PMID- 33023906
OWN - NLM
STAT- MEDLINE
DCOM- 20210616
LR  - 20210616
IS  - 2399-6641 (Electronic)
IS  - 2399-6641 (Linking)
VI  - 9
IP  - 4
DP  - 2020 Oct
TI  - Reducing wait time for administration of systemic anticancer treatment (SACT) in 
      a hospital outpatient facility.
LID - 10.1136/bmjoq-2019-000904 [doi]
LID - e000904
AB  - The demand for systemic anticancer treatment continues to rise due to the 
      increasing numbers being diagnosed with cancer and developments in treatment 
      options. The net result is greater pressure on services and subsequent patient 
      delays. Delays in treatment could decrease the benefit of the therapy and be 
      detrimental to patient experience. Patients with human epidermal growth factor 
      receptor-2 (HER 2) positive breast cancer within Raigmore Hospital waited an 
      average of 41 min from the scheduled appointment time despite the administration 
      of subcutaneous (SC) trastuzumab being scheduled for a 15 min treatment window. 
      Given the frequency of these injections, this was having an adverse impact on 
      patients and services. The aim of this project was for patients with breast 
      cancer to receive treatment within the 15 min window. Lean principles were 
      applied to reduce waste and increase value. Exploration of the problem led to the 
      solution of relocating the administration of SC trastuzumab from the Macmillan 
      Day Bed Unit (MDBU) to the Highland Breast Centre (HBC). Multiple improvement 
      tools and techniques were used to implement the change. Data were collected on 
      the median number of treatment episodes of SC trastuzumab per week at baseline 
      and patient wait from appointment time to treatment completion was calculated at 
      baseline and as an ongoing measure. Patient experience feedback was gathered 
      following relocation of the treatment. Following relocation, the average time 
      from scheduled appointment to discharge was 14 min (66% reduction). Patient 
      experience feedback was positive and identified an unanticipated outcome; the 
      regular Friday afternoon clinic, identified as most efficient for the service, 
      was found by patients to be particularly convenient for their own planning. 
      Through the application of Lean principles, the service was redesigned in a cost 
      neutral way and resulted in a reduction in the wait time for treatment.
CI  - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Macleod, Angeline
AU  - Macleod A
AUID- ORCID: 0000-0002-5797-9622
AD  - Cancer Services, NHS Highland, Inverness, Scotland, UK.
FAU - Campbell, Fiona
AU  - Campbell F
AD  - Macmillan Suite, NHS Highland, Inverness, Highland, UK.
FAU - Macrae, Derick
AU  - Macrae D
AD  - Cancer Services, NHS Highland, Inverness, Scotland, UK.
FAU - Gray, Evelyn
AU  - Gray E
AD  - Medical Division, NHS Highland, Inverness, Highland, UK.
FAU - Miller, Leanne
AU  - Miller L
AD  - Pharmacy Department, NHS Highland, Inverness, Scotland, UK.
FAU - Beattie, Michelle
AU  - Beattie M
AD  - Department of Nursing and Midwifery, University of the Highlands and Islands, 
      Inverness, UK michelle.beattie@uhi.ac.uk.
LA  - eng
PT  - Journal Article
PL  - England
TA  - BMJ Open Qual
JT  - BMJ open quality
JID - 101710381
RN  - 0 (Antineoplastic Agents)
RN  - EC 2.7.10.1 (ERBB2 protein, human)
RN  - EC 2.7.10.1 (Receptor, ErbB-2)
RN  - P188ANX8CK (Trastuzumab)
SB  - IM
MH  - Ambulatory Care Facilities/organization & administration/standards/statistics & 
      numerical data
MH  - Antineoplastic Agents/*administration & dosage/therapeutic use
MH  - Appointments and Schedules
MH  - Humans
MH  - Receptor, ErbB-2/administration & dosage/therapeutic use
MH  - Time Factors
MH  - Time-to-Treatment/*standards/statistics & numerical data
MH  - Trastuzumab/administration & dosage/therapeutic use
MH  - *Waiting Lists
PMC - PMC7539611
OTO - NOTNLM
OT  - PDSA
OT  - continuous quality improvement
OT  - efficiency
OT  - healthcare quality improvement
OT  - lean management
OT  - organisational
COIS- Competing interests: None declared.
EDAT- 2020/10/08 06:00
MHDA- 2021/06/17 06:00
PMCR- 2020/10/06
CRDT- 2020/10/07 05:42
PHST- 2019/12/19 00:00 [received]
PHST- 2020/08/10 00:00 [revised]
PHST- 2020/09/21 00:00 [accepted]
PHST- 2020/10/07 05:42 [entrez]
PHST- 2020/10/08 06:00 [pubmed]
PHST- 2021/06/17 06:00 [medline]
PHST- 2020/10/06 00:00 [pmc-release]
AID - bmjoq-2019-000904 [pii]
AID - 10.1136/bmjoq-2019-000904 [doi]
PST - ppublish
SO  - BMJ Open Qual. 2020 Oct;9(4):e000904. doi: 10.1136/bmjoq-2019-000904.