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Abstract
Background The COVID-19 pandemic created new social-distancing guidelines, which exacerbated existing patient access issues at Tufts Medical Center Cancer Center. A recent survey showed treatment delays associated with COVID-19 in 27% of cancer patients(ASC-CAN 2020). Patient care & access delays impact clinical outcomes, patient satisfaction & revenue.
Objectives Baseline data from TMC Infusion Center demonstrated only 78–81% chair utilization between 11am-1pm, chair-waste time averaging 95 min & patient wait times averaging 101–126 min for linked provider-infusion visits(n=36). Objectives include decreasing patient wait times & improving throughput by 10%.
Methods Lean, Six-Sigma & IHI Model for Improvement methodologies were utilized to analyze current state & implement change strategies through a 3-phase Kaizen (figure 1). Phase 1 - Qualitative & quantitative tools, value-stream-map & driver-diagram (figure 2), were used to review current state & root causes with a subject matter expert multidisciplinary team. Three areas of opportunities were identified: patient flow between Infusion Center & Cancer Clinic, premixing drugs & lab turnaround time. Phase 2 – 4-hour Kaizen with 3 teams to root-cause analyze, design & simulate solutions. Phase 3 - Utilized Plan-Do-Study-Act methodologies to test solutions & gathered data outcomes for 30-days.
Results The patient flow team redesigned check-in/out & optimized waiting room space; resulted in 40%(n=16) wait time reduction, 53%(n=16) wasted chair time reduction, & created a one-directional flow to improve social distancing. The pharmacy team developed a drug premixing protocol based on type, longevity & cost. They also established a nursing-pharmacy huddle to review scheduled patients. This resulted in 16%(n=496) increase of drugs processed under 1-hour. The lab team used visual cues to standardize delivery of lab samples & improve lab result turnaround time (figure 3).
Conclusions Kaizen & PDSA methodologies proved effective & led to positive efficiency & patient satisfaction outcomes. Leadership & executive support were crucial for change management. Next steps include continuous monitoring of interventions to sustain processes & scheduling optimization.