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Reducing wait time for administration of systemic anticancer treatment (SACT) in a hospital outpatient facility
  1. Angeline Macleod1,
  2. Fiona Campbell2,
  3. Derick Macrae1,
  4. Evelyn Gray3,
  5. Leanne Miller4,
  6. Michelle Beattie5
  1. 1Cancer Services, NHS Highland, Inverness, Scotland, UK
  2. 2Macmillan Suite, NHS Highland, Inverness, Highland, UK
  3. 3Medical Division, NHS Highland, Inverness, Highland, UK
  4. 4Pharmacy Department, NHS Highland, Inverness, Scotland, UK
  5. 5Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
  1. Correspondence to Dr Michelle Beattie; michelle.beattie{at}


The demand for systemic anticancer treatment continues to rise due to the increasing numbers being diagnosed with cancer and developments in treatment options. The net result is greater pressure on services and subsequent patient delays. Delays in treatment could decrease the benefit of the therapy and be detrimental to patient experience. Patients with human epidermal growth factor receptor-2 (HER 2) positive breast cancer within Raigmore Hospital waited an average of 41 min from the scheduled appointment time despite the administration of subcutaneous (SC) trastuzumab being scheduled for a 15 min treatment window. Given the frequency of these injections, this was having an adverse impact on patients and services. The aim of this project was for patients with breast cancer to receive treatment within the 15 min window. Lean principles were applied to reduce waste and increase value. Exploration of the problem led to the solution of relocating the administration of SC trastuzumab from the Macmillan Day Bed Unit (MDBU) to the Highland Breast Centre (HBC). Multiple improvement tools and techniques were used to implement the change. Data were collected on the median number of treatment episodes of SC trastuzumab per week at baseline and patient wait from appointment time to treatment completion was calculated at baseline and as an ongoing measure. Patient experience feedback was gathered following relocation of the treatment. Following relocation, the average time from scheduled appointment to discharge was 14 min (66% reduction). Patient experience feedback was positive and identified an unanticipated outcome; the regular Friday afternoon clinic, identified as most efficient for the service, was found by patients to be particularly convenient for their own planning. Through the application of Lean principles, the service was redesigned in a cost neutral way and resulted in a reduction in the wait time for treatment.

  • continuous quality improvement
  • efficiency
  • organisational
  • healthcare quality improvement
  • lean management
  • PDSA

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  • Contributors This project was codesigned by FC, DM, EG, LM and AM. MB supervised the project throughout. AM conducted data collection, observations and analysis. MB drafted the paper and all authors revised before agreeing the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This work met criteria for operational service improvement work exempt from research ethical review. The project was registered with the local Clinical Governance Department (Project Registration number 2019/20 – 011)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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