In the community oncology setting, we are all too familiar with the ongoing challenge of providing quality cancer care in a declining reimbursement environment. Efficiency translates to savings, and running an efficient infusion suite is no longer a luxury but rather a necessity. Many factors affect your ability to run an infusion suite efficiently, including appropriate staffing, acuity and number of treatments, inaccurate scheduling, pending lab results, ancillary department delays, patient issues, reimbursement issues, and physician work styles.
Patients have a choice of where to go for their care, so patient satisfaction is high on everyone’s list. It can be measured by a patient survey. The survey provides a baseline measurement prior to implementing any changes in the practice. The survey should be easy to understand, concise, and distributed without bias. Make sure you ask questions that will address your concerns, and be prepared for what you may hear. Ideally, a multidisciplinary team should review the results and be empowered to drive change based on the results.
Accurate scheduling
The number-one reason for patient dissatisfaction in physician offices is waiting. The more “stops” or places a patient has to go in your practice, the greater potential for delays. Waiting can be caused by delayed lab results, doctors who are late entering exam rooms, lack of chair space, lack of an available nurse, preparation of medications, not enough staff, or too many patients at one time (otherwise known as “crunch time).” When patients are delayed continuously, they tend not to trust their appointment time and may arrive late, further confusing the schedule.
To increase efficiency and improve patient satisfaction, scheduling needs to be as accurate as possible. Most infusion suite schedules are destined to fail. In other words, the schedule that is set up on paper or in the electronic schedule does not and cannot happen. It is difficult in the real world to have a “perfect” schedule. Things happen beyond our control; you always want to have some wiggle room for those unexpected situations while at the same time creating a schedule that is as accurate as possible.
Split scheduling, or decoupling of the office visit and chemotherapy appointment, is the most accurate way to schedule chairs in an infusion suite. Accuracy in scheduling translates into a better opportunity to staff appropriately, decreased overtime, lower inventory, and efficient utilization of infusion chairs. With split scheduling, patients comes in the day before chemotherapy for an office visit with a physician, mid-level practitioner, or nurse to determine their readiness for chemotherapy. During that assessment, patients have their labs, vital signs, toxicity assessment, prescriptions, and physician orders completed, and their next-day treatment appointment time confirmed. The day of the treatment, the patient’s medications (depending on stability) may be prepared ahead of time, so that the infusion begins immediately after the IV is started.
The concept of a split schedule is met with resistance by most healthcare professionals. There is disbelief that it could actually improve patient satisfaction. But remember, the most common reason for patient dissatisfaction is waiting, and the time a patient spends waiting in your office decreases dramatically with use of a split schedule. Before a split schedule can be attempted, you have to get buy-in from all the physicians. One way to motivate buy-in is to present the potential monthly savings if overtime pay is eliminated. These savings can be realized the first month of implementation, as can savings from reductions in inventory. If you have the ability to order drugs the day before for next-morning delivery, the drugs that are expensive and used less commonly can be ordered only as needed.
Also, patients need to be prepared ahead of time for the scheduling change. A letter of explanation sent 1 or 2 months before implementation is beneficial and gives you time to address any queries or concerns. I have found that patients and caregivers are very understanding when they realize we need to do this to be able to continue to provide our services in a cost-effective manner. Policies and procedures must be developed and all staff educated about the process. Exceptions to the split schedule should be kept to a minimum so you can realize the full benefit of the cost savings and efficiency.
Efficient use of infusion chairs
The set up of the infusion suite chair template is also critical for success. No matter what format is used, paper or electronic, the times patients cannot be accommodated should be blocked out. For example, if you have three infusion nurses scheduled to start work at 8:00 am and you allow 15 minutes to start a patient, from 8:00–8:15 am you should only be able to schedule three patients for infusions; the next available slots would occur at 8:15 am and so on. This would have to be tailored to your practice size, staff, operation hours, and number of chairs. It works ideally with the split schedule because infusions start on time, as the patients were assessed the day before.
Consider utilizing nursing staff optimally by separating patients with noninfusion appointments from those with infusion appointments. Patients coming in for complete blood counts, injections, port flushes, and pump disconnects could be triaged in another area of the infusion suite, freeing up recliner space. In addition, nursing staff should not be doing tasks that could be delegated to other staff, including clerical tasks, authorizations, vital signs, injections, stocking, cleaning, and ordering supplies.
Efficiency equals cost savings and patient and employee satisfaction. Appropriate use of the infusion suite chairs, infusion schedule, and nursing staff can improve the flow of the infusion suite without adding costs to your practice. In fact, cost savings can be realized quickly, once the implementation process has been completed.
Ms. Maxwell is Director of Clinical Operations at Advanced Medical Specialties, Miami, FL. She has no conflicts of interest to disclose.