The next generation of quality improvement at MSK: Turning chemotherapy process delays into chemo express.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18230-e18230
Author(s):  
Jennifer Tota ◽  
Kathleen Levine ◽  
Jeanine Gordon ◽  
Abigail Baldwin ◽  
Jodi Wald ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Patient Experience ◽  
Wait Time ◽  
Wait Times ◽  
Pilot Program ◽  
Treatment Results ◽  
Average Wait Time ◽  
Major Bottleneck ◽  
Work Done

e18230 Background: Chemotherapy wait times can dramatically affect patient experience. MSK’s largest outpatient facility has 76 infusion spaces and 250-300 daily visits. A retrospective review of the facility’s infusion area wait times suggested that the lab (where all patients go to get their vitals and blood drawn) was a major bottleneck leading to process delays in infusion. Methods: We conducted a pilot program using a multi-pronged approach. Our goal was to decrease wait time from 40 minutes to an average of 15 minutes. Our initiative was defined as follows: (1) to redefine lab parameters that are relevant for toxicity and to only consider drawing those necessary labs; additionally, we created guidelines for timing of the labs prior to infusion treatment, (2) to introduce a program known as “ChemoExpress” which offers patients the opportunity to get blood work done prior to the day of their infusion appointment. After the labs result, the outpatient RN calls the patient, assesses symptoms and “clears them” for treatment cueing the pharmacy to prepare and “premix” the drug on the day of treatment. Results: 150 patients have enrolled in ChemoExpress. Patient satisfaction was high based on patient satisfaction surveys (n = 20). Average wait time was 9 minutes (76% less) in ChemoExpress participants as compared to an average wait of 39 minutes for those who did not participate in ChemoExpress. Conclusions: Implementing a process that enables patients to have their bloodwork drawn prior to the day of treatment and drugs prepared in advance of their treatment appointment results in greater efficiency in the overall workflow. It also offers the patient a lower wait time and a more efficient and satisfying experience.

scholarly journals Improving the wait time to admission by reducing bed rejections

2019 ◽  
Vol 8 (3) ◽  
pp. e000710
Author(s):  
Yuzeng Shen ◽  
Lin Hui Lee
Keyword(s):  
Quality Improvement ◽  
Wait Time ◽  
Wait Times ◽  
Quality Improvement Effort ◽  
Average Wait Time ◽  
Bed Management ◽  
Ward Level ◽  
Resultant Increase ◽  
Admissions Process ◽  
Improvement Effort

Congestion at the emergency department (ED) is associated with increased wait times, morbidity and mortality. We have identified prolonged wait time to admission as a significant contributor to ED congestion. One of the main contributors to prolonged wait time to admission was due to rejections by ward staff for the beds allocated to newly admitted patients by the Bed Management Unit (BMU). We have identified this as a systemic issue and through this quality improvement effort, seek to reduce the incidence of bed rejections for all admitted patients by 50% from 9% to 4.5% within 6 months. We used PDSA (Plan, Do, Study, Act) cycles to implement a series of interventions, such as updating legacy categorisation of wards, instituting a ‘no rejects’ policy and performing ward level audits. Compared with baseline, there was reduction in rejected BMU allocation requests from 9% to 5% (p<0.01). The monthly percentage of patients with at least one rejection dropped from an average of 7% to 4% (p<0.01). With reduction in the number of rejections, the average wait time to the final request acknowledged by the ward for all admission sources decreased from 2 hours 19 min to 1 hour (p<0.01), thereby allowing the overall wait time to admission to decrease by 68 min, from 5 hours 13 min to 4 hours 5 min. Improvements in the absolute duration and variance of wait times were sustained. Although the team’s initial impetus was to improve ED wait times, this hospital-wide effort improved wait times across all admission sources. There has been a resultant increase in ownership of the admissions process by both nursing and BMU staff. With the conclusion of this effort, we are looking to further reduce the wait time to admission by optimising the current bed allocation logic through another quality improvement effort.

