Improving Wait Times in the Infusion Center for Head and Neck Cancer

Abstract

Problem: Head and neck cancer accounts for only 4% of all cancers in the United States but utilizes significant health care costs and resources due to prevalent treatment side effects and complications. Most patient appointments are lengthy due to the process of laboratory evaluation, clinic visit, and chemoradiation occurring on the same day. The wait time at one infusion center is one of the six lowest Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems survey scores. Purpose: A quality improvement project was conducted to reduce infusion center wait times for head and neck cancer patients undergoing concurrent chemoradiation by 50%. Methods: A multidisciplinary team approach including brainstorming sessions, fishbone diagrams, chart audits, time studies, process mapping, and run chart monitoring was used to identify factors contributing to delays and to strategize improvement interventions. The Oncology Nursing Society/American Society of Clinical Oncology 2016 Chemotherapy Administration Safety Standards served as evidence for the practice changes. Interventions included advanced laboratory evaluation and clinic visits, prior verification of laboratory studies and orders, communication with patients, and advanced chemotherapy preparation. The project outcome measure was time from patient check-in to initiation of chemotherapy. Results: The mean check-in to initiation of chemotherapy decreased from 3 hours 36 minutes (n=14) to 1 hour 45 minutes (n=57) demonstrating a 51% reduction in wait-time. Conclusions: This work is consistent with previous research that shows reduced wait times are achieved by scheduling clinic visits and laboratory evaluation prior to the treatment date and preparing chemotherapy in advance.