1. 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 2012 1

2. 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

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

4. 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 performed0 - 9.5 hrs2.6 hrs Time btw pt arrival to ward and chemo commenced2 - 24 hrs14.7 hrs Time btw bed booked and chemo commenced6 – 168 hrs59 hrs Average LOS = 10.33 days Waiting, Motion, Rejects, Staff utilisation, Processing, Inventory, Transport, Overproduction 4

5. 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

6. 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

7. 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

8. 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