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 with
a 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 PostImplementation
Revenue Enhancement/Cost Avoidance/Generalizability:
We are currently in the “Do Phase” of the Plan-Do-StudyAct” 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 turn significantly 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 mid level providers if additional protected time
to pre-review patient records is not provided.