Time-to-simulation for radiation oncology patients in an academic department.

Abstract

176 Background: In 2011, one of the two clinical simulators in our department was decomissioned in order to enable the construction of a clinical magnetic resonance (MR) simulator. As result, our clinical simulator capacity decreased resulting in increased wait times for patients undergoing treatment planning. In turn, there was a perceived increase in the number of patients added onto the simulator schedule (add-ons) immediately following consultation. This created problems of workflow on the simulator and increased clinic wait times for previously scheduled patients. A clinical Lean team was formed with the intent of 1) quantifying the number of daily add-ons and 2) identifying predictors of add-ons so that the frequency of add-ons could be predicted and if possible, load-leveled. Methods: Over an eight-week period, frequency of simulator add-ons was correlated with de-identified patient data abstracted from the medical record using one-way ANOVA and student t-tests to assess the statistical hypothesis that a patient, disease, or provider factor increased the likelihood of a patient add-on. Interviews were conducted with the clinical staff to determine perceived frequency of add-ons, predictors of add-ons, and to evaluate the rationale for add-ons. Results: On average, 7.9 (range 7.3-8.7) simulations were performed daily in our department and 0.95 (0.7-1.4) patients were added onto the simulator daily. Patient demographics, day of consultation, inpatient vs outpatient status, treating and referring physician, as well as cancer diagnosis were examined. A statistical trend for add-on patients on Friday (p=0.064, vs. Monday) was found. One physician's patients accounted for 36% of the Friday add-ons over the eight week period. The physician was interviewed and her rationale for adding-on patients was determined. Conclusions: The mean number of add-on patients was determined to be acceptably low in our department and was on average less than one patient daily. A trend for an increased likelihoood of add-on patients with a particular Friday provider was noted and as such future efforts will be directed at mitigating the number of this physician's add-on patients.