Infusion centers face significant challenges related to lengthy wait times and uneven patient loads, which can negatively affect clinical outcomes and cause unnecessary burdens for nurses or other healthcare providers. Oncology Practice Management (OPM) recently spoke with Abbi Bruce, RN, MS, OCN, Program Director, Medical Oncology and Infusion Services, Hartford HealthCare Cancer Institute at Hartford Hospital, CT, who discussed some of the factors that contribute to the complexity of infusion scheduling, and effective strategies for solving these problems.
OPM: Tell us about your role at Hartford HealthCare Cancer Institute.
Ms Bruce: As Program Director for Medical Oncology and Infusion Services at Hartford HealthCare Cancer Institute, I oversee all the medical oncology practices and infusion centers that are part of our system, which includes 23 across the state of Connecticut. My responsibilities include standardization of practice within the centers, education of staff members, implementation of policies and procedures, and the development and expansion of various programs. When new private practices are acquired by our system, I assist with the onboarding of most of these practices as well as their infusion centers.
OPM: What are some of the challenges currently facing infusion centers?
Ms Bruce: One of the major challenges currently facing infusion centers is how to optimize the scheduling of patients who need chemotherapy. In the past, this was typically done manually, and was driven by the nurses’ or physicians’ schedules, which was not very effective. There were many days when our infusion centers were quiet from 8:00 to 10:00 AM, very busy from 10:00 AM to 3:00 PM, and then quiet for the remainder of the day. During the midday peak, the number of patients might exceed the number of chairs or nurses available, resulting in patients having to wait for treatment past their scheduled start time.
In addition, it was difficult to ensure that patients were receiving the comprehensive education they needed to prepare for their infusions, which is important for decreasing anxiety and improving outcomes. Our nurses, who play a critical role in providing this patient education, were very stressed when they were not given adequate time to perform this function of their jobs.
OPM: What has been helpful in terms of addressing these challenges?
Ms Bruce: Approximately 5 years ago, we heard about the iQueue scheduling software for infusion centers. We wanted to get more details, so we reached out to the infusion center directors at Memorial Sloan Kettering, who were already using this software. They confirmed to us that it was very helpful, so we decided to implement it in one of our centers. It was so successful we decided to implement it in the rest of our centers.
The iQueue software dovetails with our scheduling system and looks at the number of chairs where we are utilizing our schedules and finds the best approach for scheduling patients through the use of mathematical algorithms.
Before we implemented the software, there were times of the day when there were too few patients and other times when there were too many patients. Now, our center has more capacity, and we are experiencing improved utilization in the early morning and late afternoons.
Wait times have markedly decreased and the load level of assignments is balanced. Patients who require shorter treatments can be finished sooner due to more efficient scheduling.
We are also seeing more job satisfaction among our nurses, who are feeling less stressed. Prior to implementing the new software, many of them were skipping lunch. Now, there is a built-in half hour for lunch for our nurses because the schedule is more balanced.
As more cancer care is delivered on an outpatient basis, we are going to see higher patient volumes. We need to keep working on solutions to reduce the issue of long wait times for patients. It is imperative that we focus on the goal of treating as many patients as possible, with the highest level of care and respect. I would recommend that centers consider trying out the iQueue software because we have found it to be an effective way of resolving many of our scheduling challenges.