Goettl J

Background: Cancer diagnosis is a devastating and painful process for patients and their families, resulting in significant stress and uncertainty. Chemotherapy treatments may provide a cure, control or palliate symptoms caused by cancer. However, delivery of chemotherapy in outpatient clinics is challenging and timeconsuming. Long wait is a common patient complaint, affects work-flow and chair time usage, increases costs, and compromises safety. We sought to review our system and implement changes that may result in decrease wait time.

Methods: Utilizing the Institute for Healthcare Improvement (IHI) model, the plan-do-study-act (PDSA) method to test and implement changes, we established a preintervention Ishikawa diagram over a 4 weeks period to study the process and determine cause of delay. Changes were implemented in a stepwise fashion, assess for improvement and revised our process over another 4 week period. We collect and analyze data for a total of 2 months. The objective of the study was to decrease wait-time to initiate chemotherapy treatment from the end of clinic visit to start of chemotherapy infusion by 20-30 minutes for 50% of patients in the oncology clinic over a three-month period.

Results: Pre-intervention data was collected on 245 patients. 55% (n=136) of these patients waited an average of 90 minutes and 45% (n=110) waited an average of 42 minutes from check-in to infusion clinic to start of chemotherapy. Identified barriers causing delayed chemotherapy administration included no consent, no prior authorization, unwritten/unsigned orders, pharmacy release delay, incomplete required labs, delay drug delivery from pharmacy, and difficulty with IV access. After the first cycle of PDSA, post-intervention data reveal a small improvement. 52% (n=199) patients waited an average of 87 minutes and 48% (n=183) average wait was 41 minutes.

Conclusions: By utilizing the PDSA cycle to test the modification of the revised workflow system and eliminate barriers to release of chemotherapy we could potentially reduce wait times for patient receiving chemotherapy at the Minneapolis VA. Updated data will be presented at the AVAHO Annual Meeting.

Background: Cancer diagnosis is a devastating and painful process for patients and their families, resulting in significant stress and uncertainty. Chemotherapy treatments may provide a cure, control or palliate symptoms caused by cancer. However, delivery of chemotherapy in outpatient clinics is challenging and timeconsuming. Long wait is a common patient complaint, affects work-flow and chair time usage, increases costs, and compromises safety. We sought to review our system and implement changes that may result in decrease wait time.

Methods: Utilizing the Institute for Healthcare Improvement (IHI) model, the plan-do-study-act (PDSA) method to test and implement changes, we established a preintervention Ishikawa diagram over a 4 weeks period to study the process and determine cause of delay. Changes were implemented in a stepwise fashion, assess for improvement and revised our process over another 4 week period. We collect and analyze data for a total of 2 months. The objective of the study was to decrease wait-time to initiate chemotherapy treatment from the end of clinic visit to start of chemotherapy infusion by 20-30 minutes for 50% of patients in the oncology clinic over a three-month period.

Results: Pre-intervention data was collected on 245 patients. 55% (n=136) of these patients waited an average of 90 minutes and 45% (n=110) waited an average of 42 minutes from check-in to infusion clinic to start of chemotherapy. Identified barriers causing delayed chemotherapy administration included no consent, no prior authorization, unwritten/unsigned orders, pharmacy release delay, incomplete required labs, delay drug delivery from pharmacy, and difficulty with IV access. After the first cycle of PDSA, post-intervention data reveal a small improvement. 52% (n=199) patients waited an average of 87 minutes and 48% (n=183) average wait was 41 minutes.

Conclusions: By utilizing the PDSA cycle to test the modification of the revised workflow system and eliminate barriers to release of chemotherapy we could potentially reduce wait times for patient receiving chemotherapy at the Minneapolis VA. Updated data will be presented at the AVAHO Annual Meeting.

Background: Cancer diagnosis is a devastating and painful process for patients and their families, resulting in significant stress and uncertainty. Chemotherapy treatments may provide a cure, control or palliate symptoms caused by cancer. However, delivery of chemotherapy in outpatient clinics is challenging and timeconsuming. Long wait is a common patient complaint, affects work-flow and chair time usage, increases costs, and compromises safety. We sought to review our system and implement changes that may result in decrease wait time.

