CS&E Abstract: MD Anderson – Patient Centered Care
Title: Improving Efficiency in the New Patient Experience by Reducing Delays in Formulating Treatment Plans at a High Volume Sarcoma Center.
Overview:
Our process improvement initiative focused on one of the Sarcoma Medical Oncology Outpatient Clinics at MD Anderson and involved a team consisting of Physician, Physician Assistant, Clinical Nurse, Clinical Administrative Director,Quality Engineer, Pharmacist.Due to the extensive treatment histories of our patient population and inherent rarity of sarcoma, the process of creating a treatment recommendation is dependent on multiple factors. Delays in acquiring all necessary data can adversely affect the quality of care in numerous aspects, in particular creating a treatment plan. In fact, we noted that the cycle time from the initial visit to the finalization of a treatment plan at times extended to several weeks. It was then decided to closely examine our current clinical processes and focus on areas that had potential for improvement. Our project is in alignment with one of the FY12 institutional goals, Operational Efficiencies.
Aim Statement:
The aim of this project is to decrease the time between a new patient’s appointment and the finalization of the treatment plan in the Sarcoma Medical Oncology Outpatient Clinic by 50% by August 31, 2012.
Measures of Success:
We recorded the time (in hours) from the patient’s initial appointment to the finalization of a documented treatment plan before and after implementation of our process improvement by reviewing electronic medical records and time stamped written documentation. Preimplementation data was collected from 9/1/2011 to 7/2/2012 and prospective data from 7/6/2012 and is ongoing.
Use of Quality Tools
We performed detailed process mapping and developed a cause and effect diagram (Figures 1,2) to identify and subsequently prioritize areas of deficiencies. It was determined that the key causes of delays in developing a finalized treatment plan were: (1) insufficient data for decision making at the time of the new patient visit, and (2) delays in obtaining diagnostic imaging.
Figure 1: Process Mapping.
Figure 2: Cause and Effect Diagram
Interventions:
Cooperation of the Business Center, clinical representative and scheduler was obtained through the Clinical Administrative Director who was a member of our project team. We then implemented a new system that begins witha Physician Assistant pre-reviewing outside patient information several days prior to patient appointment to identify missing data. This is followed by confirmation of the appointment and verbal requests to the patient to acquire missing data by a clinical representative and a scheduler. In addition, required tests are preauthorized through the insurance company and ordered prior to the patient’s initial visit via the Business Center. We did experience barriers in the Business Center,primarily due to staffing constraints,and had to outsource some functions to a clinical representative. Please refer to Figure 3 for timeline for changes.
Figure 3: Timeline
Results:
The baseline median time to finalize a treatment plan is 72 hours. After implementation of our quality improvement project the median time drastically decreased to approximately 21 hours, a reduction by 70%. Figure 4 is a control chart of the mean cycle time in hours, pre and post implementation. By observing the the data collected following the process changes, it is clear the mean has also been reduced.
Figure 4: Control Chart of the Cycle Time, Pre and Post-Implementation
Revenue Enhancement/Cost Avoidance/Generalizability:
We are currently in the “Do Phase” of the Plan-Do-Study-Act”method and are still collecting post-implementation data. Once our data collection is completed and analyzed, we will present our results to our staff and discuss wider implementation. From a financial perspective, expediting treatment plans leads to decreased costs for patients due to a shorter length of stay, particularly for out of town patients.
Conclusions and Next Steps:
Acquiring necessary data and expediting future imaging studies for the medical oncologist prior to patient’s initial consultation has clearly had a substantial impact in reducing time to formulating treatment plans; this in turnsignificantly decreases patient anxiety and increases overall satisfaction by minimizing patient visit time and burden on their financial resources. Permanently implementing such a change will require other stakeholders not involved in our pilot, particularly midlevel providers from other clinical teams.We may experience barriers including buy-in from the Business Center due to staffing shortages, as well as from other midlevel providers if additional protected time to pre-review patient records is not provided.