JOSEFINE HEDEROTH:. Hello, everyone. I’m Josephine. Hederoth, and I’d like to welcome you to today’s webinar, “Infusion Center. Operational Agility – Adapting to the new normal” presented by Bobby Jean Curkovic, clinical nurse manager at the Duke Cancer Center Raleigh, and Obehi Ukpebor, senior product manager for iQueue for Infusion Centers.
OBEHI UKPEBOR:. Thanks, Josephine. All right. Hi, everyone. Thanks again for joining. I just wanted to quickly share a few more highlights about our speaker for today, Bobbie Jean. So she currently oversees the clinical operations and fiscal responsibility for over 60 direct reports across 10 different specialty clinics. And she spent quite a bit of time working on process improvement initiatives around nursing workflows and reducing delays in patient care. She recently led the relocation of Duke Raleigh’s Infusion services to two regional sites in less than one week in light of. COVID preparations and just kindly agreed to share that bit of her story with us here today.
Thanks again for joining us, Bobbie Jean. Let’s get started. So throughout the rest of the presentation you’re going to be hearing from both Bobbie Jean and myself. Bobbie Jean will start out by giving us a brief overview of the. Duke Cancer Institute as well as the Duke. Raleigh Cancer Center. She’s also kindly agreed to give us a little bit of a historical background on some of their challenges leading up to COVID and some recent initiatives that they had taken before finally jumping right in to the myth of the impact of COVID on some of the actions that were taken to alleviate the effect.
I’ll then step in to talk a little bit about the iQueue process that happened during that one week period, including how we built some modular templates, and then finally pass it back on to Bobbi Jean to wrap things up and share how they’re preparing for any future disruptions. But before we jump right in, I just want to give you guys a heads up that we do have three polls that are set up, spread out throughout the presentation, just to keep it a little bit more interactive, get a feel for what everyone else is doing at their various centers. We do encourage your participation. We understand that some of you may have different roles and not know the exact answers to the questions but just give it your best guess.
On that note, I’m going to try and pull up the first question here. Let’s hope this works. There we go. All right. How prepared is your Infusion center for another pandemic or major disruption? Not prepared, moderately prepared, very well prepared? So we just give it about maybe 30 more seconds or get at least 80% of people participating, and then I will share the results. Looks like we have about 60% of votes so far. Let’s give it a couple more seconds here. There you have it. I’m just going to end the poll here and share the results. As you can see, 60% of you said moderately prepared, some of you very well prepared. Thankfully, no one is not prepared at all. And hopefully, by the end of this presentation, some of you will move into their very well prepared category. So on that note, Bobbie Jean, do you want to take it from here?
BOBBIE JEAN CURKOVIC: Yes. Thank you, Obehi, and thank you to everyone who has joined us today. I’m thankful to be given this opportunity to share with you some of our experiences that’s helped us become more agile operationally, adapt to our new norm, and prepare for the future. I’d first like to provide you with a brief overview of the Duke Cancer Institute. We have over 200 Infusion chairs across six main locations. Three of those locations are located in Durham County and three are located in Wake County. The ones in Wake County is the. Duke Cancer Center Raleigh, the Duke Women’s Cancer Center. Raleigh, and the Duke Cancer Center Cary. I oversee the clinical operations for the Duke Cancer Center in Raleigh located on the campus of the Duke Raleigh Hospital.
At the Duke Cancer. Center Raleigh, we provide many services to our patients and our community. We have radiation oncology, Infusion services where we provide oncologic and non-oncologic treatments to patients in Duke providers and non-Duke providers. We also have a symptom management clinic that provides symptom management care to patients on weekends and holidays, several medical oncology clinics, including hematology, benign hematology, palliative care, and also several multidisciplinary surgical oncology clinics ranging from thoracic, gastric, endocrine, head and neck, colorectal, genitourinary specialties.
Prior to working with LeanTaaS, our Infusion services at the Duke Cancer. Center Raleigh faced many challenges that resulted in delays in care due to chair unavailability and nurses being burned out. Some of those challenges consisted of having two. Infusion templates– so we would have one. Infusion template for POD A and one Infusion template for POD B– and these templates were specific to provider and nurses. In addition, the patients were being scheduled in the wrong chair links, and we didn’t have the appropriate amount of chair links to meet our demand. So we partnered with LeanTaaS in early 2019 to help us streamline our Infusion scheduling and operations.