Methods: Utilizing the Institute for Healthcare Improvement (IHI) model, the plan-do-study-act (PDSA) method to test and implement changes, we established a preintervention Ishikawa diagram over a 4 weeks period to study the process and determine cause of delay. Changes were implemented in a stepwise fashion, assess for improvement and revised our process over another 4 week period. We collect and analyze data for a total of 2 months. The objective of the study was to decrease wait-time to initiate chemotherapy treatment from the end of clinic visit to start of chemotherapy infusion by 20-30 minutes for 50% of patients in the oncology clinic over a three-month period.

Results: Pre-intervention data was collected on 245 patients. 55% (n=136) of these patients waited an average of 90 minutes and 45% (n=110) waited an average of 42 minutes from check-in to infusion clinic to start of chemotherapy. Identified barriers causing delayed chemotherapy administration included no consent, no prior authorization, unwritten/unsigned orders, pharmacy release delay, incomplete required labs, delay drug delivery from pharmacy, and difficulty with IV access. After the first cycle of PDSA, post-intervention data reveal a small improvement. 52% (n=199) patients waited an average of 87 minutes and 48% (n=183) average wait was 41 minutes.

Conclusions: By utilizing the PDSA cycle to test the modification of the revised workflow system and eliminate barriers to release of chemotherapy we could potentially reduce wait times for patient receiving chemotherapy at the Minneapolis VA. Updated data will be presented at the AVAHO Annual Meeting.

Background: A majority of end-stage cancer patients are receiving chemotherapy, regardless of performance status, in the last months of life. Oncologists continue to prescribe disease targeted therapy for patients enrolled in palliative or hospice care in an attempt to alleviate symptoms and extend life expectancy. Research indicates that chemotherapy at end of life does not accomplish either of these goals of care, and may actually do more harm than good.

Methods: An evidence based research review indicates that > 50% of all cancer patients are receiving chemotherapy during their last 4-6 months of life. Data supports a decreased quality of life and decreased life expectancy for patients receiving chemotherapy during the last months of life. There is an increase in visits to the emergency department, hospitalizations, and death in the hospital when cancer patients are actively receiving chemotherapy during end of life.

Overutilization of chemotherapy treatment is poor quality care leading to adverse patient outcomes. The intent of hospice care is to meet the physical, emotional, social, and spiritual needs of a dying patient and their family. The focus of care is on comfort, not cure. The intent of palliative care focuses on symptom control and may include a combination of comfort measures and curative interventions. This review supports further investigation into the practice of chemotherapy administration in terminally ill patients.

Background: A majority of end-stage cancer patients are receiving chemotherapy, regardless of performance status, in the last months of life. Oncologists continue to prescribe disease targeted therapy for patients enrolled in palliative or hospice care in an attempt to alleviate symptoms and extend life expectancy. Research indicates that chemotherapy at end of life does not accomplish either of these goals of care, and may actually do more harm than good.

Methods: An evidence based research review indicates that > 50% of all cancer patients are receiving chemotherapy during their last 4-6 months of life. Data supports a decreased quality of life and decreased life expectancy for patients receiving chemotherapy during the last months of life. There is an increase in visits to the emergency department, hospitalizations, and death in the hospital when cancer patients are actively receiving chemotherapy during end of life.

Overutilization of chemotherapy treatment is poor quality care leading to adverse patient outcomes. The intent of hospice care is to meet the physical, emotional, social, and spiritual needs of a dying patient and their family. The focus of care is on comfort, not cure. The intent of palliative care focuses on symptom control and may include a combination of comfort measures and curative interventions. This review supports further investigation into the practice of chemotherapy administration in terminally ill patients.

Background: A majority of end-stage cancer patients are receiving chemotherapy, regardless of performance status, in the last months of life. Oncologists continue to prescribe disease targeted therapy for patients enrolled in palliative or hospice care in an attempt to alleviate symptoms and extend life expectancy. Research indicates that chemotherapy at end of life does not accomplish either of these goals of care, and may actually do more harm than good.

Methods: An evidence based research review indicates that > 50% of all cancer patients are receiving chemotherapy during their last 4-6 months of life. Data supports a decreased quality of life and decreased life expectancy for patients receiving chemotherapy during the last months of life. There is an increase in visits to the emergency department, hospitalizations, and death in the hospital when cancer patients are actively receiving chemotherapy during end of life.

Overutilization of chemotherapy treatment is poor quality care leading to adverse patient outcomes. The intent of hospice care is to meet the physical, emotional, social, and spiritual needs of a dying patient and their family. The focus of care is on comfort, not cure. The intent of palliative care focuses on symptom control and may include a combination of comfort measures and curative interventions. This review supports further investigation into the practice of chemotherapy administration in terminally ill patients.