Protocol for stepped wedge cluster randomized trial to evaluate the effects of SurgeCon: A quality improvement emergency department surge management platform (Preprint)

2021 ◽  
Author(s):  
Hensley Mariathas ◽  
Shabnam Asghari ◽  
Oliver Hurley ◽  
Nahid Anaraki ◽  
Christina Young ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Health System ◽  
Wait Time ◽  
Cluster Randomized Trial ◽  
Wait Times ◽  
Hybrid Design ◽  
Stepped Wedge ◽  
Patient Reported ◽  
Cluster Randomized

BACKGROUND Despite many efforts, long wait time and overcrowding at Emergency Departments (EDs) have remained a significant health system issue in Canada. For several years, Canada has had one of the longest wait times among Organisation for Economic Co-operation and Development OECD countries. From the patient’s perspective, the challenge has been described as “patients wait in pain or discomfort for hours before being seen at EDs”. In this study, we propose an innovative quality-improvement intervention called SurgeCon that includes a protocol-driven software platform and several other initiatives to reduce wait times and improve the sustainability of health systems without significant workforce changes. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador (NL) and found there was a 32% reduction in ED wait time. OBJECTIVE Our primary objectives of the trial are to evaluate the effects of SurgeCon on ED performance based on length of stay (LOS), time to physician’s initial assessment (PIA), and the number of patients leaving the ED without being seen by a physician (LWBS), patient satisfaction and patient-reported experience with ED wait times. The ultimate goal of this study is to create better value care by reducing the per-patient cost of delivering ED services. METHODS This study will investigate the effects of SurgeCon on health system key performance outcomes and patient-reported experience and satisfaction. The study uses a comparative effectiveness-implementation hybrid design. This type of hybrid design has been recommended to help achieve rapid translational gains that can hasten the movement of interventions from research to practice to public health impact. In our hybrid design, we will use a pragmatic stepped wedge cluster randomized trial (SW-CRT) design that enrols four 24/7 on-site ED physician support (category A) hospitals into a 30-month trial. All clusters (hospitals) start with a baseline period of “usual care” and are randomized to determine the order and timing of transitioning to “intervention care” until all hospitals are exposed to the intervention condition for the remainder of the study. RESULTS Data collection for this study is ongoing. To date, 15 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. CONCLUSIONS By evaluating the mechanisms behind the use of SurgeCon, we hope to be able to improve wait times and create better value ED care in this healthcare context. CLINICALTRIAL This study is registered in ClinicalTrials.gov NCT04789902

scholarly journals Improving Patient Experience of Wait Times and Courtesy Through Electronic Sign-in and Notification in the Phlebotomy Clinic

2019 ◽  
Vol 144 (6) ◽  
pp. 769-775
Author(s):  
Vincent Le ◽  
Elizabeth A. Wagar ◽  
Ron A. Phipps ◽  
Robert E. Del Guidice ◽  
Han Le ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patient Experience ◽  
Patient Flow ◽  
Wait Time ◽  
Satisfaction Score ◽  
Wait Times ◽  
Notification System ◽  
The Mean ◽  
Patients Experience ◽  
And Training

Context.— The phlebotomy clinic, which sees on average 900 patients a day, was faced with issues of congestion and noise due to inefficient workflow and processes. The staff called each patient name for his or her turn, and patients were unsure of wait time and position in line. These factors led to unfavorable patient satisfaction regarding wait times and courtesy of the staff. Objective.— To improve patients' experience of wait times and courtesy in the phlebotomy clinic through an electronic sign-in and notification system, redesign of the area, and training of employees. Design.— An electronic sign-in and notification system was implemented in the phlebotomy clinic. Several sign-in stations and whiteboard wall monitors were installed in the clinic, along with a redesign of the patient flow. A Press Ganey survey was given to patients after their visit which included 3 questions related to wait times, courtesy, and information about delays, respectively. The mean responses for each month between March 2016 and December 2018 were aggregated and compared for each measure. Results.— Overall, wait time saw a 7.7% increase in satisfaction score, and courtesy saw a 1.0% increase in satisfaction score during the course of the several interventions that were introduced. The operational efficiency of the clinic also saw a veritable increase because the percent of patients processed within 20 minutes increased by 27%, from 62% (8212 of 13 245 blood draws) to 89% (11 703 of 13 143 blood draws). Conclusions.— The interventions implemented proved to increase the patient satisfaction in each of the measures. The electronic sign-in and whiteboards provided valuable information to both patients and staff.

Improving Outpatient Infusion Clinic Wait Times at a Comprehensive Cancer Center

2021 ◽  
pp. OP.21.00118
Author(s):  
Neda Hashemi-Sadraei ◽  
Shenthol Sasankan ◽  
Nick Crozier ◽  
Bernard Tawfik ◽  
Ronald Kittson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Working Group ◽  
Outcome Measure ◽  
Wait Time ◽  
Comprehensive Cancer Center ◽  
Secondary Outcome ◽  
Cancer Center ◽  
Wait Times ◽  
Patient Wait Time

