Decrease Wait Times Research Articles

28 Vaccination experiences for children with special needs - An examination of the impact of behaviours on vaccine uptake

Abstract Background While vaccines have been one of the most effective medical interventions to reduce the morbidity and mortality of many communicable illnesses, many factors have led to suboptimal immunization rates amongst paediatric patients. One of which that has not been explored widely in research literature is the impact of maladaptive behaviours on annual immunization rates. Behaviours such as aggression, agitation and flight are common amongst children with a neurodevelopmental diagnosis such as autism spectrum disorder, global developmental delay, and intellectual delay. When children are young, physical restraints by parents are often the method used to aid in the administration of the vaccine. However, as they age physical restraints is often regarded as inappropriate. Objectives The purpose of this study is to determine the extent in which disruptive behaviours (aggression, agitation and flight) affect annual vaccination rates for children with a neurodevelopmental diagnosis above the age of 6 years where physical restraining for vaccinations is no longer deemed appropriate or safe. Design/Methods Families with children diagnosed with Autism Spectrum Disorder (ASD), Intellectual Disorder (ID), and/or Global Developmental Delay (GDD) aged 6-17 years, seen through outpatient clinics at the Ron Joyce Children’s Health Centre of McMaster Children’s hospital in Hamilton between November 2022 – April 2023 were invited to participate in this cross sectional survey. The study aimed to capture both quantitative data on vaccine uptake and qualitative data on how vaccination experiences could be improved for children with neurodiversity. Results A total of 109 participants completed the survey. Among them, forty-three (39%) participants had a diagnosis of ASD and sixty-six (51.2%) had a diagnosis of global developmental delay or intellectual disability. Forty-six (45.6%) and 82 (76%) did not receive the Covid-19 and the influenza vaccination respectively. Of the children that did not receive the CoVid-19 vaccine, fourteen (30%) of the families had brought their child to be vaccinated, but the health care team could not administer the vaccine due to their child’s behaviours and twenty-one (37%) of the families anticipated that the vaccination would be a difficult experience because of their child’s behaviours and did not bring their child to get vaccinated. Of the children that did not receive the influenza vaccine, fifteen (18%) families had brought their child to be vaccinated, but the health care team could not administer the vaccine due to the child’s behaviours and 42 (50%) families anticipated that the vaccination would be a difficult experience because of their child’s behaviours and did not bring their child to get vaccinated. The main themes that emerged from the studies on ways to improve the vaccination experience for families include administering the vaccine in a low sensory environment, decreasing wait time, and ensuring clinic staff have experience in caring for children with special needs. Conclusion Children with special needs are a vulnerable population warranting concerted effort to ensure equitable access to immunizations. Interventions such as clinics specifically designed for children with neurodiversity should be implemented with the hope to further improve immunization rates within this population.

To What Extent Can Telehealth/Telemedicine Replace In-Person Doctor Visits In the USA?

The twenty-first century has seen a wave of revolutionary technical advancement that has drastically altered the landscape of many fields. Medicine and healthcare have been affected by these advancements, especially in the areas of artificial intelligence, 3D printing, CRISPR gene editing, and virtual reality. One of the main noticeable advancements however is the rapid rise of telehealth, which has altered the patient-doctor relationship, and is one of the most notable developments in recent decades, notably in the United States. While telehealth doesn’t have a very long history, it rose to popularity during the COVID-19 epidemic, delivering important benefits like as cost-effectiveness, decreased wait times, greater accessibility, and improved mental health assistance. Nonetheless, it can be observed that Telehealth presents some issues, including the possibility of misdiagnosis, difficulties in adapting to technology for older people, and worries about data privacy. Future advancements in telehealth may include selective applications, public education, enhanced security measures, and regulations for artificial intelligence integration. Furthermore, the political atmosphere in the United States may impact and change the rate at which telehealth develops, since it appears to have gained traction in Democratic-leaning areas but not so much in Republican-leaning states. This study will look into the possible benefits, problems, and future advancements of telehealth in the United States, as well as whether it can totally replace in-person doctor visits and to what extent.

Optimizing infusion experience for patients in GI oncology at Hartford Hospital Cancer Institute.