Some of our initiatives were to first start with a provider volume analysis which helped us identify the appropriate number of chair links we needed to meet our demand. This in turn resulted in utilizing only one Infusion scheduling template rather than two that was not specific to providers or nurses. In addition, we collaborated with our physicians to list in their after visit summary exactly what was to happen from point A to point B. This then allowed the patient scheduling assistants to utilize our Infusion medication scheduling guide to schedule the patients in the correct chair links. We also uncovered opportunities to continue to fine-tune our Infusion operations while also starting to become more agile and flexible as a team.
One of our most recent initiatives that we started to pilot in mid-February of this year was a fast track, a mid track and long track patient assignments. What this means is we would look at our patient volumes by visit type and assign them to one of these tracks. So for example, fast track, we had an average volume and still do about 16 to 25 patients that meet this category. These are our one-hour or less transfusions, and we utilize a team nursing approach with this patient assignment. We also have a mid track patient assignment, which is very similar to the fast track except the visit types, around two to three-hour transfusions. And then we have the long track patient assignments, and those are patients that are receiving three hours or more transfusions, and we assign those two nurses individually.
As we are able to turn these patients over faster by deploying this fast track, mid track, long track patient assignment, we know that the rule of thumb is to pull resources as much as possible for operational efficiency. We also needed to be agile with our nurses by moving some areas to a team-based nursing approach for those fast track and mid track patients in order to turn them around quicker. First, we had to run our volume to see if we could deploy this initiative, and we were able to do that.
OBEHI UKPEBOR: All right. Before we actually move on to the next slide here, I just wanted to throw out another question out to viewers. Because we know these patient assignments are done differently at just various Infusion centers, I want to see– just get a feel for what everyone else is doing on their end. So we’re going to throw out another poll right now just to see how you all are doing your nursing assignments. Are you assigning on the fly? Are you pre-assigning to each specific nurse? Or are you doing a team-based nursing? A lot. It’s almost a tie. All right. I’m going to end the poll now and let’s share the results. OK. You guys have spoken. So majority of you do some type of pre-assignment to each individual nurse, and then some of you assign to a team of nurses. But it’s pretty tie between assigning on the fly versus pre-assigning to each nurse.
BOBBIE JEAN CURKOVIC:. So shortly after we piloted this initiative,. COVID-19 hit, and that was around mid-March. Our volume started to decrease by about 11%, and it was primarily due to patients canceling their Infusion appointments. Our senior leaders were proactive with a potential for a surge of. COVID-19 patients, and they tasked us with the potential to relocate all Infusion and medical oncology services from our cancer center to the Duke Women’s Cancer. Center and Duke Cancer Center Cary– these are two off-site locations.
The purpose for this is because our cancer center’s close to the ED entrance, so it made sense to look at this area to be prepared for a potential surge. So the first thing we did was we had to analyze which providers can go to what site, and then we had to see if this was even possible from an Infusion scheduling standpoint. In addition to this, we also implemented systemwide COVID-19 initiatives, such as the thermal screenings and deploying the face masks for all patients and visitors. I really like this picture because this is how I felt when I called.
Obehi, who is actually on vacation in. Santa Barbara, and I didn’t realize that there was a time difference because I was not thinking about that. But realizing we are on a time difference and it was very early in the morning that he answered anyways, and that’s when I feel magic started to happen.
OBEHI UKPEBOR: All right. So we get the call from Bobbie Jean. The first set of questions we had were around how many chairs are in these sites, how many nurses, what are the volumes there, what is the current setup at each of these sites. And, of course, there had to be challenges because things were quite different at those sites. The Women’s Cancer Center, which is about a 15-minute drive west of the Raleigh cancer center, only had 24 chairs while the. Cary cancer center, which is about a 30-minute drive, slightly more southwest, had only 12 chairs. So right away we knew volumes had to be switched from the 31 chair infusions that are in Raleigh to these two sites.
Luckily, two providers already had seven clinic days at the Cary site down there. So these were easy targets, and they had significant amount of volumes to drop the number of chairs needed for the remaining patients at Raleigh to fit into the Women’s Cancer Center, even with the already existing volumes at the Women’s Cancer Center. The templates, on the other hand, were very quite different across these sites. Raleigh, on one site, we had already implemented the optimized iQueue templates with very clear instructions on where treatments depending on their expected durations can be scheduled, with a very high likelihood that a chair and a nurse will be available at that time.
