Long waits for patients, overworked nurses, and difficulty scheduling—these are just some of the frustrations with infusion treatments. Cancer centers across the country continuously struggle with streamlining the infusion treatment experience for patients and staff alike. When and how patients are scheduled for their infusion treatments are critical factors for optimal patient throughput. Despite repeated efforts to improve workflows and optimize nurse schedules, a day in infusion treatment tends to frustrate patients with delays and upset staff with what seems to be a lack of resources.
The Current Infusion Center Chair Utilization Pattern
Getting scheduling right is not an easy task. Many factors contribute to the complexity of operating an infusion center, including the range and variability of patient acuity, treatment length, and treatment cycles. Typically, treatments are scheduled into an open template per the patient’s preference and/or according to their clinic and lab appointments. Add in the intricacy of scheduling nurses and assigning them to patients based on treatment times and acuity, and you have a recipe for dissatisfaction.
The factors above combine to create a chair utilization pattern shaped like a triangle, with a steady ramp-up of patients in the morning, peak volume between 11 a.m. and 1 p.m., and a steady decline until the end of the day. See figure 1 below for an illustration.
When Chair Expansion Won’t Fix Utilization
What makes infusion scheduling particularly challenging is that, on the one hand, there is untapped capacity during much of the day, but on the other hand, the midday peak of patient demand often exceeds the number of chairs or nurses available, resulting in patients waiting for their treatment well past their scheduled start time. This can also create staff burnout, as nurses in particular are confronted with a sudden spike in patient demand that can overwhelm them. The demand spike also creates unnecessary burdens on pharmacy processes due to a bolus of drugs requiring preparation and reduces overall capacity for very sick patients who must be seen for a same-day visit.
This pattern clearly is a suboptimal use of capacity and staff resources, but infusion centers often respond to the problem by expanding their infusion station capacity, which does very little to improve the situation as additional capacity does not always address overall scheduling or staffing inefficiencies. Fortunately, existing tools and methods can achieve a desired state of optimized scheduling, enhanced utilization, satisfied patients, and staff balance without specifically including expanded capacity.
So what can be done?
Optimize Your Infusion Center’s Scheduling with These Three Steps
Reaching a target state of balanced patient demand, practitioner resources, and facility capacity requires infusion center managers to approach scheduling in new ways. They must utilize the historical data available in their electronic health record and/or practice management system as well as advanced analytical methods to create a far more optimized schedule based on treatment length and patient acuity. It may sound daunting, but such tools—at least basic versions—can be developed in Excel with minimal financial investment.
We have built a tool to optimize infusion scheduling that is user friendly, integrated with Excel, and designed with the nurse manager as the end user. The tool has been created with three key elements in mind:
- Predict demand by treatment length category. Use historical data and knowledge of treatment cycles to predict the number of each treatment length to offer on a given day.
- Create an optimal template. Apply advanced and publicly available analytical methods to determine the optimal arrangements of these treatment slots to maximize utilization and throughput.
- Assign nurses to patients. Create a model that assigns nurses to patients according to nurse schedules, capacity constraints, and patient acuity.
This approach is a drastic shift in how scheduling typically occurs in an infusion center, but the resulting throughput gains and improvements in patient and staff satisfaction make it worth embracing the effort.
Case Study: Developing the Infusion Schedule Optimization Tool for a 42-Chair Infusion Center
We recently collaborated with a large southeastern cancer center (with approximately 3,500 analytical cases) that had suboptimal scheduling for its 42-chair infusion center, resulting in untapped capacity during typical morning hours followed by an afternoon peak in demand, when the staff felt there was no capacity left to see more patients. Does this sound familiar? It represents the typical triangle-shaped utilization pattern that is a pitfall for many infusion centers.
We implemented the tool discussed above with the outlined three-step approach. Our analysis demonstrated that, using the client’s existing resources of nurses and chairs available, scheduling could be optimized to smooth out the typical midday peak in demand and accommodate more patients in the morning and afternoon. On a typical day, throughput could be increased up to 40%. When comparing to the busiest day the center had experienced in the last year, our model predicted a 14% increase in throughput, all without requiring additional staff or chairs. For this client, our model demonstrated that more patients could be seen without the need to make large investments in new chairs.
In addition to increased throughput, a more optimized schedule resulted in far less stress and fewer delays in placing patients in chairs and starting their infusion treatments. Moreover, it was shown that with this approach, patients would be assigned more equitably to nurses based on an acuity rating of low, medium, or high. For example, during a shift, a nurse would see only one high-acuity patient but could also see four lower-acuity patients. This new perspective to viewing scheduling focused on staff morale in addition to patient satisfaction. Ultimately, the cancer center realized that, contrary to the prevailing belief that it had too little capacity, it in fact had ample capacity to treat not only the current roster of patients but also additional patients.
Screenshot Examples of the Infusion Schedule Optimization Tool
Input Screen: The nurse manager inserts the scheduled start time, length, and acuity of the day’s patients, as well as the start and end times of each nurse shift.
Nurse Schedule Result: The tool results in a nurse schedule, providing patient treatment start and stop times for each patient assigned to each individual nurse.
Nurse Acuity Result: The tool also results in a nurse acuity score, which indicates the acuity level that each nurse will experience throughout the day.
Published November 7, 2018