331 Background: Cancer Treatments have become increasingly complex and the volume of patients requiring infusion treatments have increased in the outpatient setting. As a part of our Clinical Care Redesign Quality Initiative, the Hartford Healthcare Team identified that our GI Oncology patients receiving chemotherapy at the Hartford Hospital Infusion Center were experiencing a mean wait time of 81 minutes from the start of check-in to the start of their first medication, resulting in patient and staff dissatisfaction and inefficient use of resources. Our objective was to reduce the mean wait time to less than 60 minutes from the start of check-in to the start of the first medication by December 2023, which in turn would improve patient and staff satisfaction. Methods: By process mapping, creation of a fishbone diagram, and multi-voting, we demonstrated that waiting for laboratory results for patients who had provider and chemotherapy visits on the same day was a large contributor to long wait times. We implemented an Advanced Preparation Process that included Unlinking infusion visits from Provider visits and obtaining patient labs prior to chemotherapy treatment day to achieve the goal. Results: By Unlinking visits beginning mid-October 2023, we were able to decrease the mean wait time from 81 minutes to an average of 53 minutes, reflecting a 54% reduction in wait time. This allowed Pharmacy and Infusion Nurses additional time to review orders and complete safety checks and spend more time with patients at the chairside. An estimated amount of 12.6 hours of chair time was made available per week, representing a potential revenue increase of $188,021 annually. Most patients appreciated the decrease in wait time even if it meant coming in two separate days. Conclusions: The project aim of reducing wait times for GI Oncology patients was achieved. A reduction in time to first drug for other patients receiving chemotherapy during our pilot period was also noted, which we attributed to Hawthorne effect. Patient and staff satisfaction were improved. Our next steps will include continuing to optimizing the process.

Lean-Based Approach to Improve Emergency Department Throughput.

Objective:Lean methodology can be utilized to increase throughput in a fast-track care area without changing staffing in a busy, urban emergency department (ED). Methods: A retrospective before-and-after analysis was performed to an improvement process in a fast-track care area within an ED with a census of 100,000 patients. The intervention utilized Lean methodologies to identify inefficiencies in the throughput model set for patients triaged to fast-track. Multiple ED stakeholders were involved in formulating a more efficient framework for how patients would receive care when triaged to fast-track. Results: There was a decline in the patient's overall length of stay (-9%, p=0.08), arrival to the room (-10%, p=0.4418), and ED attending to disposition (-9%, p=0.003). Additionally, all aspects of patients leaving prior to treatment completion (against medical advice (-29.4%, p=0.006), elopement (-20.4%, p=0.049), and left without being seen (-5.3%, p=0.11)) declined. Discussion:Identifying wasted time and resources in a patient's stay in the ED allowed for a more efficient throughput model to be developed. This resulted in patients being able to be seen in a more methodical manner leading to decreased wait times and lower left without being seen rates. Conclusion: A Lean-based throughput model was implemented to improve efficiency, reducing the length of stay and increasing the volume of patients evaluated per shift without additional costs. This improvement led to fewer patients leaving before treatment and demonstrated the value of process improvement in healthcare.

A - 66 Factors Impacting Appointment No-Shows and Cancellations in Neuropsychology: Predictors for Improving Access to Care for a Diverse Patient Population

Abstract Objective Access to care can be impacted adversely by appointment adherence. We aimed to identify predictors of no-shows and cancellations for neuropsychological services offered by a healthcare system serving diverse communities. Method Demographics and appointment status were documented from a sample of 537 consecutive patients scheduled for neuropsychological evaluation at an outpatient psychiatry clinic. Patients included 220 males and 317 females with an average formal education of 11.01 years (SD = 3.87) and age of 55.64 years (SD = 16.2). Chi-square analyses were used to evaluate the association between appointment status and gender, race/ethnicity, payor, availability of a collateral, and MyChart access. Multivariate analysis of variance was used to assess the relationship between age, education, proxy income, and prior no-show rate with appointment status. Results The overall rate of no-shows or late cancellations was 20%, and some patients no-showed multiple times. No-shows and late cancellations were associated with historical no-show rates and older age (F = 14.60, p < 0.0001), while race/ethnicity and MyChart activation had slight impacts (χ2 = 5.572, p = 0.062 and χ2 = 3.69, p = 0.055, respectively). Being a monolingual Spanish speaker was associated negatively with MyChart activation, but positively with collateral availability (p < 0.05). Conclusions No-show rates, which impact access to care, are high and associated with prior history of no-shows. Other factors, such as MyChart activation and culturally-associated barriers may also impact access. Implementing interventions addressing prior no-show rates and enhancing MyChart access could significantly increase show rates; such improvements could increase patient access to care, reduce the system’s financial burden, and decrease wait times for other patients.

Consequences of delaying non-urgent surgeries during COVID-19: a population-based retrospective cohort study in Alberta, Canada

ObjectivesTo ensure sufficient resources to care for patients with COVID-19, healthcare systems delayed non-urgent surgeries to free capacity. This study explores the consequences of delaying non-urgent surgery on surgical care...

M-Thyroid Care Mobile App: Virtual Video Consultation Application for Thyroid Clinic

The present study aims to enhance thyroid clinics by proposing solutions through collaboration between medical experts and researchers, thereby enhancing the quality of healthcare services. To minimize unnecessary in-person consultations, a doctor requested the development of an app to address non-critical physical consultation appointments. Design-based research is a robust methodology that combines theory-driven inquiry with real-world problem-solving to develop interventions or serve as the basis for the research being discussed. M-Thyroid Care is designed to provide a practical and cost-effective platform for online consultations, facilitating video calls between patients and doctors. By leveraging this technology, the app aims to enhance patient monitoring and optimize the efficiency of thyroid clinic consultations. Moreover, the integrated chat feature allows for real-time communication, fostering effective doctor-patient interaction even outside of scheduled appointments. Additionally, the app enables the sharing of files, videos, and images, empowering doctors to review diagnostic reports and relevant visual data remotely. This further streamlines the consultation process. By reducing the reliance on physical visits for non-critical cases, the app has the potential to enhance access to specialized care, decrease wait times, and optimize resource utilization in the clinic setting. The prototype has the potential to enhance patient care, as demonstrated by this proactive engagement with stakeholders.

The Role Of Mobile Banking In Improving Service Efficiency To Customers In The Digital Era

This paper explores the impact of Mobile Banking services, specifically the BSB Mobile application, on customer satisfaction and operational efficiency at Bank Sumsel Babel. As Mobile Banking becomes increasingly vital in the digital era, offering greater convenience and speed, this study investigates how the BSB Mobile application affects these aspects of banking service. The research aims to evaluate the effectiveness of the BSB Mobile application in enhancing customer service and reducing operational errors. It addresses a gap in existing literature by providing fresh insights into the specific challenges and benefits experienced by Bank Sumsel Babel. To achieve this, a qualitative research approach was employed, involving three months of direct observation at the Bank Sumsel Babel Tanjung Raja Sub-Branch, complemented by in-depth interviews with both staff and customers. Additionally, a thorough literature review was conducted to support the analysis. The findings reveal that the BSB Mobile application positively influences customer satisfaction by decreasing wait times and improving transaction accuracy. However, it also highlights persistent issues with network connectivity and application usability. The study concludes that while the BSB Mobile application contributes to improved customer satisfaction and operational efficiency, continuous enhancements are required to address these technical challenges. The main implication of this research is that Mobile Banking can significantly boost banking operations, provided that technological reliability and effective user training are prioritized to overcome existing limitation.

(167) Penile Plication is Well Tolerated Under Conscious Sedation: A Prospective Comparison of Deep Intravenous Vs. Nursing Administered Conscious Sedation

Abstract Introduction Penile plication is a common and effective surgical treatment for Peyronie's Disease. Although generally performed under general or spinal anesthesia, patient tolerability of penile plication under conscious sedation (CS) has several advantages: reduced anesthetic risk, health care cost savings, decrease wait times, and the ability conduct in outpatient facilities. While CS would provide significant potential benefit, there have been no evaluations of patient-reported tolerability to penile plication completed under conscious sedation nor comparisons with varying administrations. Objective To evaluate and compare patient-reported tolerability of penile plication performed under two CS sedation approaches: (1) deep intravenous conscious sedation (IVCS) administered by anesthesiologists and (2) nursing administered conscious sedation (NACS). Methods We evaluated procedure tolerability in a prospective cohort of 40 adult patients (23 IVCS; 17 NACS) undergoing primary penile plication between August 2022 and May 2023. Revision surgeries, and those with hourglass or hinge deformities were excluded. IVCS patients were administered midazolam (5mg) and ketamine (20mg) along with a continuous infusion of propofol (25-50 mcg/kg/min) and remifentanil (0.05 mcg/kg/min). NACS sedation protocol consisted of midazolam (1-2 mg) and fentanyl (50-100 ug). Patient baseline characteristics, procedure information, pain assessments (Likert scale; 0 [no pain]-10[most pain]) made by the patient and surgeon before during and after the procedure were collected. Following a post-surgical healing period, patients were contacted and administered an evaluated standardized patient tolerability questionnaire. Overall patient tolerability, pain assessments, and complication rates were compared descriptively, and using Wilcoxon sign-rank tests and McNemar tests. Results Baseline characteristics were similar between IVSC and NACS groups. Median pre-operative curvature of the IVCS cohort was 55 degrees (IQR=43.75-76.25) whereas the NACS curvature was 45 degrees (IQR=45-60). There was a 100% procedural success rate with no intra-operative concerns leading to the abortion of the procedure or conversion to general anesthetic. At six-week post-operative follow up, all patients had functional curvature. 100% of patients in the IVCS and NACS cohorts reported that they would recommend CS to others. Additionally, 95% (19/20; CI95=75.3%-99.0%) of those undergoing IVCS and 93.3% (14/15; CI95=70.2-98.8%) of the NACS cohort would choose CS over general anesthetic if they had to undergo the same surgery again. Sedation choice did not differ between CS groups (p=1.0). Most patients reported no pain pre-operatively (IVCS:[18/20]; NACS:[13/15]; p=1.0), peri-operatively (IVCS:[16/20]; NACS:[13/15]; p=0.68), or immediately post-operatively (IVCS:[14/20]; NACS:[14/15]; p=0.20). Two-hour post-operative pain did not differ between groups (p=0.89). Median two-hour post-operative IVCS pain was 2.5 (IQR=0-5.0) whereas median NACS pain was 3.0 (IQR=1.5-3.0). Conclusions Penile plication is exceptionally well tolerated when completed under either anesthesiologist administered intravenous conscious sedation or nursing administered conscious sedation. Most patients would choose conscious sedation over general anesthetic for the procedure in the future and all would recommend conscious sedation to others. Self-reported pain did not differ between groups and most patients reported no pain pre-, peri-, or immediately post-operatively. These results suggest that penile plication surgery can be completed in an outpatient setting under conscious sedation administered by trained nursing staff, which is expected to decrease costs, risks and wait-times of the procedure. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Selective centralized booking as a low-cost alternative to centralized referral.

SummaryCentralized referral systems have been successfully implemented to shorten and equalize surgical wait times; however, ongoing expenses make sustaining these projects challenging. We trialed a low-cost centralized booking project for hernia surgery in a community hospital from July to November 2019. Eligible patients (i.e., those with visible or palpable inguinal or umbilical hernias who were agreeable to an open mesh repair) were booked with the first available surgeon after initial consultation. Centrally booked patients with either inguinal or umbilical hernias waited a mean of 82 (standard deviation [SD] 32) and 80 (SD 66) days, respectively, while those who did not use the centralized system waited 137 (SD 89) and 181 (SD 92) days, respectively. Centralized booking increased operating room utilization as a larger pool of patients was available to call when last-minute cancellation occurred; centralized booking also effectively equalized wait-lists among 6 surgeons. Selective centralized booking is a promising concept that led to more efficient utilization of available operating room time with a significant decrease in wait times; this system could potentially improve access for all patients awaiting general surgery without requiring additional funding.

Improving Waiting Time for Chemotherapy with Ahead-of-Time Drug Preparation.

Waiting time for chemotherapy infusion is a fundamental factor to measure quality of care. It has been shown that a prolonged waiting time is related to a higher incidence of anticipatory nausea and poor patient adherence to scheduled appointments and recommended oncology treatment programs. Some chemotherapy regimens can be prepared hours ahead-of-time, due to long stability. We aimed to study the effect of an informatic-led workflow redesign intervention, facilitating workflow changes in the Oncology Pharmacy, on patient waiting time. This intervention included changes on EHR processes and the chemotherapy CPOE. Their main effect was allowing ahead-of-time preparation of selected chemotherapy regimes. We conducted a cross sectional study, comparing waiting times pre and post intervention periods. A total of 4600 programmed chemotherapy episodes were included. We found a 26.5 % decrease in the mean wait time in the post intervention period (p > 0.02). We were able to show a decrease in waiting time and a measurable impact of the intervention. This evaluation produced valuable and actionable data for Oncology units and adds a valuable, Latin American experience to the literature.

Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study.

Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children's acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care-based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care.

Effectiveness of Wait Time Targets and Patient Satisfaction Feedback in Decreasing Wait Times for Prescription Services in an Outpatient Pharmacy

Background: Long wait times for prescription services at the Outpatient Pharmacy of the Dr. OEN SOLO BARU Hospital in Indonesia have led to high numbers of complaints. In response, to decrease these wait times, the hospital undertook an intervention to determine wait time targets and provide feedback on patient satisfaction to personnel in the Outpatient Pharmacy. Objective: To measure the impact of providing wait time targets and patient satisfaction feedback to pharmacists in terms of decreasing wait times for prescription services at the Outpatient Pharmacy. Methods: This quasi-experimental research study had a single-group interrupted time-series design. Data on wait times and patient satisfaction were collected from “waiting patients”. The study participants were 35 employees (6 pharmacists and 29 technicians), and the intervention entailed provision of wait time targets and patient satisfaction feedback to the participants every week for 5 consecutive weeks. Results: The wait times for prescription services decreased by 11.13 minutes (17%) for compounded prescriptions and by 12.70 minutes (37%) for noncompounded prescriptions. There was a significant change in average wait time for both compounded and noncompounded prescription services from week 0 to week 4 (p &lt; 0.001). There was also a significant change in patient satisfaction from week 0 to week 4 (p &lt; 0.001). Patient satisfaction increased significantly in conjunction with the decrease in wait times for prescription services. Conclusions: The intervention of providing wait time targets and feedback on patient satisfaction to pharmacists helped to reduce wait times for prescription services. RÉSUMÉ Contexte : Les longs délais d’attente pour les services de délivrance de médicaments sur ordonnance à la pharmacie ambulatoire de l’Hôpital Dr. OEN SOLO BARU en Indonésie ont donné lieu à un nombre élevé de plaintes. En réponse, afin de réduire ces temps d’attente, l’hôpital a cherché à déterminer des objectifs de temps d’attente et à fournir des commentaires sur la satisfaction des patients au personnel de la pharmacie ambulatoire. Objectif : Mesurer l’incidence, sur le temps d’attente pour la délivrance de médicaments sur ordonnance à la pharmacie ambulatoire, de la remise aux pharmaciens d’objectifs de temps d’attente et de commentaires sur la satisfaction des patients. Méthodes : Cette étude de recherche quasi-expérimentale était conçue selon une série temporelle interrompue à groupe unique. Les données sur les temps d’attente et sur la satisfaction des patients ont été recueillies auprès des « patients en attente ». Au total, 35 employés (6 pharmaciens et 29 techniciens) ont participé à l’étude, et l’intervention consistait à remettre aux pharmaciens des objectifs de temps d’attente et des commentaires sur la satisfaction des patients chaque semaine pendant 5 semaines consécutives. Résultats : Les temps d’attente pour les services de délivrance de médicaments sur ordonnance ont diminué de 11,13 minutes (17 %) pour les ordonnances relatives aux préparations magistrales et de 12,70 minutes (37 %) pour les ordonnances relatives aux préparations non magistrales. Une différence significative a été observée entre les semaines 0 et 4 (p &lt; 0,001) concernant le temps d’attente moyen pour les services de délivrance de médicaments sur ordonnance relatifs aux préparations magistrales et ceux relatifs aux préparations non magistrales. Une différence significative a également été observée dans la satisfaction des patients entre les semaines 0 et 4 (p &lt; 0,001). La satisfaction des patients a augmenté de manière significative parallèlement à la diminution du temps d’attente pour les services de délivrance de médicaments sur ordonnance. Conclusions : La remise aux pharmaciens d’objectifs en matière de temps d’attente ainsi que de commentaires sur la satisfaction des patients a permis de réduire les temps d’attente des services de délivrance de médicaments sur ordonnance.

Effectiveness of Wait Time Targets and Patient Satisfaction Feedback in Decreasing Wait Times for Prescription Services in an Outpatient Pharmacy.

Long wait times for prescription services at the Outpatient Pharmacy of the Dr. OEN SOLO BARU Hospital in Indonesia have led to high numbers of complaints. In response, to decrease these wait times, the hospital undertook an intervention to determine wait time targets and provide feedback on patient satisfaction to personnel in the Outpatient Pharmacy. To measure the impact of providing wait time targets and patient satisfaction feedback to pharmacists in terms of decreasing wait times for prescription services at the Outpatient Pharmacy. This quasi-experimental research study had a single-group interrupted time-series design. Data on wait times and patient satisfaction were collected from "waiting patients". The study participants were 35 employees (6 pharmacists and 29 technicians), and the intervention entailed provision of wait time targets and patient satisfaction feedback to the participants every week for 5 consecutive weeks. The wait times for prescription services decreased by 11.13 minutes (17%) for compounded prescriptions and by 12.70 minutes (37%) for noncompounded prescriptions. There was a significant change in average wait time for both compounded and noncompounded prescription services from week 0 to week 4 (p < 0.001). There was also a significant change in patient satisfaction from week 0 to week 4 (p < 0.001). Patient satisfaction increased significantly in conjunction with the decrease in wait times for prescription services. The intervention of providing wait time targets and feedback on patient satisfaction to pharmacists helped to reduce wait times for prescription services.

Reducing time toxicity: Impact of a fast-track infusion pathway on overall wait-times and patient satisfaction at a large safety-net health system.

386 Background: Time toxicity is an emerging concept focusing on the impact of cancer care beyond traditionally measured outcomes: the time spent towards receiving care. Although the inherent complexity of cancer care can pose a challenge to improve time toxicity, addressing system and workflow inefficiencies through process improvement is an effective mitigation strategy. Here we present the impact of a fast-track infusion pathway on the wait-times and patient satisfaction at a large safety-net system. Methods: Parkland Health (PH) is the safety-net system for Dallas County, TX. The PH oncology infusion center supports cancer disciplines and other subspecialties. Factors such as timely patient arrivals, preference for coupled visits and same-day lab draws, and heterogeneity of treatments (medicine specialties vs. oncology) significantly impact wait times. In July 2022, a multidisciplinary team was formed to reduce wait times at the infusion center, including members who had previously participated in the ASCO Quality Training Program (QTP). This report is focused on developing a fast-track pathway for patients with injections or &lt;30-minute infusions. Patients with coupled appointments and same-day lab draws were eligible for fast-track. Wait times were calculated from the time patients were checked in at the front desk to the first medication administered. A dedicated team (RN and MA) and separate waiting areas/infusion bays were designated for fast-track patients. Fast-track patients were surveyed for satisfaction. Results: Baseline infusion volume for the 3 months prior to fast-track implementation was 106 patients per day with average wait time of 167 minutes. In the seven-month period after fast-track implementation, average daily fast-track and main infusion center combined volume was 115. The first PDSA cycle was focused on improving workflows and communication with pharmacy. In the second PDSA cycle, the fast-track infusions were moved to another area to infusion chairs to better patient flow. In May 2023, average volumes and wait times for fast-track and main infusion were 28/80 minutes and 87/107 minutes, respectively. This represents a 40% decrease in wait time for fast-track and 36% for main infusion. In our survey, 89% of fast-track patients reported their wait time to be shorter and 92% rated their experience good or excellent. Conclusions: Implementing and optimizing a separate process for short treatments reduced the wait times for both the short infusions (fast-track) as well as long infusions (main infusion) without a need for additional staff, infusion chairs, or space. The observed decrease in main infusion wait-time is likely the result of decongestion of their process by moving some of the volume to fast-track. We hope to further decrease our wait-times through additional PDSA cycles and leveraging process improvement methodology.

Intravenous hydration station in the chemotherapy infusion unit: A feasibility pilot study to improve efficiency, capacity, and wait times.

44 Background: Intravenous hydration (IVH) is frequently administered to oncology patients in outpatient chemotherapy infusion units. High demand for IVH often leads to capacity restraints in the chemotherapy infusion unit, negatively impacting the availability of infusion chairs for cancer-directed therapy, causing long wait times and patient dissatisfaction. This feasibility study aimed to expand the capacity for IVH and chemotherapy at a regional site of an academic medical center, through a dedicated hydration station outside of the conventional infusion chairs. Methods: A mobile space adjacent to a nurses’ station, within the chemotherapy infusion unit, was designated and converted to accommodate two patients simultaneously for IVH. Privacy screens separated this area from the rest of the infusion unit. Patients were directly scheduled into hydration station chairs. One nurse provided patient monitoring within the hydration station. The hydration rate was standardized to 1 liter per hour, subject to change at the discretion of treating physicians. Outcomes collected included the number of patients treated, total hours of hydration, wait times, and patient satisfaction, which was ascertained by a survey administered during February 2023 of the pilot phase. Results: Over a six-month period from December 2022 through May 2023, a total of 784 patients received IVH in the hydration station. This equates to 11 hours of IVH per day, and a cumulative total of 1,590 hours over the course of six months. The average wait time from check-in to starting IVH was 7 minutes. During the same period, the average wait time for chemotherapy was halved to 16 minutes. Among 28 patients who completed the satisfaction survey and had previously received IVH in a conventional infusion chair, 24 (86%) reported that the hydration station was either better or equivalent to their prior hydration experience. 23 (82%) patients reported a shorter or similar wait time compared to the conventional process. Overall, 84% were satisfied with their experience. Importantly, no patient safety issues were reported during the six-month period. Conclusions: IVH can be safely and effectively administered outside the conventional infusion chair, resulting in decreased wait times and high patient satisfaction. This IVH model increased the capacity for cancer-directed therapy in the chemotherapy infusion unit, with no reported safety issues. It is being standardized and implemented across other infusion units across our institution.

Rapid care transition: Implementation of an undiagnosed cancer clinic.

80 Background: There is a critical need to address potential delays in care for patients (pts) with new, undiagnosed cancer in academic medical centers that operate on a subspecialty clinic model. To bridge this gap, we established an Undiagnosed Cancer Clinic (UCC) staffed by oncology physicians and advanced practice providers (APP) to provide rapid access to specialty-led diagnostic work-up, symptom management, and disease education with the transition to subspecialists at a final diagnosis. Methods: A referral process was created, and specified provider template allocation (2 slots/week increased to 5) with a goal of referral to visit time &lt;3 business days. A nurse navigator facilitates diagnostic procedures and helps overcome barriers to care. We collected data on time from referral to UCC visit, demographics, diagnosis, and symptoms managed. Results: Prior to the UCC, median wait time for undiagnosed pts at our institution was 17 days (range 7-49) over a 4-month historical cohort (n=14). In the first 9 months of the UCC, 52 patients were seen, with a decrease in median wait time to 5 business days (range 1-21); when excluding 13 pts who requested delays or were hospitalized, wait time was 3 business days (range 1-7). Referrals increased over time from 1 to 8 per month, most from primary care providers (PCP) (31%) and emergency department (ED) (25%). Demographics include race: 65% White, 25% Black/African American, 10% Other; ethnicity: 13% Hispanic; language: 90% English, 8% Spanish, and 2% Other. The most common cancers diagnosed were gastrointestinal (35%), lymphoma (12%), genitourinary (8%), and breast (8%); 79% of solid tumor pts had metastatic disease. No cancer was identified in 15%. 58% had at least one ED visit before UCC visit, and 8% between UCC visit and establishing care with a subspecialty team. Symptoms requiring intervention were present in 63% at the time of visit, including pain, nausea, vomiting, diarrhea, and constipation. 8% of those diagnosed were referred to hospice. Conclusions: The UCC is a high-value means of specialty-led care to work up a presumed cancer diagnosis while offering symptom management and patient-centered goals of care. A team of oncology providers and clinical navigation team decreased wait time and increased access in an outpatient setting, had a low rate of ED visits following UCC-established care, and provided support and coordination of care with the ability to address barriers for marginalized communities. We are actively partnering with EDs and PCPs to expand the reach of our UCC to a broader population.

Improving access to vision rehabilitation care: implementation of the South East Ontario Vision Rehabilitation Service

ObjectifExaminer l'effet de la création du service de réadaptation visuelle du sud-est de l'Ontario (SOVRS, pour South East Ontario Vision Rehabilitation Service), dont l'administration est centralisée, mais dont les services sont offerts à l’échelle régionale, sur l'accès aux soins de réadaptation visuelle. NatureÉtude d'observation pré- (n = 1196) et post-implantation (n = 414). ParticipantsPatients adressés à la clinique de réadaptation visuelle en milieu hospitalier du Centre des sciences de la santé de Kingston et à l'une des cliniques communautaires de réadaptation en déficience visuelle du sud-est de l'Ontario aux fins d'une évaluation en basse vision entre 2014 et 2019. MéthodesOn a comparé les indicateurs de l'accès aux soins (p. ex., le degré de ruralité du patient, la diversité des sources de références, la distance à parcourir, la durée du déplacement et le temps d'attente) avant et après l'implantation du SOVRS. RésultatsAprès la mise en route du SOVRS, on a noté une hausse significative (p < 0,001) du nombre de patients issus des zones rurales qui ont été examinés dans la collectivité. De même, la clinique de réadaptation visuelle en milieu hospitalier a enregistré une augmentation significative des patients qui lui ont été adressés de l'extérieur de Kingston (p < 0,001) et de la part de médecins autres que des spécialistes des soins oculaires (p < 0,001), ce qui se traduit, pour le patient, par une réduction significative de la distance à parcourir et de la durée du déplacement (p < 0,001) de même que par une baisse de 6 % du temps d'attente médian avant d'obtenir une évaluation en basse vision et une diminution significative du temps d'attente entre le moment où le patient a été adressé à la clinique et le premier rendez-vous disponible (p = 0,011). ConclusionLe SOVRS, modèle innovateur de prestation des soins en réadaptation visuelle, a effectivement amélioré la prestation de ce type de soins ainsi que l'accès à ces soins dans le sud-est de l'Ontario grâce à l'intégration des ressources et des services régionaux.

Triage for palliative radiotherapy by clinical specialist radiation therapists: A scoping review.

Patients who could benefit from palliative radiotherapy (PRT) may be in different phases of the cancer journey: they may have minimal symptoms and preserved functional status, or could be near end of life, with multiple complex care needs. Efficient triage at PRT referral is crucial to match patients with an appropriate provider and care setting as quickly as possible. Many centres have a dedicated PRT clinic, for which triage occurs by a Palliative Clinical Specialist Radiation Therapist (PCSRT). We performedan English-language literature search of 15 databases, without date limits, based on the PICO framework. After independent screening of titles and abstracts by two authors, relevant full text papers were reviewed. Twenty studies (15 publications and five abstracts) and one government report met inclusion criteria. Studies were published over a 21-year period by investigators from four countries. By identifying bottlenecks, screening out inappropriate referrals, and assessing patients in advance of consult, PSCRT triage decreased wait times by approximately 50%, on average, compared to standard pathways (range 30-82%). Increasing efficiency by pre-booking and coordinating appointments increases patient volumes and optimizes use of resources. A triage PCSRT serving a navigator role improves continuity of care, and in decreasing the number of handoffs, safety as well. Shifting triage to a PCSRT allows multidisciplinary team members to work to their maximum scope. In one clinic, after incorporation of PCSRT triage, use of on-call services decreased, as more patients were seen during daytime appointments, contributing to cost-savings.

Effectiveness of an early operating room start time in managing pediatric trauma.

The timing of operative treatment for pediatric supracondylar humerus fractures (SCHF) and femoral shaft fractures (FSF) remains controversial. Many fractures previously considered to be surgical emergencies, such as SCHF and open fractures, are now commonly being treated the following day. When presented with an urgent fracture overnight needing operative treatment, the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day. To describe the effect of a program allowing an early operating room (OR) start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight. Starting in October 2017, patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00. We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team. Of the 44 SCHF meeting inclusion criteria, 16 received treatment before implementation while 28 were treated after. After implementation, the mean wait time for surgery decreased by 4.8 h or 35.4% (13.4 h vs 8.7 h; P = 0.001). There were no significant differences in the operative duration, time in the post anesthesia care unit, and wait time for discharge. Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons. Whereas 57% of the surgeons believed that the program was effective, only 9% of anesthesiologists and 16% of nurses agreed. The program was ultimately discontinued given the dissatisfaction. Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders. Although the program produced promising results, it also created new conflicts within the OR staff that led to its discontinuation at our institution. Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.