PURPOSE: Many factors contribute to long wait times for patients on the day of their chemotherapy infusion appointments. Longer wait time leads to nonoptimal care, increased costs, and decreased patient satisfaction. We conducted a quality improvement project to reduce the infusion wait times at a Comprehensive Cancer Center. METHODS: A multidisciplinary working group of physicians, infusion center nurses, pharmacists, information technology analysts, the Chief Medical Officer, and patient advocates formed a working group. Wait times were analyzed, and the contributing factors to long wait time were identified. Plan-Do-Study-Act cycles were implemented and included labeling patients ready to treat earlier, loading premedications into the medication dispensing system, increasing the number of pharmacy staff, and improving communication using a secure messaging system. The outcome measure was time from patient appointment to initiation of first drug at the infusion center. The secondary outcome measure was patient wait time satisfaction on the basis of Press Ganey score. RESULTS: Postintervention, the mean time from appointment to initiation of first drug decreased 17.6 minutes ( P < .001; 95% CI, 16.3 to 18.9), from 58.1 minutes to 40.5 minutes (43.5% decrease). Patient wait time satisfaction score increased 8.9 points ( P < .001; 95% CI, 6.0 to 11.82), from 76.2 to 85.1 (11.7% increase). CONCLUSION: Exploring real-time data and using a classic quality improvement methodology allowed a Comprehensive Cancer Center to identify deficiencies and prevent delays in chemotherapy initiation. This significantly improved patient wait time and patient satisfaction.

Evaluating Virtual Care Experiences for Patients with Covid-19 Chief Complaints: Best-Practices Recommendations (Preprint)

2020 ◽  
Author(s):  
Saif Khairat ◽  
Malvika Pillai ◽  
Barbara Edson ◽  
Robert Gianforcaro
Keyword(s):  
Patient Experience ◽  
Wait Time ◽  
Secondary Outcome ◽  
Major Drawback ◽  
Cross Sectional ◽  
Average Wait Time ◽  
Adherence To Medication ◽  
Virtual Care ◽  
Chief Complaints ◽  
Virtual Visits

BACKGROUND Importance: Positive patient experiences are associated with illness recovery and adherence to medication. The shift toward virtual visits creates a need to understand the opportunities and challenges in providing a patient experience that is at least as positive as in-person visits. OBJECTIVE To evaluate the virtual care experience for patients with Covid-19 as their chief complaints. METHODS We conducted a cross-sectional study of the first cohort of patients with Covid-19 concerns in a virtual clinic. We collected data on all virtual visits between March 20-29, 2020. Outcomes: The main endpoints of this study were patient diagnosis, prescriptions received, referrals, wait time and duration, and satisfaction. The secondary outcome was the reported choice of alternative care options. RESULTS Of the 358 total virtual visits, 42 patients marked “Covid-19 Concern” as their chief complaint. Of those patients, 23 (54.8%) female patients, the average age of patients was 33.9 years, and 41 (97.7%) patients were seeking care for themselves and one (3.3%) visit was for a dependent. For all virtual visits, the average wait time (SD) was 157.2 (181.7) minutes and the average wait time (SD) for Covid-19 Concern visits was 177.4 (186.5) minutes. Covid-19 Concern phone visits had an average wait time (SD) of 180.1 (187.2), compared to 63.4 (34.4) minutes for Covid-19 Concern video visits. Thirteen (65%) patients rated their provider as “Excellent” with similar proportions among phone (64.3%) and video (66.7%). CONCLUSIONS This study evaluated the virtual experiences of patients with Covid-19 concerns. There were different experiences for patients depending on their choice of communication. Long wait times were a major drawback in the patient experience. We have learned from evaluating the experience of our first cohort of Covid-19 Concern patients.

scholarly journals P012: Why did you leave? Contacting left without being seen patients to understand their emergency department experience

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S61-S61
Author(s):  
B. Brar ◽  
J. Stempien ◽  
D. Goodridge
Keyword(s):  
Health Care ◽  
Wait Time ◽  
Wait Times ◽  
Average Wait Time ◽  
Left Without Being Seen ◽  
Care Processes ◽  
Time Period ◽  
Initial Interaction ◽  
Improving Health Care

