Recently Novant Health’s nurse managers Lisa Rioux, RN, BSN, OCN, CRNI and Susan Perrella, RN came together to discuss addressing the operational bottlenecks at their system’s Presbyterian Medical Center in Charlotte, NC. iQueue for Infusion Centers, which uses machine learning and predictive analytics to solve the math underlying optimal appointment scheduling, improved schedules and resources so effectively that Novant could open a whole new infusion center with minimal patient waiting areas. If you missed the conversation, see the summary below, or view the webinar recording or its transcript.
The optics for a better new infusion center
When Novant Health opened a new 80-bay infusion center, the system envisioned a patient journey that could entirely skip the waiting room and see staff or receive treatment upon arrival. Having invested in iQueue for Infusion Center’s predictive technology for better scheduling, Novant Health was confident enough to plan for only a small waiting room for this new large center. Novant Health nurse managers Lisa Rioux, RN, BSN, OCN, CRNI and Susan Perella, RN, OCN explained how they implemented this plan and how it continually improves the patient experience every day.
Presbyterian Medical Center is part of Novant Health, a large not-for-profit healthcare system in North Carolina, South Carolina, and Georgia. This 576-bed regional hospital is located in uptown Charlotte, North Carolina. In October 2020, they opened a new seven-story cancer outpatient facility. Every detail of this building was designed with an oncology patient in mind, reflecting an environment of healing.
The system currently treats over 100 types of cancer, with 32 cancer specialists in 12 specialty clinics. Two infusion centers fall under Presbyterian Medical Center. One center is hospital-based and currently operates using 17 chairs, three beds, and one injection chair. There are typically two nurses, CNAs, one scheduler, and a charge nurse. The other infusion center utilizes 43 infusion chairs, six beds, and one injection chair. About half of their patients are seeing a physician somewhere in the building, such as a radiation oncologist, and coming in for an infusion the same day.
Managing capacity to reduce patient wait times at infusion centers
The aim of designing a proportionally small waiting area is to move people through quickly. This means coordinating the many needs of oncology and infusion patients – labs, pharmacy, physician visits, and imaging – which historically Novant Health managed through spreadsheets to block out time (e.g. infusions scheduled on the hour, injections on the half-hour). Unsurprisingly, this manual process led to many bottlenecks and pain points. Novant Health implemented LeanTaaS’ iQueue for Infusion Centers to solve the underlying math between matching and linking these patient services, resulting in a much more efficient and optimized process.
Novant’s initial goal was to decrease patient wait time and increase satisfaction, but this solution also resulted in doubled level of satisfaction for the nurses. Perella said, “we want (our nurses) to step away and not feel like they were handing off too much to one of their co-workers.”
Leading up to the opening of the new Center, the nurse managers set up templates in iQueue for Infusion Centers, using predictive volumes of the oncology patients being currently seen, as well as the growth that was expected to happen over the next 12 months. Rioux said, “our team reviewed the iQueue generated templates based on our historical data, and began building those templates within Epic. Prior to iQueue, we had a crosswalk that listed when our infusions could be scheduled, but they were scheduled based on how long they were. So the morning part of our day was usually typically very busy. We reworked our crosswalks to get more accurate tracking of the cycle times so iQueue and Epic could build a more accurate template for us to rely on for learning our trends.”
“We communicated our purpose and goals to our referring providers, nurse, and scheduler when training began. Then we provided scripting to our nurses and schedulers so that patients that have been coming to us for weeks or months or years even … they’d understand the why behind it, to get them in and out of the infusion center in a more efficient way.”
The results — reduced wait times for patients and less burnout for nurses at infusion centers
iQueue went live in June 2020. Compared to historical data, they soon saw a 41% reduction in the average infusion wait time, as well as almost a 10% decrease in the average drug wait time. Rioux added, “what was impactful to us was that we had free chairs. So those patients that were coming to their appointment weren’t waiting in a waiting room. The physician’s office calling to add on an appointment for a patient could more easily get those appointments made. Patients weren’t waiting in a waiting area for a free chair.”
Over time, infusion wait times went down across the board, even during peak hours. They saw the number of patients waiting more than 15 minutes before they got back to their chairs cut in half. Rioux added, “We still have some internal workflows that we’re changing and adapting in order to improve that as well.”
While the Novant team still has work to be done and goals to be accomplished, they continue to see improvements using iQueue for Infusion Centers. They continually make adjustments based on the data to create a shorter patient wait and better experience. But one of the best outcomes they’ve already seen is simple but critical. Rioux explained, “Since we’ve gone live with iQueue, nurses truly are able to go to the break room, and have 30 minutes of downtime. They can enjoy their lunch without feeling stressed to get back in and take care of the patients. That’s been huge.”