Congress Abstracts 2003

6

EFFECTIVE STRATEGIES FOR DECREASING UNSCHEDULED WALK-IN INFUSION APPOINTMENTS. Teresa Mazeika, BSN, OCN^®, Dana Farber Cancer Institute, Boston, MA.

Background: The solid tumor ambulatory infusion unit at a major comprehensive cancer center serves approximately 120 scheduled patients on a daily basis. This nurse-driven service delivers an extensive range of chemotherapy regimens, transfusions, and hydration, as well as providing symptom management, extensive health teaching, and supportive care. Prior to the implementation of this project, this infusion service would see between 11 and 35 unscheduled patients in addition to the scheduled volume on a daily basis. This unscheduled volume resulted in increased wait times, which in turn resulted in patient, nurse, and physician dissatisfaction. It also provoked concerns regarding the safe delivery of care in a busy ambulatory setting. A review of clinic statistics revealed that approximately 60% of these unscheduled patient visits could have been avoided. A quality improvement task force was convened to evaluate the scope of this concern and to develop a framework for problem solving.

Project: The quality improvement task force included representatives from the infusion service nurses, support staff, and information systems. Physicians and nurse managers served as consultants. The project objectives were to investigate the nature of the unscheduled patient volume and to develop a plan for managing this problem. The task force met weekly to determine factors contributing to unscheduled appointments. Examples of causal factors were patients leaving without checking out, poor guidelines for scheduling patient appointments, and a scheduling process that was confusing for the patients. Subsequently, a rapid cycle improvement analysis was employed to formulate the solution, implementation, and continuous monitoring strategy. This plan was presented to the nursing and support staff, as well as physicians. Consensus was obtained, and the plan was implemented.

Evaluation: After three months, success of this project is evident by a 29% decrease in unscheduled patient visits into the infusion clinic. Continued monitoring occurs on a quarterly basis. Clinicians have voiced increased satisfaction because of the decrease in unscheduled visits and the patients have voiced recognition of improvements in our system since the implementation of the quality improvement initiative.

Interpretation: Clinical oncology nursing staff can successfully lead quality improvement initiatives to improve patient care flow, increase staff and patient satisfaction, and ultimately lead to a safer environment for providing oncology treatments. This initiative can be a useful model for other cancer centers that also have been faced with the dilemma of unscheduled patient visits.