So for example, if we look at 8:00 AM on the right here, there’s a bladder two-hour available, there’s a one-hour available, a three-hour available, and a treatment plan for four to five-hour appointment. For these guys, on the other side, they had an open template where they would schedule every 15 minutes. There is no clear way of schedulers to know if the center had been scheduled to run out of chairs or if there was even going to be a nurse available. So now here comes the fun part. Not only did the cancer center had their challenges, but we here at LeanTaaS also had our own set of challenges. And we had to figure out, OK, how do we go from this 12-week iQueue implementation process to this in one week?
A typical iQueue deployment involves getting all the right stakeholders together for a kick-off call, collect then all the relevant operational parameters– so number of chairs, number of nurses, hours of operations, any other center-specific constraints that need to be met– and then we, of course, need to go through a rather lengthy data collection process depending on how responsive and agile an IT team is. Once we get all that data and operational parameters, we then feed these in as input to the optimization algorithm to generate level-loaded templates. And then we engage with your EHR build team to set up the right resources and build out the new schedules in your EHR.
What stood out for this particular COVID deployment at the Raleigh cancer center was the speed and agility which everyone involved performed, starting with Bobbie Jean. Bobbie jean did a very quick and dirty data collection for us– pretty much looking through the schedules and– so they use. Epic as well as some internal systemwide daily report that get emailed out. Then there was Jill, the chair cadence expert who not only configured and set up the right resources in one day for us but she also got on a 10:00 PM call with us to hash out a few details. Then 10:00 PM Eastern time, so 7:00 PM West coast time.
Then there was Gloria, the scheduling lead who came in with three members from our team on a Saturday morning for a scheduling conversion party, which lasted pretty much the entire morning. I think they ended up leaving at 2:00 PM. But pretty much, they moved over 1,000 patients from Raleigh, which is closing down into Macon Pond and Cary, and made sure that each of these new patients had the right expected durations. They converted the existing patients on Macon Pond and Cary schedules to make sure that they were setup correctly to work with the new iQueue templates. And that’s because we need to make sure we have the right expected duration to track the chair utilization to know when we’re scheduled to just have a very bad day.
So even the Duke data team was phenomenal during this time. Historically, it’s typically taking a few weeks to turn data requests around, given their typical workload and processes in place. However, they were able to turn around the live data feed for the new locations just right at the end of the one week timeline, which is pretty impressive. And now here’s where the templates come in– building in modular templates. As of day one when Bobbie. Jean made that call, it was only confirmed that 27 chairs would be available at the Macon Pond location. So we had to first figure out a way of shrinking that 31 chair Infusion template at Raleigh into 27 chairs.
We built this out as our new base solution by shaving off some appointments and then optimize it around that to fill up the gaps while taking into consideration the volume and mix of treatments already at Macon pond site, again, from the data that. Bobbie Jean had collected. Fast forward two days later, we find out that Bobbie Jean was able to work out some magic and get approval for nine more chairs by pretty much converting a conference room and Infusion waiting room area into Infusion spaces. So with the addition of these new chairs, we were then able to easily scale up the 27-chair version of the templates to 36 chairs within minutes in iQueue. We thought that was about all the changes that would happen during this one week.
But a few days after operating on the new schedule, the team finds out that the mid track area was just getting too packed, and it wasn’t too safe for operations anymore with COVID and the six-week social distancing requirement. So we needed to drop down by two chairs, and we quickly deployed a 34-chair version of the template on the same day just by removing some slots. So with this new model, the team had three versions of templates with different volumes and different chair counts that could be easily turned on or off or scaled up or down and deployed at any time by adding or removing slots. And the scheduling needs as well, they could quickly go to iQueue and view the templates and see which slots needed to be removed or added, as depicted by the red and green slots on the bottom right of your screen.
So that’s pretty much for each duration. So each vertical here, that’s a one-hour, two-hour, three-hour, or four to five, six blocks, and that’s just saying which of these blocks should you take away, which should you add? Now you might be wondering, what if I don’t have a team this agile to make quick changes to the templates on my end? Well, for one, iQueue is already exploring options working with your internal teams to automate the build for some of the EHRs. And two, we actually already do have some future planning tools built within iQueue to help proactively groom the schedule and fix problems early on before patients start to arrive on the day of treatment so long as the data is already flowing into iQueue and all the templates are in there already and they could be deployed with just a few clicks. All right.
So on the left here, so this is now how you can use iQueue. Just quickly deploy templates, use iQueue to groom your schedule. On the left is the iQueue appointment book-in table, which schedule has been used to, one, see the best times to book patients based on the current state of the schedule. Two, see when nurses have already been double or triple-booked, e.g. from 9:00 AM, so the second column, this orange one, is comparing the hourly starts that have been scheduled versus what the template recommends. So we can see when nurses have been double or triple-booked from 9:00 AM to 12:00 PM here.
And three, they can also see when the center is expected to run out of chairs. In this case, those are the red slots or cells here from about 11:45 to 12:45. To the right is the iQueue huddle calendar which gives a quick glance of what the schedule is expected to look like over multiple days across different locations with respect to how the chairs are expected to be utilized throughout the day. The top row of the schedule here is the closed down Raleigh cancer center, which is why it looks empty. It’s just the green template lines that are showing up there right now.
The middle section, that’s. Macon Pond, and Cary is at the bottom. And for this particular example, we can see that on Friday at. Cary, the schedule is already overbooked from 10:00 AM up until about 12:30 PM. And at the same time, you can see that on the shoulders of the day, so in the early morning and later afternoon, there is still some opportunity to move patients to those hours. And if we just look up, at Macon Pond, we can see in the middle of the day there is room. So that’s opportunity for schedulers to say, hey, can we move some of these patients to the shoulders of the day or move them to a different location? All right. And now it’s time to bring Bobbie Jean back in to talk more about some other changes that the Raleigh team had to implement.
But really quickly, let’s just do one last pulse check here to see how everyone’s doing. This is going to be our last question, I promise, and then at the end, we can open it up for people to ask questions. Let me pull up this poll here. And this is also going to be a good segue to Bobby Jean’s next point. And again, the emphasis here is still keeping the same team around nursing assignments. All right. So some of you spoke earlier– more the polls spoke earlier– 40% of you say you do pre-assignments. How long does it take you to pre-assign your patients to nurses?
Let’s share results. All right. So it looks like there’s a tie between less than 30 minutes, one or two-hour. Majority of you with respect to the scale here, you assign on the fly. But there’s a handful of you that it takes two to three hours to do their allocation, which is good. So, Bobbie Jean, do you want to take it from here and let’s talk about that process at Raleigh?
BOBBIE JEAN CURKOVIC: So when we moved to Macon Pond, we were in the beginning phase of piloting our fast track, mid track, long track initiative. And in order for us to ensure that we weren’t running out of chairs and there wasn’t too many patients assigned to nurses, we needed to create a nurse assignment sheet in Excel that helped us see a visual of the patient allocation. And so we found that this was a lot like playing Tetris, and it took a good four to five hours of focused concentration, because we would go ahead and put the one-hours in the fast track, the two-hours in the mid track, and then the three plus hours in the long track. But often we’d find we might have to move a couple of patients around to make sure that we weren’t running out of chairs.
So we shared this Excel sheet with LeanTaaS, and they helped us revise the nurse allocation tool. And that helped us cut our time down to just one hour. And so you can see on the right there that basically it took what we were doing in Excel and converted it and did the work for us. So you can see the short track, medium track, and long track patient assignments. The only reason right now it takes one hour is because we, from a clinical standpoint, find it helpful to know the patient’s name and what they’re getting. And so right now we are working with Duke IT to be able to pull in that patient health information.
But until then, it will allocate the patients by CSN number, and then we pull the PHI information into our tracking tool. So in mid-May we moved back to the Duke Cancer Center Raleigh. Our volumes are back to pre-COVID. Some of the things that we’re keeping specifically, we are still going strong with our fast track, mid track, and long track patient assignments. This has really helped us ensure that our lobby is decompressed to maintain our social distancing measures. We also took our fast track and mid track and assigned to those two. POD B, and our long track is assigned to POD A.
Some additional things that we did moving back was that we started pre-screening patients 24 hours in advance, but we also really needed to focus on how we can decompress our lobbies. And so what we did is we converted an exam room on our third floor into a port clinic, and we also converted an intake bay on that same third floor to a phlebotomy station. And the reason for this is because we have several high volume providers on the third floor, and this allowed us to pull those patients to the third floor and first floor for their phlebotomy or lab services prior to seeing the doctor.
