Utilizing Staff Feedback to Drive a Departmental Wide Process Improvement Initiative on Radiation Treatment Appointment Durations

Abstract

Feedback from radiation therapists (RTs) indicated appointment durations for certain disease sites were not reflective of actual workload. In addition, changes in complexity initiated during treatment planning have the potential to impact workflow and time allocation. It was apparent that a full review of treatment appointment durations was warranted. Current model at the Durham Regional Cancer Centre (DRCC) for radiation appointment scheduling includes 10 min booking increments per prescription for standard techniques with 10 minute spaces on each hour booked out. Extra time may be requested by radiation therapists if indicated. The evaluation of the current model included: a survey of Ontario radiation therapy centre’s bookings and timing of a variety of techniques over a three week time period at DRCC. Upon review of Ontario centres bookings, the most common arrangement was 15 minute increments for treatments. Additional detail was collected from these centres on the durations they have allocated for various techniques. Timing was performed for 90 patients from each of the following categories: breast tangents, ¾ field breast, electrons, VMAT, SBRT, conformal lung, IMRT lung, palliative and other radical. Timing was performed manually to account for pre and post treatment activities, which are essential elements of care. In the breast tangent, electron clinical markup and in-patients categories the treatment times measured exceeded the current booking guidelines. Additional time is also required on treatment units to perform SBRT dry runs and image preparation. These were previously incorporated into the day but not formally booked as an activity. Careful consideration of provincial timeline targets and workload was incorporated into proposed changes. A pilot was initiated to increase appointment durations by 10 minutes for a limited number of techniques, rather than edit the overall model of appointment scheduling. A 30 min slot was added to select treatment unit schedules daily to allow for patient preparation activities. The plan is to monitor the pilot and seek feedback from staff prior to implementing formally across the department.