Purpose: To decrease the rate of chemotherapy admissions that do not meet the McKesson InterQual Criteria by 50% and increase infusion chair utilization to 6 hours per day by June 30, 2013.
Background: Diminished access to the Infusion Clinic at the North Florida/South Georgia Veterans Health System (NFSGVHS) resulted in 88 bed-days of care at a cost of $190,784 in fiscal year (FY) 2013 Q2. These hospital admissions were due to chemotherapy and infusion that did not meet McKesson InterQual Criteria.
Methods: Literature review, value stream analysis, benchmarking, chart reviews, spaghetti diagram, gemba walk, and time flow analysis.
Data Analysis: A majority of patients were scheduled at 8:00 am, but the actual infusion did not start until 10:00 am. This resulted in a 2 hour wait time and an increased demand on staff during peak hours. At least 44% of treatments were for venous access device (VAD) flushes and labs drawn rather than on actual chemotherapy. There was also a large amount of time spent by nursing staff on telephone calls, supply retrieval, and VAD labs rather than on chemotherapy.
Results: Infusion chair utilization increased from 3.6 hours in September 2013 to 6.9 hours in August 2014. There was a reduction in hospital admissions for chemotherapy that did not meet McKesson InterQual Criteria from 88 bed-days in FY12 Q2 to 30 bed-days in FY14 Q3. By FY14 Q3, NFSGVHS had approximately $86,720 in costs avoided by reducing the number of hospital admissions that did not meet InterQual Criteria admissions to 40 days.
Implications: There is a need to spread VAD access to the outpatient clinics and improve access to the Infusion Clinic through an acuity-based scheduling model. There is also the need to have chemotherapy labs drawn the day before chemotherapy appointments and to restructure the nursing profile to ensure safe patient-nurse ratios and allow accurate chair utilization data collection.