Hartford HealthCare Cancer Institute in Hartford, Connecticut, has 33,000 workers, $4.3 billion in operating revenue and a medical staff of 4,000 providers. 

It offers the full continuum of care with seven acute-care hospitals, the state's longest-running air-ambulance service, behavioral health and rehabilitation services, a physician group and clinical integration organization, skilled-nursing and home health services, and a comprehensive range of services for seniors, including senior-living facilities.

THE PROBLEM

Over the years one of the biggest problems facing infusion centers has been the challenge of adequately scheduling appointments for patients receiving chemotherapy. Historically, this always has been a manual process, usually determined by nurses and driven by the schedules of providers.

The manual approach to scheduling often would cause many logistical problems. For example, infusion centers might be slow in the mornings and late afternoons, but overly busy from 10 a.m. to 2 p.m., creating a bottleneck for all involved.

"During these busy times, nurses often would have to juggle as many as four to five patients at once," said Abbi Bruce, RN, OCN and program director of medical oncology and infusion services at Hartford HealthCare Cancer Institute. "Nurses, providers and managers all felt this way of scheduling wasn't effective as each patient is unique and might require different education, support and dedicated time during the busy window, delaying the process even more."

While the manual scheduling process has been around for years, staff knew there had to be something more effective out there.

PROPOSAL

The team at Hartford HealthCare heard about LeanTaaS' iQueue for Infusion Centers several years ago, and prior to onboarding the technology at their centers they started talking to executives at other health systems who had used the technology.

"One of the hospitals we spoke with was Memorial Sloan Kettering Cancer Center of New York, one of the nation's top cancer centers," Bruce recalled. "After hearing positive feedback from Sloan Kettering and additional infusion centers from across the country, we decided to give the platform a try.

"The ability to collect meaningful data that improves the overall effectiveness of scheduling and patient and staff satisfaction is invaluable."

Abbi Bruce, RN, Hartford HealthCare Cancer Institute

"iQueue for Infusion Centers leverages machine learning and predictive analytics to help centers stay operationally agile by optimizing scheduling templates, level-loading the daily schedule across the nursing staff, flagging future problem days for preventive action, and identifying which appointments should be rescheduled to improve the experience for patients and staff alike," she added.

The platform ensures that appointments are consistent across the day, especially during the midday peak hours, that add-on patients are easier to schedule, that patient wait times are reduced and that nurse workloads are more balanced, she said.

MEETING THE CHALLENGE

iQueue for Infusion Centers is used by Hartford HealthCare Cancer Institute's team of nurses and schedulers to improve the experience both for staff and patients.

"As with every new technology, it can take a little time for staff to get used to," Bruce noted. "However, iQueue is easy to use, and once nurses and staff understand the benefits first-hand, it seamlessly fits into our workflows. iQueue can be deployed in four to six weeks with some IT involvement, and requires minimal IT involvement for maintenance, updates or support after deployment.

"The process started a full month before our go-live," she continued. "We had the ability to review templates ahead of the go-live, and it was truly a slow and steady process."

RESULTS

The technology has changed the way the cancer institute schedules its patients for the better, and it's invaluable to the team, Bruce said.

"We now have more capacity, so we can see patients throughout the entire day," she noted. "We have worked closely with our providers to help them understand the importance of the tool and the benefits it provides. They have partnered with us to see patients earlier in the day, as well as through the lunch hour, to improve the overall scheduling of the patients throughout the day.

"There's a nurse-allocation tool that incorporates the acuity of the regimen and determines the best schedule for each nurse working that day," she added. "On the patient experience side, our wait times have significantly decreased. Because of our increase in efficiency, patients that have short treatments can get in and out quicker and nurses are able to get their lunches and are happier, which makes our patients happier."

The cancer institute has been extremely pleased with the results of its iQueue for Infusion Centers pilot, Bruce said.

"Across the board, we've seen reduced patient wait times, improved asset utilization without having to add nurses or chairs, improved patient access to treatment throughout the day, and positive impact on nursing staff's workday," she said.

Specifically, some results the institute has seen include:

Patient wait time

• Infusion wait time has decreased by 27.3% (35% for unlinked).
• Drug wait time has decreased by 5.1% (13.5% for unlinked).

Asset utilization

• The average daily scheduled volumes have increased by 9.1%.
• The average daily completed volumes have increased by 9.6%.
• The effective turns per chair has increased by 22.1%, from 1.73 to 2.11.
• Maximum chair occupancy has decreased by 10.0%.

Patient access

• The average daily scheduled patient hours have increased by 9.0%.
• The average number of scheduling lead days has decreased by 14.3% from 14 days to 12 days.

ADVICE FOR OTHERS

"Infusion centers across the country should use technology, instead of relying on manual-based methods for optimizing their operations," Bruce advised. "The ability to collect meaningful data that improves the overall effectiveness of scheduling and patient and staff satisfaction is invaluable.

"Based on our experience, the issues we faced are common challenges most centers face," she concluded. "Additionally, the industry as a whole is seeing more outpatients when it comes to chemotherapy, utilizing technology allows nurses, and hospitals, and health systems a better way to manage these increasing volumes and improve their overall workflows."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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