Congress Abstracts 2003

5

DESIGNING OUTPATIENT FLOW: SAILING THROUGH THE STORM. Joan Strohm, RN, OCN^®, Vicki Caraway, RN, BSN, Janice Provenzano, RN, CGRN, and Christine Ellis, RN, BSN, OCN^®, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

Oncology patient care has reached a new level of complexity as patient management continues to shift to outpatient settings. Incorporation of multiple clinical programs into new space and undefined clinic flow has created additional issues for our patients and staff in navigating the system. Four large programs, previously located in separate clinic spaces, were relocated to the same area, presenting a challenge to providing quality, timely care to patients and families at H. Lee Moffitt Cancer Center and Research Institute. A “Clinic Flow Team” was formed to address these challenges. The purpose of this process was to improve overall clinic flow by decreasing wait times for both providers and patients and improving the check-out process, while maintaining confidentiality. Nurses in our clinic work closely with multiple team members to ensure seamless flow through the clinic and comprised most of the team (five nurses). Additional team members included the manager, one medical assistant, and one patient support representative. Initially, the team met on a weekly basis and then bimonthly, focusing on the following: check-in process, getting the patient into the examination room, check-out process, and room turnover. Delays in any one area had an impact on the entire process. After comprehensive review of the issues, several interventions were implemented. These interventions included implementing a flag system outside examination rooms; offering onsite phlebotomy services; implementing patient pagers; moving initial patient triage from central location to examination room; enhancing communication systems; and clarifying responsibilities. Recommendations made by the team first were presented to physician program leaders for input and then to the staff for implementation. Interventions were implemented over a six-month period of time. Staff and patients report satisfaction with the outcome. Patient responses good, very good, or excellent to “waiting time in clinic for appointment” on a satisfaction survey increased from 82% to 90% over a six-month period of time. Clinic staff identified shorter provider wait times, improved communication, and enhanced team cohesiveness as a result of the process. Problem resolution involving those closest to the issue, as in the scenario described, yields a successful and satisfying outcome.