Scheduling and Patient Flow in an Outpatient Chemotherapy Infusion Center INFORMS November 10, 2014 Sarah Bach
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Scheduling and Patient Flow in an Outpatient Chemotherapy
Infusion Center
INFORMS
November 10, 2014
Sarah Bach
2
Collaborators
• Amy Cohn, Ph.D.
• Brian Denton, Ph.D.
• Alon Weizer, MD
• Louise Salamin, MSA, BSN, RN
• Carol McMahon, BSN, RN
• Corinne Hardecki, BSN, RN
• Carolina Typaldos, MPH
3
Current Team
• Jeremy Castaing
• Vera Lo
• Donald Richardson
• Matt Rouhana
• Stephanie See
• Pamela Martinez Villarreal
4
Cancer and Cancer Treatment
• Cancer Statistics
– In 2014 there will be an estimated 1,665,540 new cancer cases
– Second leading cause of death in the United States
• Chemotherapy Infusion Center
– Facility where cancer treatment is given on an outpatient basis
– Over 50% of all cancer patients receive chemotherapy treatment
Source: American Cancer Society. (2014). http://www.cancer.org
5
University of Michigan Comprehensive Cancer Center
• 93,319 outpatient visits annually
• 51,884 infusion treatments annually
• 5% increase in patient volume annually
University of Michigan Cancer Center
6
Project Goals
• Improve quality of cancer care delivery in the infusion center
– Reduce patient waiting times
– Reduce total length of day of operations
– Others:
• Promote equity in nurse workload
• Improve patient and nurse safety
• Reduce cost associated with pharmaceutical waste
Patient Flow
Patient Arrives
Labs Collected
Clinic Appointment Infusion
Pharmacy
Patient Discharged
7
Project Initiatives
Patient Arrives
Labs Collected
Clinic Appointment Infusion
Pharmacy
Patient Discharged
8
Stochastic
optimization
to improve
infusion
scheduling
Dynamic
decision tool
focused on
preparing
more drugs
in advance
Analyzing idea of
uncoupling labs
Quantifying lab
processing
delays and
recommending
improvements
9
Additional Motivation
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5
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M
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MDa
ily
Av
era
ge
La
b A
pp
oin
tmen
ts
Infusion Lab Before Clinic
Lab After Clinic Clinic & Infusion
None Phlebotomist Capacity
50% of work before 10:30 AM
10
Decoupling of Visits
Lab Clinic Infusion
Day 1: Day 2:
11
Assessing Decision of Decoupling
Decoupling becomes beneficial when roundtrip travel time and lab draw time < 1 hour
Advantages
• Reduce patient wait times on day of infusion or clinic visit
• Reduce UMHS Cancer Center lab workload in morning
Disadvantages
• Patients must complete two visits
12
Feasibility of Decoupling Visits
• Survey results indicate 9% of patients interested in a 2 day schedule
Data Source: Infusion Survey of Patients on Monday, June 10, 2013. 251 Responses.
0%
10%
20%
30%
40%
50%
60%
Perc
ent
of
Pati
ents
Patient Reasons for Opposing a 2 Day Schedule
13
Methods
• Pulled data from electronic health record for Aug 2012 – Feb 2013 (9429 patients)
– Patient addresses contained in this data set
• Calculate distance and driving duration for each patient address to the UMHS Cancer Center
14
Methods
• Google Maps API used to determine distance and driving duration from patient addresses to UMHS Cancer Center
15
24020016012080400
1400
1200
1000
800
600
400
200
0
Driving Time (min)
Fre
qu
en
cy
Histogram of Patient Driving Time to Cancer CenterClarity Data Aug 2012 – Feb 2013 (9429 patients)
Excludes patients with driving time > 4 hours
Quantifying Driving Time to UMHS
Driving Duration Percent of Unique
Patients
Less than 30 min 29%
30-60 min 36%
60-120 min 22%
120-240 min 9%
Over 4 hours 4%
16
Patient Location in Michigan
• 9 satellite lab facilities in Southeast Michigan
17
Methods
• Labs can be drawn at any of 9 satellite facilities associated with UMHS
18
Driving Time to Closest Lab Facility
24020016012080400
2000
1500
1000
500
0
Driving Time (min)
Fre
qu
en
cy
Histogram of Patient Driving Time to Closest Lab FacilityClarity Data Aug 2012 - Feb 2013 (9429 Patients)
Excludes patients with driving time > 4 hours
19
Results of Satellite Facilities Analysis
Driving Duration Percent of Patients
to Satellite Facilities
Percent of Patients to Cancer Center
Less than 30 min 52% 29%
30-60 min 23% 36%
60-120 min 15% 22%
120-240 min 7% 9%
Over 4 hours 3% 4%
20
Results of Satellite Facilities Analysis
• Conservatively, encourage decoupling visits for patients within 15 minutes of satellite facility
– 32% of patients
21
Conclusion
• Patients live closer to UMHS and satellite facilities than perceived by Cancer Center providers and staff
• Encourage decoupling of visits for patients within close proximity
• Educate patients on utilizing satellite facilities
22
Future Work
• Pilot decoupling of visits
– Barriers: Physician workflow differs with lab location
• Investigate alternative improvements to lab process
– “Fast track” phlebotomist
– Prioritizing lab processing
23
Acknowledgements
• This project is funded in part by
– University of Michigan Comprehensive Cancer Center
– Center for Healthcare Engineering and Patient Safety (CHEPS)
– The Seth Bonder Foundation
– The TDC Foundation
24
CHEPS & the HEPS Master’s Program
• CHEPS: The Center for Healthcare Engineering & Patient Safety
• HEPS: Industrial and Operations Engineering (IOE) Master’s Concentration in Healthcare Engineering and Patient Safety offered by CHEPS
• CHEPS and HEPS offer unique multidisciplinary teams from engineering, medicine, public health, nursing, and more collaborating with healthcare professionals to better provide and care for patients
• For more information, contact Amy Cohn at [email protected] or visit the CHEPS website at: https://www.cheps.engin.umich.edu
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