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This article has been peer reviewed. It is the authors' final version prior to publication in Journal of Oncology Practice, Volume 15, Issue 10, October 2019, Pages e906-e915.

The published version is available at Copyright © American Society of Clinical Oncology


Background: Delays in initiating elective inpatient chemotherapy can decrease patient satisfaction and increase length of stay. At our institution, we observed that 86% of patients admitted for elective chemotherapy experienced a delay (greater than 6 hours) with a median time to chemotherapy of 18.9 hours. We developed a process improvement initiative to improve time to chemotherapy for elective chemotherapy admissions.

Methods: Our outcome measure was time from admission to chemotherapy administration in patients admitted for elective chemotherapy. Process measures were identified and monitored. We collected baseline data and utilized performance improvement tools to identify key drivers. We focused on these key drivers to develop multiple plan-do-study-act (PDSA) cycles to improve our outcome measure. Once we started an intervention we collected data every two weeks to assess our intervention.

Results: At the time of interim analysis, we observed a median decrease in time to chemotherapy administration from 18.9 hours to 8.85 hours (p value:0.005). Median time to lab resulted decreased from 3.17 hours to 0.00 hours. There was no change in time from signature to nurse releasing the chemotherapy. We noticed more providers were signing the chemotherapy prior to patient admission.

Conclusions: By implementing new admission workflows, optimizing our use of the Electronic Medical Record to communicate among providers, and improving pre-admission planning we were able to reduce our median time to chemotherapy for elective admissions by 53.2%. Improvement still needed to meet our goals and to ensure sustainability of these ongoing efforts.

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