Utilization of value stream mapping to improve chimeric antigen receptor (CAR) T-cell patient experience at an academic medical center (AMC).

Abstract

6607 Background: Value Stream Mapping (VSM) is commonly used to identify waste, reduce process cycle times and implement process improvements in the product and manufacturing space. VSM was applied to analyze and improve the patient experience for individuals receiving CAR T cell therapy at this AMC, with emphasis on safety and quality of care, efficient patient flow and improved communication across the care team. Methods: Fifty-three multidisciplinary representatives from 21 teams across the AMC participated in at least one of the five 4-hour VSM sessions. Comprehensive VSM workflows were created for each step in the current CAR T cell patient journey, from initial referral through post-infusion care. Future state analysis was performed, with emphasis on identification of information technology improvements, communication and pain points. Baseline outcome metrics were established to assess effectiveness of future state VSM improvements. Results: Visual mapping of the CAR T cell patient journey identified several opportunities for improvement. A total of 72 improvement projects were outlined, which could be grouped into four main categories: (1) establish channels for improved care team communication, (2) build information technology infrastructure to support efficient patient flow and quality of care, (3) develop teaching tools for patient and care team education, and (4) delineate standard of care and clinical trials operational workflows. Baseline outcome metrics were measured across the patient population (n = 33), including time from consent to cell collection, length of inpatient stay, intensive care unit (ICU) utilization, and percent of readmissions within 7 days. Outcome metrics will be tracked and reported after future state changes to determine effectiveness of VSM-based process improvements. Conclusions: CAR T cell therapy is a novel therapy, which poses new challenges for coordination across a multidisciplinary care team at an AMC. The VSM approach is a useful tool to identify process and infrastructure improvements that can improve the patient journey. This approach can be generally applied to drive process improvements across clinical care.