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How to Unclog Your Infusion Center Webinar Transcript

Welcome to today’s webinar, how to unplug your schedule and maximize infusion’s resources. I’m Josephine Hederoth, Marketing Associate at LeanTaaS. Today’s webinar will be presented by Ina Huang, product implementation manager for iQueue for Infusion Centers. Before we start the webinar, there are a few tips and guidelines I’ll go over. If you think of a question during the webinar, you could submit in the Q&A widget under consoles. We will answer them at the end of the session. All of the consoles and those you see on your screen can be moved and resized. If you’re experiencing any technical problems during the webinar, you have a window called LeanTaaS Webinar Tips. You can find solutions to the most common problem. A recording of this webinar will be sent to your email within 24 hours, if you’d like to re-watch or revisit any part. Finally, if you have any comments about the webinar, please submit using the survey widget. Any thoughts are greatly appreciated. Thank you all for joining us today and thank you Ina for presenting. 

INA HUANG: All right. Hi everyone, thanks again for attending our webinar. My name is Ina, I am a Product Manager on the iQueue for Infusion product team. So as Josephine mentioned, this webinar is really about how lead times can affect your infusion schedule. So this is the agenda for today’s webinar. First, we will go over the concepts of lead time and clog time, and look at the typical scheduling progression at infusion centers. Next, we will talk about how to use data to assess your current scheduling lead time, and how to best schedule appointments with different lead times. Lastly, we will address what guidelines to implement based on looking at your data and strategies to adopt those guidelines. So let’s get started. What is scheduling lead time? Scheduling lead time is a concept that most of you are probably very familiar with already. Let’s say, someone books an appointment and then in the future shows up for that appointment, this time span is the scheduling lead time. 

Clog time is a another term might be new to a lot of you, but will be very helpful in understanding your scheduling challenges. Let’s say, there is another person who puts an appointment, but some time in the future cancels the appointment. That wasted time is what we call clog time. It’s the time that canceled appointments sits on the schedule taking scheduling availability away from other appointments. This webinar is about how to manage your infusion lead time to make sure that you are utilizing your infusion resources in the most efficient way. How quickly do your schedules fill up? This is a chart showing scheduled volume this week, to eight weeks out. You can see on the y-axis, we are looking at the scheduled volumes and the x-axis we have this week, next week, two weeks out, and so on. 

The point of the chart is that almost all infusion centers scheduled will look something like this, where this week and next week might be completely full, but there are also appointments on the books six, seven, eight weeks or more out. The Scheduling lead time determines how quickly your availability opens up. The shorter that lead time, the quicker the availability will open up, and vise versa. However, the exact profile of your center or your chart will look like depends on a variety of factors, including provider preference, treatment type, patient population, and culture. For example, if the patient population at your infusion center are mostly [INAUDIBLE] patients, the scheduling lead time might fall on the shorter side, whereas if you’re treating mostly non-oncology patients, some appointments might get booked months out. 

Now after we saw how the schedule volumes would typically look like in the upcoming weeks, let’s take a look at how a single day schedule was built up over time. The x-axis in this chart is the hours of the day, and the yellow bars are the appointments scheduled across hours of the day. As you can see, the schedule for that day fills up as we get closer and closer to that date. This is a typical progression we’ve seen at most infusion centers, where we can see a few weeks out, schedules are already full in the middle of the day. So why this happens? Why do infusion centers tend to schedule their appointments far in advance? 105 00:05:50,670 –> 00:05:54,550 There can be a lot of pressure to book appointments far out, and we find that they generally come from three main drivers. The first one is provider. Providers usually include the entire treatment plan in their after visit summaries. Their preference is to get the clinic visits onto the schedule all at once, and infusions often happens on the same date or the same week. For example, in the checkout notes it may say, please schedule this patient for the fourth cycle which could include several months of weekly visits, with both office visits and infusion treatments. 

Since provider schedules often get overbooked, they wants to book patients as soon as possible, causing the schedules to be even more full. The second main driver is scheduler. Schedulers are required to follow provider’s guidelines, or they may want to secure the time slot that a patient prefers. 125 00:07:00,790 –> 00:07:04,240 However, sometimes they don’t have availability for the particular slot being requested at any time in the near future, and therefore they need to book the appointment far out to be able to book into a particular time slot. Sometimes the schedulers may just want to get all the appointments in at once, because they know how difficult it can be to book an appointment close to the date of treatment. The last driver is patients. 

Patients may want ample time to plan ahead, arrange transportation, or simply know what to expect in their future. Patients also want to make sure that the slots that they have today will be reserved for all of their future treatments. You can see that in all of these cases, there is a mindset of grabbing appointments early for individual patients before the availability runs out. However, it’s important to keep in mind that the purpose is not to [INAUDIBLE] appointments for the early bird only, rather the goal of every infusion center is to be able to provide treatment for all patients who need it, regardless of whether they’re scheduled. It may seem that you are putting patients first by booking appointments far in advance. However we will explore in the rest of this weather why this thinking can be flawed, and what you can do to really increase the patient access. Here are some common issues we’re seeing with booking far in advance, and we will make the connection between the lead times and these issues very clear. 

The first one is unpredictability of appointments. What do we mean by this? Appointments scheduled far in advance are more likely to change. Either they could be canceled outright, it could be moved or they could have their order changed. The second issue is clogged schedules. While this is related to the number of resources that you have, clog time and lead time can have a surprisingly high impact on this. When you schedule very far out, it 168 00:09:41,160 –> 00:09:44,610 can be hard to find availability when it gets close to the day of treatment. Schedulers are therefore forced into discretionary overbooks. The last issue is suboptimal chair utilization. Due to the unpredictability when scheduling far out, chairs and nurses can end up underutilized when the appointment gets canceled. 

On the other hand, it can be over utilized. This will happen when schedulers don’t have enough space to accommodate urgent patients at your peak hours. These could have been managed better if scheduling were more optimal. Now we will talk about the logic of how lead times can contribute to these problems. This chart that you are seeing right now is showing how cancellation rates are related to lead time. The x-axis is lead time, and on the y-axis we are looking at a number of appointments scheduled with different lead times. Orange means that the appointment was completed, whereas blue means appointment was canceled, either on the day of, or ahead of the time. You can see that appointments booked far out, have a higher likelihood of being canceled. 

Why? This is because often the course of treatment could change for that patient, or the patient’s condition could change. Depending on the center some of these appointments could have been cancelled weeks earlier, but it can be difficult to close the loop between clinics and infusion scheduling. So most recent changes to the patient’s plans might not be respected, and the other times patients could be too sick to treat or their labs do not meet their requirements for the treatment on the day of. Of course, there will always be some unavoidable events in the infusion center. Our goal is to minimize them. Infusion resources are very limited. And we want to book appointments that are more likely to happen. However, due to the low scheduling lead time, we often have a lot of appointments being canceled down the road. A long clog time as the result. These cancelled appointments may be clogging your schedule for a significant amount of time, blocking the availabilities that could have been relieved for urgent patients. 

In this chart, we want to help quantify the amount of clog. The x-axis is how long the cancelled appointments have stayed on the schedule, the y-axis in this chart is the number of canceled appointments. While you can see that most appointments are canceled fairly soon, you can see that there’s still a significant chunk of canceled appointments clogging your schedule for more than four weeks. These are the appointments highlighted in yellow, purple, and pink. This is a lot of time spent to a lot of lost scheduling availability. Imagine having and additional ten slots every single day for the past four weeks if the scheduling had been more optimal. Now that we’ve talked over that issue related to having lower scheduling lead time, we want to discuss potential solutions and our recommendations on how to implement them. The first one is to reduce your scheduling lead times. The second one is to keep your scheduled appointments up to date. The last one is to reserve some slots for common shortly time appointments. 

Now let’s talk about each of them in more detail. 

Recommendation one. Reduce scheduling lead times. This addresses the issue of clogged schedules, for most scheduling availability. You saw this chart a minute ago, and the idea from that slide was that appointments both with lower lead times have higher chance to be canceled. Now you may wonder how far is too far out. Where do you draw the line? One way to think about this is that, it’s more likely than not that a scheduler will need to go in and re-book or cancel that appointment. There’s simply no benefit to locking it down. In this example, we see that the threshold is 30 days. We book an appointment more than 30 days in advance, there is a 50% chance that appointments will not happen. You can use this chart to get a rough guideline on how far out you should schedule in order to avoid and set up unnecessary cancellation. For those of you who are already on iQueue, ask your product manager about getting the right guidelines on scheduling lead times. 

Recommendation two. Keep scheduled appointments up to date. It is important to establish a feedback loop, so that with appointment details changed, they can be reflected back on the schedule as soon as possible. Here are some options. Option 1. Make updates to schedule in real time. This is the most ideal option, but also the hardest one to implement. It’s hard to implement because updates usually come from the provider side, who don’t have the time or assets to make changes on infusion schedules. What usually works well is option 2, which is to set up a weekly patient review meeting with the clinical staff, to go over the upcoming weeks appointments and cancel any treatments for patients whose condition is not stable. Which means, higher chance they will not show up or end up being a same day cancellation. This option has been proven to have a sizable impact on reducing the number of no shows and same day cancellation. The last one is, reserve slots. If you are already on a iQueue, chances are you may not need reserve slots. Having an optimal scheduling template that aims to accommodate your highest volume days combined with normal cancellation rates, is usually enough to meet the add-on needs at most infusion centers. However, it’s in the data we find that there is a consistent demand for appointments booked on, or close to the date of treatment, we would want to reserve some slots on the schedule to accommodate this. 

The two most common time frames we have for reserve slots are same day add-ons, or one week out appointments. First, we will talk about assessing the need to reserve slots for same day add-ons. On the left hand side, we are showing an example of how the add on volume compares to the no show and same day cancellation volume. The x-axis is still hours of the day, and the y-axis is the number of appointments. With color coded add-ons in green, same day cancellation in pink and no shows in purple. How to read the chart? This chart is basically saying that you had more add-ons than same day cancellations and no shows. As you can see that the green portion is greater than the pink and purple area. If you look at the breakdown by hours, you can see that you have more add-ons in the afternoon. Now, the question is when do I need the reserve slots for a same day add-on? We think that if you have more no show and cancellations than add-ons, you could use those slots to see the urgent add-ons. However, if you feel like you have more no shows and cancellations than add-ons– Sorry, if you feel like you have more add-ons than no shows and cancellations, it would make sense to reserve some slots for those add-ons. For people who are on iQueue, you can go to add-ons and no show analytics to view this chart based on your own data. Similarly, you can do the same exercise to evaluate whether you need some reserve slots for the one week out appointments. Instead of using the add-on and no show analytics, you would need to go to booking patterns to take a look.

 In this example, you can see that we have a consistently [INAUDIBLE] around 9:30, 11:00 AM, 1:00 PM, 2:00 PM and 3:00 PM. You can use this analytic to understand your demand within one week of lead time and by hours of the day. To learn more about how to use these analytics tools, please contact your product manager. The key takeaways. If you feel that you have low scheduling availability, or schedules that always seem to stray from what you have planned, long lead times could be a culprit. Look at your data to diagnose the issue and make recommendations. Generally, we think that there are two things that usually work well. The first one is cap your long lead time, and the second one is to reserve some slots for common short lead time appointments. With that, this is all we want to cover in this webinar.

JOSEPHINE HEDEROTH: OK, so now we’re going to move onto that Q&A section of the webinar. So if you have any questions, please submit them in the Q&;A widget that you see on your screen. And it looks like we have two questions already. The first one is, what can we do if lead times are completely provider driven? Our schedulers often don’t have any choice in how far out they’re booking. 

INA HUANG: This is a really good question, I’m sure that most of you may have this and some similar problems at your infusion center. So we find that providers [INAUDIBLE] to looking at hard data. One take away from this webinar is that it’s important to be able to quantify the problem. Can you tell them how frequently cases are getting rebooked? How many patients’ worth of clogging could be relieved if the lead times were reviewed. And what about how many additional patients would be able to be treated if the scheduling lead times were shorter. These are all the metrics that every provider cares about. It’s important to reiterate that there is a lot of pressure to do what’s best for the patient, with what’s right there in front of you. So we think that the goal of the whole cancer center is to provide quality care for all patients who need it. And again, if you’re already on iQueue, please re-talk to your product manager to discuss getting the right metrics in front of your providers, or getting a reference call with another center who has already implemented one of these guidelines. 

JOSEPHINE HEDERHOTH: We have one more question. We have to book very far out because nothing is available any earlier, what can we do about this? 

INA HUANG: So this is definitely a little bit tricky, and often it’s a positive feedback loop, because nothing is available until far out, you don’t book until far out and the clog time count how the problem driving appointment way into the future. We think that, when you have this problem it’s worth looking at the root cause of why there is no availability on the schedule. Of course, clog times are usually, likely part of it, but it could also be the way that your schedule’s backed up. If scheduling is not optimal, you may not be utilizing your infusion resources in the most efficient way. Is this because patients are requesting the middle of the day only? This is a question that you might want to ask yourself. If you’re already on iQueue tablets which are designed to accommodate your higher volume days, you should be able to have enough availability to schedule appointments. However, you might not have enough openings at your preferred times, usually 10 to 12 PM. 

Our general recommendation is that you should try to level out your appointments to other day and also across the week. Instead of squeezing everyone in at your peak hours, you should try to fill patients to late afternoon, or early morning whenever is possible. As mentioned in the last recommendation, if you know that you will have some urgent add-ons who have clinic visits on the same day, you would want to protect some [INAUDIBLE] slots for those appointments. 

JOSEPHINE HEDEROTH: OK, so it looks like that was the last question. And as a reminder, the recording of this webinar will be emailed to you within 24 hours. So thank you so much, Ina for today’s webinar, and thank you everyone for joining us today. Have a great day.

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