Like any major organization, City of Hope depends on processes to succeed. Sometimes, these processes must be completely redesigned to keep up with changes and improve patient care. The Accelerating Care Excellence (ACE) program recently took on three processes that affect how clinical staff members work.

ACE team members perform a skit about lab test workflows. (Photo by p.cunningham)

One ACE team focused on a new electronic system for ordering medical tests, a second studied how to reduce delays in processing specific lab tests, and a third examined inventory management of supplies for clinical trials.

All three teams reported their successes April 29.

Electronic order entry

City of Hope is transitioning from paper to an electronic system for medical records, prescriptions and medical test orders. The electronic system will offer clinicians advantages such as instant access to patient information and automatic alerts about potential prescription drug interactions.

Through ACE, a team of physicians and employees started to design electronic orders for medical tests.

Team members identified categories of information that were most important, and then created templates for various different test orders. The team will continue their efforts in the next rounds of ACE events to build more information into the forms.

“We are in the very beginning stages of developing this new system and we wanted to start off on the right foot,” said ACE facilitator Houri Yeghiayan. “Our team represented all possible departments that have contact with medical test orders so we could understand how to build the best electronic form.”

Lab test results

Many patients undergo lab tests as part of their visits to City of Hope. Those tests help physicians assess how a patient is doing and which therapy the patient will receive.

City of Hope’s lab technologists manage hundreds of tests daily, and it may take them a day or more to report a test result. But sometimes a patient’s scheduled treatment depends on results of a test taken earlier that same day. Holdups in these test results can result in waits for treatment.

“The old work process allowed a 24-hour turnaround time for a specific test, but there are a few patients whose chemotherapy treatment is determined by those same-day results,” said Jamie Lee, team leader and senior analyst in the Information Technology Services Department. “We wanted to address how to identify and prioritize those patients for the lab.”

Among the ACE team’s improvements:

• They renovated lab space and rearranged equipment to enable greater efficiency.
• Team members created a system to identify and prioritize patients who require immediate results for treatment.
• They set up a centralized call center to manage inquiries and reduce interruptions to the work flow.

Inventory management

Managing supplies needed for clinical trial patients can be difficult. Some clinical trials require several years to complete, and study sponsors often ship all required supplies for every patient all at once.

An ACE team examined the entire inventory system to develop a more efficient, centralized process for managing these materials.

“One consequence of having so many different shipping schedules was that clinical trial supplies were stored in numerous locations around campus, rather than in one, more manageable location,” said Joe Singh, team leader and ACE facilitator.

The team identified one room to serve as the centralized inventory location for all clinical trial supplies. They added shelving for more storage and organized all of the materials so that anyone could find necessary items. The team also is developing a system that will use visual reminders to alert staff to reorder or restock supplies.

The next ACE events are scheduled for May 23 through 27. 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.