identify deficiencies and prevent delays in chemotherapy initiation. This significantly improved patient wait time and patient satisfaction.
许多因素导致患者在化疗输液预约当天等待时间过长。等待时间过长会导致护理质量不佳、成本增加以及患者满意度下降。我们开展了一项质量改进项目，以缩短综合癌症中心的输液等待时间。
由医生、输液中心护士、药剂师、信息技术分析师、首席医疗官和患者权益倡导者组成的多学科工作小组。对等待时间进行了分析，并确定了导致等待时间过长的因素。实施了计划-执行-研究-行动循环，包括更早标记准备好接受治疗的患者、将预处理药物加载到配药系统、增加药房工作人员数量以及使用安全消息系统改善沟通。结果指标是从患者预约到在输液中心开始使用第一种药物的时间。次要结果指标是基于Press Ganey评分的患者等待时间满意度。
干预后，从预约到开始使用第一种药物的平均时间减少了17.6分钟（<.001；95%置信区间，16.3至18.9），从58.1分钟降至40.5分钟（减少43.5%）。患者等待时间满意度评分提高了8.9分（<.001；95%置信区间，6.0至11.82），从76.2提高到85.1（提高11.7%）。
探索实时数据并使用经典的质量改进方法使综合癌症中心能够识别缺陷并防止化疗开始时的延误。这显著改善了患者等待时间和患者满意度。
