The Impact of a Long-Acting Erythropoiesis Stimulating Protein on Patient Throughput in a Hospital-Based Ambulatory Oncology Clinic

Abstract

Objectives To quantify labor and time expended, resources used, and the net impact on patient throughput and staff time (from the institution's perspective) associated with short-acting (epoetin alfa) and long-acting (darbepoetin alfa) erythropoietin stimulating proteins (ESPs). Design Prospective time/motion assessment and retrospective chart review of patient visits and resources used. Setting Single hospital-based ambulatory oncology clinic. Methods Time and motion measurements related to patient treatment and drug preparation were collected for (1) patient check-in; (2) phlebotomy; (3) laboratory processing; (4) pharmacist assessment/counseling; and (5) ESP preparation, administration, and documentation. ESP use for 266 chemotherapy cycles administered between August 1, 2003 and March 31, 2004 was grouped as epoetin alfa only and darbepoetin alfa only. Results For 313 observed events, the mean total time calculated for the 5 prespecified activities associated with a visit for ESP administration was 55.4 minutes, of which pharmacy assessment/counseling was responsible for the majority of time expended (22.6 min). A significant (23%) reduction in the number of mean visits per cycle was recorded for the darbepoetin alfa group ( P < 0.001, resulting in 1 less visit per average chemotherapy cycle). This difference remained statistically different (42% reduction; P < 0.001) when the mean number of visits specifically for ESP administration was compared between the darbepoetin alfa and epoetin alfa groups. Darbepoetin alfa recipients also received significantly fewer doses of ESP per cycle compared with those given epoetin alfa (P < 0.001). The use of darbepoetin alfa saved the clinic 125 hours of staff/patient time per cycle with a potential of 120 hours/cycle additional savings if the epoetin alfa patients had received this long-acting ESP. During calendar year 2004, 610 patients received a red-cell growth factor following chemotherapy for a solid tumor. These patients represent an average of 3,660 cycles of chemotherapy per year. The reduction in visits (1/cycle) with long-acting ESP, at 55.4 minutes of staff time per visit, will potentially result in avoidance of 3,379.4 hours of staff time or 1.62 full-time equivalents per year. Conclusions Patient office visits for ESP administration are associated with significant time for clinic staff. A long-acting ESP, such as darbepoetin alfa, may enable significant time savings for clinic staff and providers by reducing the number of necessary visits for ESP administration. The time saved also provides an opportunity to reallocate staff to perform additional supportive care activities.