In a hospital setting, helping staff focus on their care-giving mission and creating efficient systems benefits one very important person: the patient.

Joe Singh, right, and Harriet Bartos perform a skit about lab test orders. (Photo by p.cunningham)

With that in mind, three teams of City of Hope staff members recently met through the Accelerating Care Excellence (ACE) program to improve organization of staff workspace, appointment systems and forms in the Geri & Richard Brawerman Ambulatory Care Center. One team examined the nursing station in the 2B surgical clinic, a second team identified opportunities to improve scheduling in the 1D infusion clinic and the third focused on improving legibility of lab test orders.

2B nurses station

Nurses in the 2B surgical clinic not only see patients arriving for appointments, but also fill out important medical documentation. Without planning, that volume of paperwork can lead to clutter and inefficiency.

“We found that supplies, materials and forms were held in many different places, and the nurses’ station was set up with space that was wasted,” said Lydia Sandoval, an ambulatory care assistant in the 2B surgical clinic and team leader for the rapid improvement event. “There were many small issues that added up to an inefficient workflow.”

The team implemented several improvements to the nursing workflow:

• Each exam room is now stocked with all necessary forms, allowing nurses to complete paperwork directly with each patient.
• Wasted space became additional counter space, enabling efficient assembly of medical charts.

The team reported that the changes improved work efficiency and resulted in greater staff satisfaction, which also improved patients’ experiences.

Brenda Williams, left, and Christian Flores show the difficulty of scheduling patient infusion appointments. (Photo by p.cunningham)

The Brawerman Center manages about 2,500 infusion appointments each month. Estimating the time needed for appointments can be challenging because some medications take longer to administer or are more complex than others. Scheduling that better matches the length of patients’ actual infusion time could lead to greater efficiency and satisfaction.

The team analyzed the requirements of the most common infusion procedures and began developing a standard chart to help schedulers determine the best appointment options for patients. Team members also will test a plan that dedicates a space specifically for procedures that take less than an hour.

“Our schedulers do an amazing job of managing their very complicated duties in addition to distractions from patients, clinical staff and lobby foot traffic in the waiting areas, so anything we can do to make their jobs easier while also making the process more patient friendly was a top priority,” said Mary Scott, director of clinical practice and education, who led the team.

Lab test orders

City of Hope employees also continued improving the lab test order process. Team members recently focused on improving order forms’ legibility.

“Physician names on the laboratory orders that were difficult to read or identify sometimes resulted in delays in the availability of those lab test results for the patient’s subsequent appointments,” said Joe Singh, regulatory coordinator for the Clinical Trials Office in the Department of Regulatory Support Services and team leader for the lab test orders effort.

Among the team’s improvements to lab test orders:

• Creation of an electronic lab test order form to eliminate legibility issues
• Set up of a visual check of lab test forms to ensure information is complete before submission

The team is finalizing the electronic lab test order form and plans to release it to medical oncology clinics by the end of October.

The next ACE events are scheduled for Nov. 1 to 5.

For more information, employees may visit www.coh.org/ACE. Questions about ACE also may be addressed to Tricia Kassab, vice president of quality and patient safety, at tkassab@coh.org.