City of Hope staff members, nurses and physicians have come up with a way to make the hematopoietic cell transplantation preparation process faster and more efficient, saving time for patients and funds for the organization.

Marisa Remorca-Isidro, left, plays the part of a patient in an ACE skit with Brenda Williams. (Photo by p.cunningham)

The team tackled the process as part of the Accelerating City of Hope Excellence (ACE) program, which encourages the institution and its employees to identify opportunities for improvement, find solutions and change processes for the better.

ACE improvements often move quickly, with changes typically implemented within five days, but sometimes complicated issues can take much longer. The recent transplant-preparation project was one of those complex, long-term projects.

Team members focused on “Cytoxan mobilization,” a combination treatment used to get some patients ready for hematopoietic stem cell transplants. Team members sought ways to save time during the treatment, which often has had long wait times and inflexible scheduling. The team reported its successes Jan. 27.

Before patients can get what are called autologous stem cell transplants — infusions of their own blood stem cells — they go through Cytoxan mobilization. This is a combination of high-dose chemotherapy (called Cytoxan) and growth factor drugs that increase stem cell production. It can take up to 27 hours when the patient is treated as an inpatient. The team aimed to improve the process by transitioning treatment to an outpatient setting.

“We want to move this process to an outpatient setting because it will greatly decrease the time patients have to spend undergoing the procedure,” said Amin Rabiei, team leader and facilitator for the Cytoxan mobilization improvement event.

When they looked into the process, they found a key reason for long waits and infusion times: City of Hope typically gives patients their Cytoxan mobilization on the same day that physicians implant a port for an intravenous catheter called a Hickman line.

This constraint can add hours to the process.

According to Rabiei, physicians perform Hickman placements only within City of Hope Helford Clinical Research Hospital operating rooms and only on Friday mornings.

“We already were planning to move these Hickman placements to the Outpatient Surgery Center but during the event we evaluated the feasibility of using other locations as well, which will not only free up valuable Helford Hospital operating room time, but also give us greater flexibility in the days we can do the placements — and by extension, Cytoxan mobilizations,” Rabiei said.

Additionally, the team is assessing the need to have the Hickman line inserted on the same day as the Cytoxan mobilization. Some patients may soon be able to have their Hickman placement done on a different day, further reducing their infusion time.

The next ACE events are scheduled from Feb. 20 to 24. For more information, employees may visit www.coh.org/ACE. Questions about ACE also may be addressed to Tricia Kassab, R.N., B.S.N., M.S., vice president of quality and patient safety, at tkassab@coh.org.