Reducing wait time for administration of systemic anticancer treatment (SACT) in a hospital outpatient facility

BMJ Open Quality

article

Angeline Macleod¹  Fiona Campbell²  Derick Macrae¹  Evelyn Gray³  Leanne Miller⁴  Michelle Beattie⁵ 

[1] Cancer Services;Macmillan Suite;Medical Division;Pharmacy Department;Department of Nursing and Midwifery , University of the Highlands and Islands

关键词: continuous quality improvement;    efficiency;    organisational;    healthcare quality improvement;    lean management;    PDSA;   

DOI  :  10.1136/bmjoq-2019-000904

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

The demand for systemic anticancer treatment continues to rise due to the increasing numbers being diagnosed with cancer and developments in treatment options. The net result is greater pressure on services and subsequent patient delays. Delays in treatment could decrease the benefit of the therapy and be detrimental to patient experience. Patients with human epidermal growth factor receptor-2 (HER 2) positive breast cancer within Raigmore Hospital waited an average of 41 min from the scheduled appointment time despite the administration of subcutaneous (SC) trastuzumab being scheduled for a 15 min treatment window. Given the frequency of these injections, this was having an adverse impact on patients and services. The aim of this project was for patients with breast cancer to receive treatment within the 15 min window. Lean principles were applied to reduce waste and increase value. Exploration of the problem led to the solution of relocating the administration of SC trastuzumab from the Macmillan Day Bed Unit (MDBU) to the Highland Breast Centre (HBC). Multiple improvement tools and techniques were used to implement the change. Data were collected on the median number of treatment episodes of SC trastuzumab per week at baseline and patient wait from appointment time to treatment completion was calculated at baseline and as an ongoing measure. Patient experience feedback was gathered following relocation of the treatment. Following relocation, the average time from scheduled appointment to discharge was 14 min (66% reduction). Patient experience feedback was positive and identified an unanticipated outcome; the regular Friday afternoon clinic, identified as most efficient for the service, was found by patients to be particularly convenient for their own planning. Through the application of Lean principles, the service was redesigned in a cost neutral way and resulted in a reduction in the wait time for treatment.continuous quality improvementefficiencyorganisationalhealthcare quality improvementlean managementPDSAhttp://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND