The Health Roundtable The Chemo Boat – Lean Chemotherapy Presenter: Fiona Gillanders & Nicole Goodman Hospital Code Name: Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct

The Health Roundtable KEY PROBLEM Length of stay (LOS) of patients admitted to hospital for a cycle of chemotherapy routinely grossly exceeds the number of days the chemotherapy protocol requires for delivery. 2

The Health Roundtable AIM OF THIS INNOVATION Reduce the LOS of planned admissions for chemotherapy by 20% 3

The Health Roundtable BASELINE DATA MeasurementRangeAve Time btw admission booked and pt arrival to ward1 - 7 days3. 6 days Time btw pt arrival to ward and medical admission performed hrs2.6 hrs Time btw pt arrival to ward and chemo commenced hrs14.7 hrs Time btw bed booked and chemo commenced6 – 168 hrs59 hrs Average LOS = days Waiting, Motion, Rejects, Staff utilisation, Processing, Inventory, Transport, Overproduction 4

The Health Roundtable KEY CHANGES IMPLEMENTED  Store room reduced from 4 areas to 2.  Chemotherapy room reorganised.  Change of nurse allocation culture,  chemotherapy accredited nurses separated out across roster covering all shifts  chemotherapy accredited nurses allocated to patients due to receive chemotherapy.  Change of delivery time of outsourced chemotherapy to pharmacy  brought forward to an earlier time, removing “wait time” in pharmacy. 5

The Health Roundtable KEY CHANGES IMPLEMENTED  Pre admission:  Outpatient chemotherapy group education attended,  Outpatient insertion of Central venous access device (when required),  Outpatient pathology attended and reviewed  Chemotherapy reconstituted and delivered to ward one day prior to patient admission.  Chemotherapy Checklist form created and implemented:  enables chemotherapy administration to commence prior to medical review/admission  (as occurs in outpatient chemotherapy suites) 6

The Health Roundtable OUTCOMES SO FAR Measurement Range Post Pre Average New Baseline Time btw admission booked and pt arrival to ward0 days 1 – 7 days0 days 3. 6 days Time btw pt arrival to ward and medical admission performed0 - 2 hrs 0 – 9.5 hrs1.25 hrs 2.6 hrs Time btw patient arrival to ward and chemo commenced15 – 30 mins 2 – 24hrs26 mins 14.7 hrs Time btw bed booked and chemo commenced26 mins 6 – 168 hrs26 mins 59 hrs Ave LOS = 5 days50% reduction! 7

The Health Roundtable LESSONS LEARNT  Chemotherapy administration is a complex process requiring input from multiple disciplines.  A coordinated and systematic approach can greatly reduce resource wastage, particularly time spent waiting.  Such a process has the capacity to greatly improve outcomes for the organisation and, most importantly, the patient. 8