Introduction: As experienced in Emergency Departments (EDs) across Canada, Saskatoon EDs have a percentage of patients that leave before being assessed by a physician. This Left Without Being Seen (LWBS) group is well documented and we follow the numbers closely as a marker of quality, what happens after they leave is not well documented. In Saskatoon EDs, if a CTAS 3 patient that has not been assessed by a physician decides to leave the physician working in the ED is notified. The ED physician will: try to talk to the patient and convince them to stay, can assess the patient immediately if required, or discuss other appropriate care options for the patient. In spite of this plan patients with a CTAS score of 3 or higher (more acute) still leave Saskatoon EDs without ever being seen by a physician. Our desire was to follow up with the LWBS patients and try to understand why they left the ED. Methods: Daily records from one of the three EDs in Saskatoon documenting patients with a CTAS of 3 or more acute who left before being seen by a physician were reviewed over an eight-month period. A nurse used a standardized questionnaire to call patients within a few days of their ED visit to ask why they left. If the patients declined to take part in the quality initiative the interaction ended, but if they agreed a series of questions was asked. These included: how long they waited, reasons why they left, if they went somewhere else for care and suggestions for improvement. Descriptive statistics were obtained and analyzed to answer the above questions. Results: We identified 322 LWBS patients in an eight-month time period as CTAS 3 or more acute. We were able to contact 41.6% of patients. The average wait time was 2 hours and 18 minutes. The shortest wait time was 11 minutes, whereas the longest wait time was 8 hours and 39 minutes. It was found that 49.1% of patients went to another health care option (Medi-Clinic or another ED in Saskatoon) within 24hrs of leaving the ED. Long wait times were cited as the number one reason for leaving. Lack of better communication from triage staff regarding wait time expectations was cited as the top response for perceived roadblocks to care. Reducing wait times was cited as the number one improvement needed to increase the likelihood of staying. Conclusion: The Saskatoon ED LWBS patient population reports long wait times as the main reason for leaving. In order to improve the LWBS rates, improving communication and expectations regarding perceived wait times is necessary. The patient perception of the ED experience is largely intertwined with wait times, their initial interaction with triage staff, and how easily they navigate our very busy departments. Therefore, it is vital that we integrate the patient voice in future initiatives geared towards improving health care processes.

scholarly journals National initiatives to promote quality of care and patient safety: achievements to date and challenges ahead

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Dalia Dreiher ◽  
Olga Blagorazumnaya ◽  
Ran Balicer ◽  
Jacob Dreiher
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Healthcare System ◽  
Quality Indicators ◽  
Patient Experience ◽  
Health Care Providers ◽  
Care Providers

Abstract Background The quality of healthcare in Israel is considered “high”, and this achievement is due to the structure and organization of the healthcare system. The goal of the present review is to describe the major achievements and challenges of quality improvement in the Israeli healthcare system. Body In recent years, the Ministry of Health has made major strides in increasing the public’s access to comparative data on quality, finances and patient satisfaction. Several mechanisms at multiple levels help promote quality improvement and patient safety. These include legislation, financial incentives, and national programs for quality indicators, patient experience, patient safety, prevention and control of infection and accreditation. Over the years, improvements in quality indicators, infection prevention and patient satisfaction can be demonstrated, but other fields show little change, if at all. Challenges and barriers include reluctance by unions, inconsistent and unreliable flow of information, the fear of overpressure by management and the loss of autonomy by physicians, and doubts regarding “gaming” of data. Accreditation has its own challenges, such as the need to adjust it to local characteristics of the healthcare system, its high cost, and the limited evidence of its impact on quality. Lack of interest by leaders, lack of resources, burnout and compassion fatigue, are listed as challenges for improving patient experience. Conclusion Substantial efforts are being made in Israel to improve quality of care, based on the use of good data to understand what is working and what needs particular attention. Government and health care providers have the tools to continue to improve. However, several mechanisms for improving the quality of care, such as minimizing healthcare disparities, training for quality, and widespread implementation of the “choosing wisely” initiative, should be implemented more intensively and effectively.

Triage of Rheumatology Referrals Facilitates Wait Time Benchmarks

2016 ◽  
Vol 43 (11) ◽  
pp. 2064-2067 ◽  
Author(s):  
Chandra Farrer ◽  
Liza Abraham ◽  
Dana Jerome ◽  
Jacqueline Hochman ◽  
Natasha Gakhal
Keyword(s):  
Quality Improvement ◽  
Connective Tissue ◽  
Patient Outcomes ◽  
Inflammatory Arthritis ◽  
Wait Time ◽  
Wait Times ◽  
Referral Letter ◽  
Advanced Practice ◽  
Priority Ranking ◽  
Improve Patient

