Recently, Seattle Cancer Care Alliance’s Angela Rodriguez, MSN, RN, CNSBC, OCN, SANE-A, Associate Director of Clinical Operations and Rachel DuPree, BSN, RN, Infusion Nursing Supervisor, discussed how SCCA managed the scheduling and staffing challenges driven by the unique layout of their center, using iQueue for Infusion Centers from LeanTaaS. They shared their solutions for maintaining a balanced infusion workload across multiple staff specialties and spaces, achieving infusion staffing optimization.
Managing dispersed staff and space
Seattle Cancer Care Alliance (SCCA) is one of the only NCI-designated comprehensive cancer centers in the Pacific Northwest. It unites doctors from UW Madison, Fred Hutch Research Center, and Seattle Children’s Hospital. This network and partnership is aligned to deliver high-quality and high-value care to their patients, which involves making the most of their resources and staff.
The main clinic is headquartered in South Lake Union. However, their inpatient hospital is in Seattle’s university district, plus an additional five community sites. They have a total of 63 bays with a mixture of beds and chairs. On average, 1,150-1,400 patients are treated on regular weekdays and 80-100 patients are seen on Saturdays, Sundays and holidays.
Daily staffing is adjusted to patient volumes. The goal is to have a ratio of three patients per one nurse at any given time. This usually equates to about six to eight patients per nurse per day. The average length of stay for patients is between two and a half to three hours per segment, with some as short as five minutes and others as long as 12 hours or more.
SCCA’s physical layout presents unique challenges for nursing scheduling. With the infusion center spread across multiple floors in the main clinic, down long hallways and around odd corners, there was the potential for safety issues caused by nurses caring for patients in different locations, not to mention longer wait times and delayed care access for patients.
A complicated scheduling scenario
To address this concern, SCCA created special teams based on sub-specialties to help limit the distance that nurses might need to go caring for patients. However, nurses and support staff still had to relocate themselves daily.
The subspecialties, from solid tumors to bone marrow transplants to hematology, led to different demands on nurses. This contributed to decreased staff satisfaction as the workload was perceived as inequitable.
Scheduling across the dispersed space and diverse subspecialties had its own complications. Adding to this, SCCA also had decentralized scheduling, with over 50 schedulers throughout the institution who can schedule into their unit at any given moment. These used different Epic templates based on their floor plan to allow them to meet these different scheduling needs and avoid capacity issues.
Inefficient manual processes inhibit cancer center optimization
This complicated scheduling scenario took a lengthy process to manage. As DuPree described, “Creating nursing assignments was a manual process that couldn’t be easily adapted to new initiatives. Making the schedule for the next day was a four-hour plus process with multiple people creating a schedule and editing it. There was one handwritten original schedule for each side or subspecialty. Because of the way the assignments were done, we would have flex rooms, and kept nursing assignments overbooked. We were manually calculating nurses’ acuity hours to ensure that assignments weren’t too heavy and to see how many nurses we needed for each subspecialty.”
A lot of unnecessary work was required when the schedule needed to be adjusted throughout the day for unexpected changes like cancellations, urgent add-ons or late calls. The charge nurse had to alter their own copy of the schedule, then walk to the station where the original was located to update it, while notifying the RN of the change.
This was inefficient and presented multiple opportunities for communication breakdowns and errors. DuPree explained, “Something had to change with these inefficiencies. These were our initial goals: we wanted to improve staff on staff satisfaction by balancing our workload, maintain and enhance patient safety by maintaining the co-location of RNs for their patients, maximize patient access by optimizing physical space, and provide timely access to minimize patient delays.”
Leveraging iQueue for Infusion Centers in the face of COVID-19
On top of the existing scheduling challenges, COVID-19 added another layer of complexity.
DuPree continued, “We knew during this time we needed to be agile and flexible because we didn’t know what additional changes were coming our way. That’s why we decided to implement the nurse allocation tool in iQueue for Infusion Centers.”
“iQueue mixes or pools appointments into one unit and our RNs are divided into pods so they are co-located with their patients. Transfusions and hydrations are mixed more evenly with heavier chemo regimens across the unit. Our flex rooms are no longer necessary, and our support staff have an even workload.”
iQueue for Infusion Centers reduced the time the SCCA team spent on nursing assignments and allowed them to make real-time adjustments. Speaking to the results of this, DuPree said, “It now takes 30 minutes or less to make the nursing assignment for the next day. The Gantt view helps visualize the nursing assignments throughout the day and pass off can be easily identified. And this real-time data allows transparency and a more accurate grasp of the current status. Using iQueue and altering our layouts allowed for greater utilization of space without being over capacity.”
The outcome of infusion staffing optimization with iQueue
Impressively, the SCCA infusion team was able to achieve their original goals of better utilization and ensuring level loading of patient acuity for their nurses. From 2020 to 2021, patient waitlists were reduced by 80%, and nurses’ workload was balanced throughout the week, so they could work a consistent, predictable schedule rather than undergo lighter days and heavier ones. They were also able to save valuable time with their new and improved efficient operational processes, leading to patient volumes being restored to pre-COVID levels in fall of 2021.The SCCA team was thus established for more flexible staffing and scheduling for any other unforeseen needs in the future.
To learn more about infusion staffing optimization at other organizations with unique challenges, visit the iQueue for Infusion Resources page.