Transitioning chemotherapy administration from the inpatient setting: Creating bed capacity and improving the patient experience.

Abstract

152 Background: Administration of selected multiday chemotherapy regimens typically requires an inpatient stay at an academic quaternary care facility. A growing oncology population exceeding the capacity of oncology allocated beds led to occasional cancellation of patients scheduled for curative-intent treatment, necessitating a reevaluation of our processes. A multidisciplinary group formed to pilot a process by which certain regimens would be transitioned to the outpatient arena and others would be split, requiring only a portion of the regimen to be given inpatient. Methods: The utilization of a variety of quality improvement tools and processes determined the feasibility and safety of transitioning previously inpatient-based regimens to the outpatient setting and identified those regimens that were most appropriate to pilot. An evaluative ranking process identified high-dose cytarabine for treatment of acute myeloid leukemia and infusional cyclophosphamide for multiple myeloma as most appropriate to be home-based regimens. Phase II of the pilot involved developing a process for the administration of select rituximab-based regimens between the inpatient and outpatient setting, with tightly fitted communication to ensure seamless transitions in care. Patients receive rituximab in the ambulatory clinic and are then admitted to a reserved hospital bed for the remainder of the regimen. Results: Since pilot inception and abstract submission, 20 patients have either received their entire regimen as an outpatient or by using our split location process. Preliminary analyses reveal an increased bed capacity for acute patients and outside hospital referrals by preventing scheduled admissions and reducing overall length of stay for rituximab-based regimens. Survey responses from patients and families are overwhelmingly positive. Conclusions: Care delivery models must be continually evaluated to adapt to change in this dynamic health care era. Our pilot suggests beneficial outcomes for patients and health care systems alike. As an institution, we have seen the effects that integrated team communication and tighter care coordination have on patient care and outcomes.