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It’s Time: Smoother, Faster Services for Cancer Patients

Concord Repatriation General Hospital
Project Added:
12 August 2016
Last updated:
19 August 2016

It’s Time: Smoother, Faster Services for Cancer Patients

Summary

This project developed initiatives to reduce waiting time and delays for patients receiving chemotherapy and other treatments in the haematology and oncology units at Concord Cancer Centre, within Concord Repatriation General Hospital (CRGH). New business processes were developed, patient information brochures distributed, patient education needs reviewed, a staff education ladder developed and minor building and refurbishment works planned.

View a poster from the Centre for Healthcare Redesign graduation, August 2016.

It's time poster

Aim

To decrease the overall waiting time for patients in the Haematology and Oncology Units at CRGH by 30%, by July 2016.

Benefits

  • Increases timely access to care.
  • Increases service capacity using current resources.
  • Increases organisational understanding of service demand and capability.
  • Improves the definition and understanding of staff roles and responsibilities.
  • Improves patient outcomes by allowing staff to spend more time with patients.
  • Improves governance of the service.
  • Increases staff satisfaction and morale.

Background

The haematology and oncology units at Concord Cancer Centre provide cancer and non-cancer treatments in the areas of oncology, haematology, apheresis, neurology and immunology. There is an increasing demand for these services as referrals grow and new treatments emerge. A survey conducted in October 2014 revealed that patients attending the outpatient department at CRGH were waiting up to two hours beyond their scheduled appointment time for medical consultations and treatments.

Prior to the project, there were large variations in business processes within the haematology and oncology units. The lack of a specific information technology scheduling system made it difficult to manage flow and service demand, while the separate units each had their own allocated chairs, causing an uneven distribution of workload and skill mix among staff. As patients are unwell and travel significant distances to attend their clinic or treatment appointment, long waiting times resulted in patient dissatisfaction with the service and an increasing number of complaints.

Implementation

  • Patients were scheduled for blood tests the day before their treatment to reduce waiting time when they present for chemotherapy. Medical consultations were also scheduled on days when the patient was not receiving treatment.
  • A fast-track solution was implemented, where treatments taking less than 30 minutes were identified and staff resources for these patients streamlined.
  • Information brochures were developed and distributed to patients, explaining the new changes and how they would benefit.
  • New chairs, refurbished chairs and artworks were added to the patient waiting room to provide a relaxing and comfortable environment. Comfortable seating will also be purchased for the terrace area, to provide patients and their families with a relaxing outdoor space.
  • A large single desk will be installed, to replace the two separate desks currently used by the oncology and haematology units. This will allow staff to work together as a combined team across all treatment modalities and provide staff with a more even allocation of workload.
  • The information technology system was enhanced so that all patient appointments and treatment length can be visualised. By having a visible schedule for all chairs, patient demand can be better matched against available staff, reducing patient waiting time. It also helps the multidisciplinary team (MDT) identify where the patient is in the unit. A specific oncology information technology solution is being developed for SLHD, to provide enhanced scheduling functionality, e-prescribing and patient safety for all patients receiving chemotherapy.
  • Nursing admission and assessment documentation for haematology and oncology patients were reviewed and documents are being finalised by a working group to standardise the process for all patients. This will reduce duplication and confusion for staff in the merged unit.
  • A skills development document was developed for nursing staff. This document describes the anticipated acquisition of skills within prescribed timeframes, so that nurses can move from novice to expert. This will enable nurses to be proficient in all treatment modalities delivered within the merged unit and enhance their ability to deliver standardised and accurate information to patients.
  • Patients requiring chemotherapy currently receive one-on-one education delivered by a nurse a number of days before starting their treatment. Several other cancer day units provide group sessions with chairside nurses, reinforcing the information when they administer treatment. A group session involving the MDT , particularly allied health specialists, will enhance the patient’s understanding of how to access the MDT and how the team supports their care. This solution also involves further education for chairside nurses, to improve their ability and confidence in delivering more structured patient education. As of August 2016, this solution has yet to be implemented.

