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Increase infusion volume with machine learning, for better infusion center scheduling

Transform Spotlight: How St. Mary’s Medical Center rebalanced infusion scheduling and increased nurse productivity with iQueue in 7 weeks

At LeanTaaS’ fourth annual Transform Virtual Hospital Operations Summit, oncology and infusion leaders from St. Mary’s Medical Center (part of SCL Health, now Intermountain Health) discussed their facility’s issues with patient capacity and scheduling, and how they deployed technology to delay a costly remodel project and provide a relaxed and positive experience for patients and nurses alike. For the full session, visit here

Located in Grand Junction, Colorado, St. Mary’s Medical Center is the largest in its area and has delivered comprehensive care to patients in western Colorado and eastern Utah for over a century. St. Mary’s Cancer Center, the only one in the region accredited by both the Commission on Cancer (COC) and the American Society of Radiation Oncology (ASTRO), maintains an especially high standard of care. Infusion scheduling and capacity challenges, however, were consistently disrupting the quality experience that St. Mary’s strove to provide to both patients and nurses.  

We all work with cancer patients enough to know they’re taking time away from something they’d rather be doing – time from work, friends, family – and we want the time they’re in our clinic to be valuable and not just be spent waiting.” – Autumn Clark, BSN, RN, OCN Clinical Nurse Manager Cancer Center and Infusion Services, SCL Health St. Mary’s Medical Center 

Infusion capacity bottlenecks prevent best use of chairs

Infusion centers at St. Mary’s experienced daily compression in their infusion schedules, with appointments stacking up between 10am and 2pm. Nurses, scheduled to work ten-hour shifts, were drowning in patients and procedures during those times. With this workflow they struggled to take lunch breaks and were exhausted by the end of their shifts. Worst of all, they reported having limited time and energy to develop true relationships with their repeat patients, a deep motivator for most oncology nurses. Patients meanwhile suffered from unduly long wait times, as the schedule allowed for little flexibility in chair or nurse assignments if preceding treatments ran long or other patients needed to be added. 

Underlying these issues was a problem creating consistent schedule load-leveling and “evening out” of infusion chair utilization throughout the entire day. Front line staff at St. Mary’s had already implemented process improvements themselves, and had diverse perspectives to offer on how patients should best be scheduled, but variance in reasoning and function made actually achieving efficiencies difficult. Staff also lacked consistent operational data points to rely on for informed decision making. 

The day-to-day operational inefficiencies meant that overall, St. Mary’s was unable to fully tap into its available infusion capacity, and meanwhile patient volume was growing rapidly. The ability to accommodate an increasing number of appointments had become critical. St. Mary’s needed to either find a way to successfully implement operational changes to unlock new capacity or request a $4-5 million expansion to build more. 

We thought we could find a solution in LeanTaaS that would give us operational efficiencies we needed, allowing us to hopefully avoid that huge capital ask.Kevin Dryanski, MBA, Director, Oncology Service Line & Laboratory & Blood Bank, SCL Health St. Mary’s Medical Center

Analytics-driven infusion nurse scheduling templates support level-loading at St. Mary’s 

To support daily level-loading and better chair utilization, St Mary’s chose to implement LeanTaaS’ iQueue for Infusion Centers analytics solution. Throughout the process, estimated to take three to five months, leaders and team members from both St. Mary’s and LeanTaaS met for weekly workshop sessions to share status updates, progress, challenges, and discoveries. Bringing perspectives from across the infusion center into these meetings ensured that all possible problems and potential for innovation were regularly addressed. The cadence eliminated any communication lag time, as any questions among stakeholders could be answered instantly, and the iQueue team supported collaboration between clinical users and technical experts. 

We as a team can’t say enough about our partnership with LeanTaaS and the support we’ve gotten from them throughout. They listened very closely to what our needs were, then on the technical side…as we worked with our IT team here, we sometimes can’t speak their language, so LeanTaaS helped us bridge that communication gap…when we were working on the back end of our EMR, those teams understood each other.  Vanessa Sprang, BSN, RN, Clinical Nurse Manager & Business Manager, Cancer Center and Infusion Services, SCL Health St. Mary’s Medical Center

With the ongoing mutual support sustained during the implementation process, St. Mary’s three to five month estimate turned out to take only seven weeks – and the results began to manifest. 

The scheduling templates iQueue produced, built from historic data on predictive AI, fostered a universal understanding of which appointments, patients, and treatment should be placed in which slots, so schedulers could build level-loaded schedules efficiently and reduce redundant communication. With appointments spread appropriately throughout the day and longer treatments beginning in the morning, nurses’ workloads were eased and they had space to build quality rapport with patients. Patients noticed much shorter wait times and simpler journeys through their treatment days. iQueue also offered operational data reports that tracked time stamps of each patients’ journey, so that nurses and schedulers could see possible roadblocks and find new ways to improve. The LeanTaaS team in turn continued to support St. Mary’s post-implementation to empower further success.

Last but certainly not least – the satisfaction level of our staff, our scheduling team, our nursing team [is high] but we’ve also seen it flow into our pharmacy staff and our providers, since everything is much more reliable and consistent. Operations flow like they should from day to day, and there are no fires to put out on a daily basis. So everyone is happy, as well as super engaged in the new operational model with the LeanTaaS iQueue software. –Kevin Dryanski

Results of infusion schedule level-loading, by the numbers

Beyond the staff, nurse, and patient satisfaction, iQueue produced noticeable results in St. Mary’s. With average compliance to the scheduling templates at 90%, St. Mary’s has so far achieved: 

  • 8% patient volume growth, with no chairs, nurses, or other resources added, and safe nurse-to-patient ratios preserved
  • Average patient wait times under five minutes, which supported much higher patient satisfaction 
  • 1.3 additional appointments per nurse, which nurses absorbed into workloads as their burdens were alleviated  

St. Mary’s has subsequently delayed its request for millions of dollars for a physical expansion, and helped deliver the caliber of experience for which the center continues to be known. 

For the full story, including details of St. Mary’s iQueue implementation, visit the Transform event page.

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