Authors (including presenting author) :
Mr. C.C. MAK (1), Mr. Stephen C.Y. IP (1), Ms. Pauline P.L. Lee (1)
Affiliation :
1 Department of Clinical Oncology, Queen Mary Hospital
Introduction :
Total Patient Journey Time (TPJT) for all Oncology patients in HKWC in average are all within target (<60min for doctor consultation & <120min for medication collection). However, for Clinical Oncology and Medical Oncology patients the waiting time is still out of target (>120min) for medication collection (cytotoxic drug available at Chemo Day Centre). By Value Stream Mapping the factors inducing prolonged waiting time at the Chemo Day Centre was outlined including idle time and cycle time, and improvement plans at different time points to address key areas.
Objectives :
* Identify and improve key areas during the Patient Journey from registration to doctor consultation to cytotoxic drug available at Chemo Day Centre.
* Enhance patient total waiting time by reducing sub-optimal idle time.
* Ensure cytotoxic drug is prepared accurately and efficiently and keeping in time to use before its short expiry.
Methodology :
The nursing team reallocated staff duties to facilitate the Advance Preparation program service hours.
Prioritized patient appointments, and evenly distributed quotas, also reinforced communication between Pharmacy and COD SOPC.
Address the sub-optimal queuing system by transitioning to a new queuing system and installed a new wireless paging system.
Prioritize registration, and timely remind patients if they do not show up after their scheduled appointment time.
Redesigned the layout of the infusion room by stacking partitions and reshuffling reclining chairs to minimize wasted space. With the support from Facility Management team to source space-saving furniture to optimized the use of limited physical spaces.
Result & Outcome :
The Advance Preparation Scheme has successfully reduced the average waiting time by 1.5 hours, benefiting 10%-15% of total patients daily. Additionally, all patients benefit from the advance preparation, leading to a reduction in waiting time attributed to limited spaces.
Waiting time for the first cytotoxic drug was improved from approx. 90-120mins to approx. 7mins as patients are now able to start infusion first thing in the morning when AP drugs are ready at 9:15am and fully utilize the timeslots available. The second batch of AP are prepared first in the morning, constitute of subsequent chemo drugs for the patients and are ready by 9:45am. The number of cases per day for AP is around 10-15 cases per day. With each chemo protocol stapled with patient’s ticket number, all protocols were prepared in chronological order as they are received. Preparation time also denoted on every worksheet and label, ultimately reaching the target for “first in, first out”. Time tracking of every patient and product has enabled us to easily identify which drug has been lagging or has been taking an unusually long preparation time, where an immediate action can be done to resolve any problems which can cause the delay.
Conclusion:
The vastly growing of AP has greatly reduced the waiting time for an increasing number of patients and have utilized the timeslot early in the morning. The new Queue management system has also given us the gateway into closely monitoring every patient’s drug and safeguarding the target of “first in, first out”, thus allowing their waiting time to be shortened yet similar whenever possible. Advance preparation reduces patient waiting time by 1.5 hours for 10%-15% of total patients, enhancing patient satisfaction throughout their healthcare journey.