Project status

Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

  • Planning phase: July 2015 – December 2015
  • Implementation phase: January 2016 – December 2016

Implementation site

  • Concord Repatriation General Hospital, SLHD

Partnerships

  • ACI Centre for Healthcare Redesign
  • Peter MacCallum Cancer Centre, Melbourne
  • Olivia Newton John Cancer Centre, Melbourne
  • Royal North Shore Hospital Cancer Centre, Northern Sydney Local Health District
  • Crown Princess Mary Cancer Centre, Western Sydney Local Health District
  • Prince of Wales, Nepean, Liverpool and St George Hospitals’ Ambulatory Cancer Centres

Results

To ensure patients are ready for treatment on the day, all required preparation is done beforehand. This includes a review of blood tests, medical consultation, chemotherapy prescribing and pharmacy preparation. These elements are measured each month, with results to date are in the tables below.

Oncology department Sept 2015 May 2016 June 2016
Blood tests on day 85% 70% 25%
Medical consultations on day 55% 50% 25%
Number of patients delayed 85% 75% 58%
Haematology department Sept  2015 May 2016 June 2016
Blood tests on day 60% 40% 25%
Medical consultations on day 50% 30% 28%
Number of patients delayed 80% 65% 55%

The following measures will be collected each month and results will be used to ensure implementation is on track:

  • delays in minutes between specific points in the patient’s treatment day
  • percentage of patients who start treatment within 15 minutes of appointment time
  • delay time in minutes waiting for availability of chemotherapy
  • staff satisfaction
  • percentage of chemotherapy charts that are signed off and in the pharmacy prior to treatment day.

Lessons learnt

  • Reducing the number of solutions to a manageable number is difficult for large projects where solutions are interdependent.
  • Change is difficult, even when staff are committed to the change.
  • Communication must be well planned, consistent and repeated frequently.
  • Keeping all stakeholders informed sometimes means that alternate pathways of communication may need to be employed.

Further reading

  • Aranda S, Jefford M, Yates P et al. Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: results from a randomised, controlled trial. Annals of Oncology 2012; 23(1): 222-231.
  • Breen S. Meeting the information needs and reducing distress of patients beginning chemotherapy at the Peter MacCallum Cancer Centre. Supportive Care Final Report 2008/09. Western & Central Melbourne Integrated Cancer Service; August 2010.
  • Cook C, Towler L. Quicker cancer care: reshaping patient pathways. Nursing Management 2009; 16(4): 20-23.
  • Dobish R. Next-day chemotherapy scheduling: a multidisciplinary approach to solving workload issues in a tertiary oncology center. Journal of Oncology Practice 2003; 9(1): 37-42.
  • Kallen MA, Terrell JA, Lewis-Patterson P et al. Improving wait time for chemotherapy in an outpatient clinic at a comprehensive cancer center. Journal of Oncology Practice 2012; 8(1): e1-e7.
  • Macmillan Cancer Support. Improving cancer patient experience: a top tips guide. London: Macmillan Cancer Support; October 2012.
  • Murray D, Carle A, Kirsa SW et al. Developing a performance data suite to facilitate lean improvement in a chemotherapy day unit. Journal of Oncology Practice 2013; 9(4): e115-e121.
  • Peng S, Tan YS, Hairom Z et al. Improving wait times for elective chemotherapy through pre-preparation: a quality improvement project at the National University Cancer Institute of Singapore, National University Cancer Institute and National University Health System, Singapore. Journal of Oncology Practice 2015; 11(1): e89-e94.
  • Robinet JE. Bringing Order to Orders at the Nebraska Medical Centre. Quality in HealthCare Case Study. American Society for Quality; July 2006.
  • Santibanez P, Chow V, French J et al. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation. Health Care Management Science 2009; 12(4): 392-407.
  • van Lent WA, Goedbloed N, van Harten WH. Improving the efficiency of a chemotherapy day unit: Applying a business approach to oncology. European Journal of Cancer 2009; 45(5): 800-806.

Contacts

Geraldine Antonio
Clinical Redesign Project Manager
Concord Repatriation General Hospital
Sydney Local Health District
Phone: 02 9767 5315
Geraldine.Antonio@sswahs.nsw.gov.au

Liesl Duffy
Performance and Redesign Program Manager
Performance Unit
Sydney Local Health District
Phone: 02 9395 2370
Liesl.Duffy@sswahs.nsw.gov.au

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