Reducing wait times for initiation of chemotherapy at the Bellevue Cancer Center.

Abstract

461 Background: The Bellevue Hospital Cancer Center is the primary oncologic referral center for the NYC Health and Hospitals System. It experiences high demand for infusion therapies requiring the resources of an infusion center and the expertise of chemotherapy registered nurses (RNs). From November 2021 to December 2022, there was a shortage in the number of chemotherapy RNs and the number of infusion chairs. This resulted in prolonged wait times for treatment initiation and difficulty accommodating requests to start treatment within 7 days. Here, we evaluate the impact of capacity building interventions on the success rate of treatment initiation within 7 days. Methods: We examined requests for initiation of infusion treatment within 7 days for all malignancies from December 2021 to December 2022. Our primary process measure was the percentage of requests fulfilled each month. We collected key variables for each chemotherapy request including number of RNs, number of infusion chairs, and the number of days between subsequent infusions. Finally, a root cause analysis was conducted to determine the causes for decreased RN and infusion care capacity. Using all the data above, a Plan-Do-Study-Act process was created to address key capacity deficiencies. Results: Our findings revealed an increase in successful treatment initiation within 7 days from December 2021 to December 2022. From August 2022 to December 2022, 100% of all requests within 7 days were successfully scheduled. There was also an increase in the number of available infusion chairs in this time interval, from a minimum of 18 in December 2021 to 22 in December 2022. There was also an increase in the number of chemotherapy certified RNs. These findings are summarized in the table below. There were key interventions to address capacity shortages. Facilities in the Ambulatory Cancer Center and the inpatient hematology/oncology unit were repurposed into additional infusion spaces. There were also additional pay lines created for chemotherapy RNs, increased recruitment, and hiring of Nursing Agency RNs. Conclusions: We describe the capacity limitations surrounding infusion therapy at the Bellevue Cancer Center. Key interventions included strategic recruitment, financial approval of new chemotherapy RN pay lines, hiring agency RNs, and repurposing ambulatory and inpatient spaces. This resulted in increased capacity and 100% fulfillment of urgent treatment initiation requests. As the number of patients requiring infusion services at the Bellevue Cancer Center grows, long-term capacity building solutions will be essential.[Table: see text]