San Antonio, TX—Oncology nurses at The Ohio State University, Columbus, have been altering their chemotherapy infusions scheduling and achieving higher volume, along with increased patient and nurse satisfaction. At the Oncology Nursing Society 41st Annual Congress, 2 of these projects were described at poster sessions, the Stephanie Spielman Comprehensive Breast Center and the Wexner Medical Center.
No, You Can’t All Come at Once!
The Stefanie Spielman Comprehensive Breast Center was experiencing fluctuation in the volume of patients seen throughout the day and week. The bulk of patients were being scheduled between 10:00 AM and 2:00 PM; this caused safety concerns and inefficiencies, because nurses were unable to accommodate a growing volume of scheduled patients and same-day add-ons, said Lindsey Radcliff, BSN, RN.
“What was wrong? We were seeing about 50 patients between 10:00 AM and 2:00 PM, and add-ons. Patient safety was jeopardized,” Ms Radcliff explained.
A multidisciplinary task force was formed to determine how best to meet patients’ needs safely and efficiently while maximizing patient flow, scheduling, and staffing patterns. They designed a “mini-LEAN” project to revise the scheduling process by spacing chemotherapy treatments throughout the clinic day and week. (LEAN is a method that improves performance by removing waste or nonessential parts of a process.)
Specifically, the group created a scheduling template that added earlier morning appointment times and adjusted nursing schedules to accommodate treatment duration, as follows:
- The number of patients to be accommodated directly coincides with the number of nurses working in each time slot
- Early morning appointments are given to patients having only an infusion visit
- Between 9:30 AM and 1:00 PM, time slots are for patients with a provider visit before their treatment
- From 2:00 PM to 4:00 PM, appointments are resumed for patients with infusion-only visits
- Patients whose infusion times are ≥6 hours long must be scheduled by 11:00 AM.
The center now has more morning time slots and more nurses to accommodate these patients. By 9:00 AM the unit is fully staffed with 11 or 12 nurses. Their cutoff time has been extended as well. “It used to be 3 PM, but we realized we can take 30-minute infusions at 4:30 and still be done by 6 PM,” she said.
Greater accommodation of add-ons won buy-ins from physicians. “They were tired of us refusing add-ons, but we just couldn’t take them! Now, I don’t know of a time when we have ever had to tell physicians no,” she added.
The new template has produced a 15% increase in the number of patients seen in a day, without additional stress. “When we used to have 50 patients, it was a crazy day because 5 or 6 came in just 4 hours. Now we see 65, and because they are more spread out, sometimes we are just looking for things to do,” she said.
Initially, some patients were unhappy with their new appointment times. “Some who had been there for years were upset they couldn’t come at 11 AM anymore, but then they realized if they come for a 30-minute infusion at 3:30 they are out of here much faster than when they came earlier.”
Give Me a Break!
At The Ohio State University Wexner Medical Center, scheduling was overhauled to address a complaint from nurses, said Shavonda Neal, BSN, RN, who presented the poster.
“Our problem was that nurses were not going to lunch. Period. With the model we created, everyone should have a chance to go to lunch,” said Ms Neal.
Their unit has 40 beds and chairs, and 15 nurses manage an average of 70 patients on weekdays, 35 on Saturday, and 15 to 20 on Sunday.
In the new model, patients are evenly scheduled throughout the day, but the schedule is blocked from 11:00 AM to 12:30 PM daily during the week. Between 7:30 AM and 10:30 AM, 35 patients are scheduled, and between 12:30 PM and 5:00 PM, another 35 or more are scheduled, but the lunch break is free of patients.
Other patients needing blood, hydration, platelets, and so forth are added on to the schedule as needed.
The goal for a 70-patient day is for each nurse to have 6 patients—3 in the morning and 3 in the afternoon. The nurse should be able to take care of each patient with minimal float help. The float nurse will be able to field beeping pumps, call lights, and double-checks within each pod, she explained.
Treatments of long duration are scheduled early in the day, and patients with physician appointments or radiation therapy are given priority in scheduling. Charge nurses and schedulers collaborate to maintain the approved number of patients per time slot.
The majority of nurses have been able to leave for lunch within the 11:00 AM to 12:20 PM time frame, and they are able to relieve each other for lunch within a pod when staffing does not permit having floats, she said.
Patient satisfaction scores have remained >95%. After just 3 months under the new model, nurse satisfaction scores (based on the National Database of Nursing Quality Indicators) increased from 80.00 to 89.47, Ms Neal reported.
“Our nurse satisfaction percentage is very high. Nurses are absolutely happy,” she said.
Keeping lunchtime sacred for nurses remains a challenge, she acknowledged. Patient visits have steadily increased, making it hard to optimize patient flow and reduce patient wait times while maintaining nurse and patient satisfaction.