In addition, we also pulled a high volume provider from our first floor up to our third floor and pulled a low volume clinic from the third floor down to the first floor. All of these initiatives have really helped us decompress our lobby. There’s only been a handful of times where I’ve had to send out a message saying that we’re starting to get a little full, and within minutes, we’re able to decompress. The other thing that we are focusing on here is less is best because we might have to relocate tomorrow. We just don’t know. So we know that if there’s a potential for any other pandemic, we’re going to be ready.
The first thing we’re going to do is activate our task force. So this task force consists of several relevant departments to help us deploy a relocation, and then we’ll reactivate our combined template. Then we will do our provider volume analysis with LeanTaaS to ensure that we have the appropriate chair links to chair, meet our demand all while maintaining that fast track, mid track, long track patient assignment. Some of the lessons we learned in this journey are to think outside of the box, to take a bird’s eye view of what space you have, and get creative. We took a conference room and created the mid track there. We took an Infusion waiting room and created a fast track clinic there, and then utilized their current Infusion area for our long track. And also, when we started talking about deploying or relocating off-site, we thought we might have to extend our hours to the evening, such as 8:00, 9:00 PM, but we didn’t have to do that. And the other thing is to utilize telehealth to its fullest potential because that drastically helped us decompress our cancer centers. Thank you everyone.
OBEHI UKPEBOR: All right. So thanks, Bobbie Jean. That brings us to the end of this webinar. Thanks for sharing your story with the larger iQueue learning network community of. Infusion center leaders across the nation, Bobbie Jean. Thank you. We hope you all benefited from this webinar and are in a slightly better position and feel more prepared for future potential disruptions if they happen.
Well, we’re going to open it up for some questions, but for those of you who have to hop up now and maybe wondering what next, you will get an email from us by tomorrow with the link to the recording, the slide deck, and an executive summary of this webinar. Also, feel free to reach out to us at email@example.com if you have additional questions and if you like a deep dive into iQueue. So it seems like we have a couple of questions here so far, and, Bobbie. Jean, maybe some of these, you might be able to answer. Do you do chemo on the weekend?
BOBBIE JEAN CURKOVIC:. So that is what we call our symptom management clinic, and we run that. It’s basically an extension of our Infusion hours, but we are open on the weekends and holidays. There’s only two days out of the year that we’re closed– that’s Thanksgiving. Day and Christmas Day– and it’s purely symptom management. We do not provide chemotherapy, but the intention of that is because previously we would be closed on, say, if you take. Thanksgiving weekend, we would be closed Thursday,. Friday, Saturday, Sunday.
So if any of our oncology patients needed some kind of symptom management care, they would end up in the emergency room, which is the last place we want them to be. And so now we’re here, we’re available. Right now our hours are 8:00 to 1:00, but we will be extending till 4:30 once our volume continues to pick up. So right now it’s just symptom management care, and that can include anything from blood to IV fluids to blood cultures, antibiotics, anti-medics, et cetera.
OBEHI UKPEBOR:. Thanks, Bobbie Jean. Next question here is on a– it’s a combination of questions. What are you considering fast track and what is mid track?
BOBBIE JEAN CURKOVIC: So fast track are all of our patients that are receiving one-hour or less Infusions. So it could be a simple injection, it could be IV fluids, but anything that’s typically one hour or less. Our mid track is anything that’s around two hours. So we always start with one-our, two-hour patients in this section of assignments. And then If the volume is low, we’ll expand it to our three hours, but we monitor it to make sure we don’t run out of chairs.
OBEHI UKPEBOR: Yeah. And just to add to that, when we did the volume analysis, what we saw was they had the volumes to be able to quickly turn around those chairs. So when you dedicate that chair, you know that you’re going to be fully utilizing it throughout the day, and It’s not affecting your other treatments both for the fast track and the mid track. And even for cases where you might not have been scheduled to fully utilize those chairs, on that iQueue allocation tool, it’s able to slot in appointments and fill in the gaps for you, which was that manual process that. Bobbie Jean and her team had to do with the. Excel not knowing when to fill up those gaps. It’s like 100% fit in a Tetris puzzle.
BOBBIE JEAN CURKOVIC: Yes.
OBEHI UKPEBOR: All right. So next question here is, would Bobbie jean be willing to share her contact information?
BOBBIE JEAN. CURKOVIC: Absolutely. Is this– do I share it here now or–
OBEHI UKPEBOR: I can type it here. So that’s bobbie dot jean dot curkovic?
