Reducing patient wait time on an inpatient hematology and transplant unit.

87 Background: The University of Wisconsin Hematology and Bone Marrow Transplant services admit 250 patients per year for scheduled treatment. Time from patient arrival to chemotherapy initiation averages 7 hours. This long time leads to patient dissatisfaction and prolonged length of stay. Chemotherapy often begins in the evening when physicians and pharmacists are not on site to clarify treatment questions.

METHODS: A multidisciplinary team was formed in April 2015 as part of the ASCO Quality Training Program. The team developed the aim to reduce time from 7 hours to 5 hours to allow for more daytime nursing shift chemotherapy starts. The group created a process map and an Ishikawa diagram to identify causes of treatment delays. The team observed that treatment orders were often written and signed after hospital admission, though the plan of care was available prior to admission. Using a prioritized list, the initial process change was to have physicians write and sign chemotherapy treatment plans prior to admission. The process measure was the percentage of orders signed before admission. The outcome measure was time from arrival to chemotherapy start. Balance measures included narrative comments from physician and nursing staff about the process change. Data were obtained from EHR time stamps. Physicians were asked to begin making signed treatment plans available after August 1, 2015.

RESULTS: Data from 55 patients prior to the change (May 1-July 31) and 52 patients post-change (August 1-October 16) were analyzed. The number of treatment plans signed prior to admission increased from 27% to 58% (p = 0.0018). Mean time from admission to treatment pre-process change was 404 minutes and 383 minutes post-change. When plotted on a control chart, a sustained shift in the process was not apparent. Feedback from physician and nursing staff did not identify efficiency or safety concerns with the new process.

CONCLUSIONS: Though the percentage of orders signed prior to admission increased, there was no improvement in the time from patient admission to treatment initiation with this change. Future PDSA cycles will include increasing the percentage of orders signed prior to admission as well as address other sources of delay identified in the process map.