The Health Roundtable F inding a new way to increase capacity - Introduction of an acuity scale into an outpatient chemotherapy unit Presenter: Lucy Burns Hospital - St George Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct b_HRT1215-Session_BURNS_STGEORGE_NSW

The Health Roundtable KEY PROBLEM  This is a problem of limited space and resources colliding with an ever increasing volume of patients needing to be treated.  Over the last 4 years, the number of patients receiving treatment has increased by 30%  Waiting times were heading upwards  The number of patients breaching the 2 week unofficial KPI for ready to treat patients regularly exceeded 15 per month (163 for the period). 2

The Health Roundtable AIM OF THIS INNOVATION  The improvement we were aiming for was a decrease in both waiting times and number of breaches  Renovations are necessary and planned but are still a long way off  Somehow we needed to find a way to be more efficient and treat more patients per day without any increase in space or nursing numbers 3

The Health Roundtable BASELINE DATA  Over the last five years, the number of haematologists and medical oncologists has increased along with the number of treatments able to be provided in the outpatient setting. This has lead to an increasing number of referrals for treatment and consequently an increase in the number of patients requiring timely treatment  Unfortunately this was also leading to increased waiting times 4

The Health Roundtable KEY CHANGES IMPLEMENTED  Following an extensive literature search, we adapted an acuity scale originally used to justify the need for more nurses in a US chemotherapy unit.  We gave everything we do including chemotherapy, apheresis, education, transfusions etc, a score out of 20.  Instead of planning each day according to the number of patients each nurse could take (5), we now would book according to how many points were available (20 per nurse)  Allocation of patients along with points is done the afternoon prior to treatment so each nurse can plan their day a little and see that the allocation is evenly spread. 5

The Health Roundtable KEY CHANGES IMPLEMENTED  HODC Acuity Scale 6

The Health Roundtable OUTCOMES SO FAR  The scale was introduced on a trial basis in mid May 2011 and had an immediate impact.  Both waiting times and breaches started to drop.  The impact has been ongoing and the scale is now an established of our booking process. 7

The Health Roundtable LESSONS LEARNT  The St George HODC Acuity Scale is easy to use and easily adaptable for other centres and other purposes.  It has allowed us to keep operating effectively and efficiently where otherwise we would have reached capacity a year ago  It is cost neutral and just requires a slight shift in thinking away from numbers of patients to points per day.  It is already in use at the Sutherland Hospital Outpatient Oncology Unit and a copy has also been sent to the NSW Cancer Institute following an on-line discussion about booking systems and waiting times with other outpatient unit managers from around the state. 8