Birmingham VA reducing wait times for chemotherapy - Birmingham, Alabama VA Health Care System
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Birmingham, Alabama VA Health Care System


Birmingham VA reducing wait times for chemotherapy

Aliceson O'Hara RN, Infusion Nurse; Dr. Devika Das, Staff Physician, Medical Oncologist; and Dr. Barbara Gleaton, Oncology Pharmacist in Birmingham VA Oncology Clinic

Aliceson O'Hara RN, Infusion Nurse; Dr. Devika Das, Staff Physician, Medical Oncologist; and Dr. Barbara Gleaton, Oncology Pharmacist in Birmingham VA Oncology Clinic

By Derrick Smith, Public Affairs Specialist
Friday, June 12, 2020
A team consisting of nurses, pharmacists, physicians and supportive and quality improvement staff of the Birmingham VA Health Care System (BVAHCS) has implemented a process to reduce wait times for chemotherapy patients waiting for laboratory results.

The process is highlighted in the American Society of Clinical Oncology article ‘Reducing Infusion Clinic Wait Times Using Quality Improvement’.

One of the basic tenets of high-quality patient centered care as outlined by Institute of Medicine is timelines and efficiency. Patients with cancer already spend a lot of time between clinic visits, scan appointments, travel time, etc. We are actively looking at all our internal processes to make sure we can cut down on any avoidable wait times for our Veterans so they can spend maximum time with their loved ones at home while still getting the highest quality of care they deserve,” said Dr. Devika Das, Section Chief of Oncology Birmingham VAHCS.

Dr. Das explained by working as a team and using some quality improvement tools, they implemented a process change in the work flow of patients who come in only for chemotherapy appointment (without a simultaneous provider appointment) and are able to safely get labs a few days prior to their infusion date to be fast tracked and were able to reduce average wait times for those patients from 1 hour and 33 minutes to 1 hour and 12 minutes. She further explained we are also looking at other team-based communication models to further improve on this using staff and patient feedback.

According to the ASCO article, time studies were conducted, and a process map was drafted that identified delays in medication preparation, laboratory results, and clinic communication.

“During brainstorming sessions, the team noted the bottle neck effect of the check in process for Veterans in the Hematology/Oncology Clinic. All Veterans were having vitals collected in the order they presented to clinic, I recommended the intervention for a fast track clinic to identify those Veterans who were not waiting on laboratory results prior to treatment. This would allow for a more efficient and complete clinical pharmacy chart review including up to date vital signs and in turn earlier notification to pharmacy to begin preparing the medications, which allows medication administration by nursing staff to start sooner,” said Barbie Gleaton, BVAHCS Oncology Clinical Pharmacy Specialist. “The expedited clinic also results in reduced waste and cost. Many chemotherapy agents cause changes in BP/HR and/or require adjustments for changes in body weight and medication interventions must be made in the form of dose reductions or sometimes treatment delays. If pharmacy were to have medications prepared prior to gathering this vital information, it could result in thousands of dollars of waste for the medial facility. Thus, in effect, this intervention also is a cost containing intervention.”

Collin Plourde, a fellow in the VA Quality Scholars Fellowship, spent a great deal of time working on the process collecting data and the implementation of process changes targeted toward reducing wait times.

“I was very happy with how motivated the providers and nurses were to try small changes that could improve the lives of their patients,” Plourde added.

The reduction in wait times is sure to benefit the Veterans and provide the opportunity for practitioners to see more patients.

“This benefits our Veterans by improving their experience and their quality of life which is the main goal in cancer care,” adds Gleaton. “Moreover, during these unprecedented times of the COVID-19 pandemic, limiting the number of patients in the waiting room allows for improved physical distancing practices, which is especially important to reduce the risk of exposure in the most vulnerable patient population who are immunocompromised.”


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