Optimizing Radiation Oncology Consult Visits Using Patient Flow Analysis (PFA)

Abstract

An efficient workflow in the oncology ambulatory care setting can improve patient experience and decrease provider burnout. The purpose of this study was to identify inefficiencies, develop an optimized workflow, and measure the resulting post-implementation impact in a high-volume radiation oncology department.We conducted an IRB-approved study in Gastrointestinal Radiation Oncology (GIRO) at a large academic cancer center. Patient Flow Analysis (PFA) was used to track 556 consults from check-in to check-out. Process maps were created and an improved clinical workflow was designed based on the findings. The specific roles and responsibilities of each clinical team member were defined and clearly communicated. Timepoints were collected using the electronic medical record (EPIC) status board, which was updated by clinical staff. Pre- vs. post-implementation metrics, including total clinic cycle times, waiting times, rooming times, and time spent with each clinical team member were compared.Initial PFA led to recommendations targeting four principal inefficiencies: (1) protracted patient rooming, (2) delays due to inefficient communication, (3) duplicated tasks, and (4) ambiguous clinical roles. There were 485 pre- and 71 post-implementation consults available for analysis. The optimized workflow resulted in reduction in overall median cycle times by 21% (91 vs. 72 min; P < 0.001). Consults > 2 hours in duration occurred in 22% of pre-implementation vs. 0% of post-implementation visits (P < 0.001). Similarly, the proportion of visits requiring < 1 hour was 16% pre- vs. 34% post-implementation (P < 0.001). Patients spent significantly less time in the waiting room (14 vs. 5 min; P < 0.001) despite no significant differences in the proportion of patients arriving early, on-time, or late. Overall, wait times at each step in the visit process were reduced by 55-70% (Table 1).PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology. Utilizing this patient-centric model reduced waiting times and total consult duration, which may improve patient satisfaction, decrease staff burnout, and provide a framework for financial savings through innovative staffing models. Efforts are currently underway to expand this process across all sections within our department.