Physician Assistant Wilmot Cancer Center/URMC Rochester, New York, United States
BACKGROUND Multiple Myeloma (MM) is an incurable cancer. Patients make frequent trips for chemotherapy infusions. Delays within the infusion center to prepare drug or wait for lab results can add up to weeks for patients over the course of their disease. The goal of the Infusion Center Pilot Program was to reduce wait times for MM patients receiving treatment in the infusion center while not increasing cost to the medical center with pre-made medications that were not used.
This quality improvement (QI) project was created with the MM care team (physician, oncology advanced practice provider and registered nurse), clerical staff, infusion center nursing, and pharmacy.
METHODS Stable patients (without unplanned dosing adjustments within 3 months) were eligible to participate. Participants were required to have labs drawn up to 3 days prior to treatment and notify clerical staff that labs were drawn, they were not ill, and planned to come to the appointment.
The oncology advanced practice provider was alerted to the phone calls, highlighted these patients, and signed the treatment plan. Pharmacy staff then prepared the medication for infusion prior to the patient’s planned appointment.
MM patients are seen by a provider in the outpatient clinic at the start of each cycle. This visit is when dose adjustments or treatment changes would be likely to occur. This program was only implemented on days patients were not seen in clinic to reduce costs of unused medications.
RESULTS Eight patients initially enrolled in the Infusion Center Pilot Program. The wait time to drug infusion was counted from the moment the patient checked into the infusion center to the time the chemotherapy was scanned by the nurse for administration. Wait times for the same patients were compared for 4 infusion treatments prior to and after participation in the study. Same day control wait times for patients getting the same drug within 1 hour of the appointment of participating patients were also compared. Of the 8 participants, 6 patients successfully had their multiple myeloma treatment(s) made in advance while 2 patients unfortunately did not because of miscommunication in pharmacy.
Of the patients who successfully had treatments made ahead of time, 5 were treated with carfilzomib and one with bortezomib. The 2 patients who did not have treatment prepared ahead of time were treated with daratumumab.
There was a decrease in wait time for matched controls and in wait times for the same patient prior to and after participation in the pilot program. Labs drawn ahead of time if treatment was not prepared in advance did not decrease wait times for patients compared with patients who had labs drawn the day of treatment.
CONCLUSIONS The institution of this program making chemotherapy prior to patient appointment times resulted in decreased time in the infusion center by patients. Our calculations showed a significant reduction of wait times in the infusion center compared to both average and same day controls. Due to these successful outcomes, an additional 37 patients have participated.
RECOMMENDATIONS We propose infusion centers prepare chemotherapy prior to patient arrival. Teams including the infusion center, physicians, oncology advanced practice providers, pharmacy, and clerical staff can create individual center work flows. Making sure all teams are in agreement is important for the program to be successful.
INNOVATION Infusion center wait times were reduced with continued measurable data.