Objective.In 2014 the Canadian Rheumatology Association published wait time benchmarks for inflammatory arthritis (IA) and connective tissue disease (CTD) to improve patient outcomes. This study’s aim was to determine whether centralized triage and the introduction of quality improvement initiatives would facilitate achievement of wait time benchmarks.Methods.Referrals from September to November 2012 were retrospectively triaged by an advanced practice physiotherapist (APP) and compared to referrals triaged by an APP from January to March 2014. Each referral was assigned a priority ranking and categorized into one of 2 groups: suspected IA/CTD, or suspected non-IA/CTD. Time to initial consult and time to notification from receipt of referral were assessed.Results.A total of 558 (n = 227 and n = 331 from 2012 and 2014, respectively) referrals were evaluated with 35 exclusions. In 2012, there were 96 (42.5%) suspected IA/CTD and 124 (54.9%) suspected non-IA/CTD patients at the time of the initial consult. Mean wait times in 2012 for patients suspected to have IA was 33.8 days, 95% CI 27.8–39.8, compared to 37.3 days, 95% CI 32.9–41.7 in suspected non-IA patients. In 2014, there were 131 patients (43%) with suspected IA based on information in the referral letter. Mean wait times in 2014 for patients suspected to have IA was 15.5 days, 95% CI 13.85–17.15, compared to 52.2 days, 95% CI 46.3–58.1 for suspected non-IA patients. Time to notification of appointment improved from 17 days to 4.37 days.Conclusion.Centralized triage of rheumatology referrals and quality improvement initiatives are effective in improving wait times for priority patients as determined by paper referral.

Minimizing wait time between chemotherapy and radiotherapy treatments.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 82-82
Author(s):  
James J. Sauerbaum ◽  
Gina DeMaio ◽  
Bradley Geiger ◽  
Regina Cunningham ◽  
Marianna Holmes ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Task Force ◽  
Wait Time ◽  
Support Staff ◽  
Cancer Center ◽  
Wait Times ◽  
Average Wait Time ◽  
Scheduling Method ◽  
Reduce Wait Time ◽  
E Mail

82 Background: Members of the scheduling teams at the Abramson Cancer Center observed prolonged delays between chemotherapy and radiation therapy treatments scheduled by staff from 2 independent departments leading to inconvenience for patients receiving concurrent chemo- and radiation therapy (CRpts). Methods: An analysis of baseline data over 6 weeks revealed that for 157 unique consecutive patients undergoing daily chemotherapy and radiation (a total of 353 encounters), the mean time between scheduled treatments was 122 minutes. For 39% of encounters the wait time was greater than 120 minutes. To improve the adjacency of chemotherapy and radiation appointments and to consistently reduce wait time between treatments to less than 120 minutes, we formed a Chemotherapy/Radiation Scheduling Task Force consisting of patient service representatives, practice managers, and physician and nurse advisors. We determined that CRpts should be scheduled using a “huddle” strategy whereby prospectively identified CRpts are simultaneously scheduled for both treatments in a coordinated manner. Identifying CRpts for coordinated scheduling was facilitated by the creation of a chemo-radiation scheduling inbox to which clinicians and support staff e-mail names of new CRpts in order to alert the scheduling team. Our two lead schedulers meet 2-3 times per week to coordinate patient schedules. A weekly scorecard of the wait times for CRpts patients is distributed via e-mail to the clinicians and support staff. Results: Over the past 6 months, we have used the huddle method for 80% of 986 consecutive CRpt encounters. Our average wait time for huddle-scheduled encounters has been reduced to 62.5 minutes with only 9% of encounters having wait times over 120 minutes. For non-huddle-scheduled encounters, the average wait time is 129 minutes with 57% having wait times over 120 minutes. Conclusions: Utilization of a huddle scheduling method has successfully reduced wait time for CRpts. Use of the huddle method continues to grow with staff training and awareness of the new process.

Waiting for scheduled surgery: A complex patient experience

2016 ◽  
Vol 22 (3) ◽  
pp. 290-301 ◽  
Author(s):  
Tracey Carr ◽  
Ulrich Teucher ◽  
Alan G Casson
Keyword(s):  
Cardiac Surgery ◽  
Patient Experience ◽  
Symptom Severity ◽  
Wait Time ◽  
Patient Experiences ◽  
Qualitative Approach ◽  
Wait Times ◽  
Complex Relationship ◽  
Healthcare Resources ◽  
Complex Patient

The aim of this study was to understand experiences of wait time among patients awaiting scheduled orthopaedic or cardiac surgery. Using a qualitative approach, 32 patients completed two interviews each regarding their wait time experiences, including effects of waiting. Patient experiences of wait time varied regardless of actual wait time and included reports of restriction, uncertainty, resignation, coping and opportunity. Participants’ waiting experiences indicate a complex relationship between greater symptom severity and less tolerance for wait time. We suggest healthcare resources focus on alleviating the deleterious effects of waiting for certain patients rather than reducing absolute wait times.

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