City of Hope staff members have taken steps to shorten the wait time for patients receiving infusion therapy, such as chemotherapy, as part of their treatment.

Brian Chu throws a ping-pong ball at a basket under the watchful eye of Sharon Steingass during a skit. (Photo by p.cunningham)

The organization recently launched a “rapid improvement event” through its Accelerating Care Excellence (ACE) program to streamline coordination between City of Hope’s infusion clinic and pharmacy staff, which work together to administer infusion therapy to patients.

A team of physicians, nurses, pharmacists and other employees focused on the processes surrounding chemotherapy appointments, aiming to move patients through their infusions more efficiently. The group was one of two teams that focused on care improvements through ACE from Nov. 29 to Dec. 3. The second team addressed improvements in the management of patients’ electronic medical records.

Infusion clinic

The pharmacy on the first floor of the Geri & Richard Brawerman Ambulatory Care Center not only serves 13 areas in the hospital, but it also prepares the chemotherapy treatments given in the infusion clinic. Prior to the rapid improvement event, treatments sometimes were delayed because of coordination and communication challenges among the pharmacy, clinic, laboratory and caregivers.

Pharmacists were not notified routinely when lab results were available for each patient, so they had no verification that they should start preparing each patient’s chemotherapy. And clinic nurses had no easy way to receive updates from the pharmacy about the status of a patient’s chemotherapy preparations. That led to interruptions in employees’ work and extended wait times for patients.

“We focused on improving how staff can provide and receive updates to each other to make the process of chemotherapy preparation more efficient,” said Lisa Hart, an organizational development consultant at City of Hope and team leader for the infusion clinic event. “We’re implementing new systems that will help everyone and cut down on the number of interruptions and delays in the process.”

Among the team’s solutions:

• Pharmacists will receive notification to begin chemotherapy preparation only when both the patient is waitlisted for treatment and the patient’s lab test results are available.
• Pharmacists will use a board with time slots and treatment order cards to organize their preparation schedule, which also provides an easy visual reference for nurses on the status of a patient’s treatment.
• A new process for delivering medications to the infusion clinic enables pharmacists and pharmacy technicians to focus on their core responsibilities, which increases efficiency.

By the end of the ACE event, the team’s changes reduced the average time between the start of chemotherapy preparation to the start of patient infusion from 42 minutes to 34 minutes. The team aims to cut the processing time in half eventually.

Dan Seyler, Carl Kildoo and Brenda Williams perform a skit about infusion clinic challenges. (Photo by p.cunningham)

Another ACE team continued work begun in October to improve the tracking and management of services and materials provided to a patient during a visit.

“Our goal was to reduce the amount of confusion in the electronic medical records process, which could lead to corrections down the line,” said Sharon Steingass, R.N., M.S.N., vice president of ambulatory services at City of Hope and team leader of the visit management event. “While most of the improvements are taking place on the administrative side of patient care, simplifying the process will provide a better experience for everyone.”

The team developed a refined process that includes the following improvements:

• Eliminating redundant or unnecessary category options to streamline record keeping
• Creating filtered views on computer screens to provide clinical staff only with pertinent information that they need to provide care

The team will roll out the new process slowly, with a pilot test planned for January.

The next ACE events are scheduled for Jan. 10 through 14.

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.