BOBBIE JEAN CURKOVIC: No. It’s bobbiejean, all one word, dot curkovic.
OBEHI UKPEBOR: bobbiejean, all one word. Here, bobbiejean dot– I should know this by now.
BOBBIE JEAN CURKOVIC: Yeah. [CHUCKLES]
OBEHI UKPEBOR: All right. There we go. All right. What is your typical nurse to patient ratio?
BOBBIE JEAN CURKOVIC: So in the long track area, it’s typically around six to eight. In the fast track and mid track areas, that’s the team nursing. So typically, we have two nurses for anywhere from 16 to 18 patients, and we’ll add in a half nurse if needed, if the volume’s over 18. And then for the mid track, we assign two nurses as well, and then sometimes utilize that other half nurse. So typically on that. POD, we’ll schedule five nurses run both clinics.
OBEHI UKPEBOR: No comment. Now, just a follow up question to that, and this is, I guess, from me, because I know people refer to nursing ratio or nurse to patient ratio differently. Some is over their entire shift and some is at one point in time or at one particular point in time. So at one particular point in time, how many chairs, for example, is one nurse responsible for?
BOBBIE JEAN CURKOVIC: Four.
OBEHI UKPEBOR: Four. OK. So a max of four at one point in time, but over the entire period of their hour, their shift, in the long track, it could be six to eight.
BOBBIE JEAN CURKOVIC: Correct.
OBEHI UKPEBOR: OK. All right. Here’s another question. What is the meaning of the team nursing for the fast and mid track patients?
BOBBIE JEAN CURKOVIC:. So what that means is when we assign patients– when we’re looking at our schedule in Epic, when we assign patients in the appointment note, we say fast track or we say mid track– depends on what chair link they’re getting. And the nurses that are assigned to the fast track patients, they know that as soon as the patient’s available, they pull that patient. It’s not assigned to one particular nurse, but it’s assigned to those nurses that are working in that– managing those fast track patients. And that’s the same team nurse-in approach that we use for mid track as well.
OBEHI UKPEBOR: Are you OCM? I believe– is that right? Are you able to provide social distancing in your Infusion suite?
BOBBIE JEAN CURKOVIC:. Yes, we are. The reason we’re able to is we have removed all of our visitor chairs and we do not allow any visitors in the Infusion suite at this time. But all of the chairs are six foot– six feet apart.
OBEHI UKPEBOR: No comment. Perfect. And I think I just found the answer to this question. Are you OCM? And that’s yes. She’s MSN, RN, OCM.
BOBBIE JEAN CURKOVIC: Oh, yes.
OBEHI UKPEBOR: OK. Perfect. Yes. Are you doing any curbside injections or screenings outside the building?
BOBBIE JEAN CURKOVIC:. No, not at this time.
OBEHI UKPEBOR: Do you have problems with long infusions, finding a space? When I run the allocation , it pushes my long infusions to the bottom, and they really need a chair.
BOBBIE JEAN CURKOVIC: So I feel like that this is actually what prompted us to move towards this different patient assignment with fast track, mid track, long track because we would have a very similar situation where our nurses would have– all of our chairs would be full, and they would be with a long infusion. And then along come would be a patient that had a two-hour infusion or even a quick five-minute injection, and they had to wait. And when I learned that this was happening, that’s when my heart broke, and I decided we have to do something different. And that is what resulted in us piloting this different type of patient assignment.
OBEHI UKPEBOR: And. Melanie Rogers, so you’re running an allocation so you’re probably an iQueue customer as well. That’s our guess. What we’ll do is we’ll just get your contact information and follow up with you later on just to learn a bit more about your specific case. OK. Also, just got a clarification,. Bobbie Jean, on the OCM. I think it was an OCM, oncology care model. Is that something you guys have?
BOBBIE JEAN CURKOVIC: I’m not familiar with that, but they can email me and we can explore more. We might call it something different. I’m not sure.
OBEHI UKPEBOR: OK. Perfect. So, sorry I may have missed when you said you had 200 chairs. How many locations are the chairs in? So 200-plus chairs that is across the Duke Cancer Institute. Duke Raleigh cancer center only has 31 chairs spread across two PODS. So POD A has 17 and POD B has 14. So that 200 chairs that is across six different locations across the Duke. Cancer Institute. All right. About 50% of our patients see the providers prior to their treatments which, if behind schedule, causes delays getting to chairs. So you have this issue and how do you handle on this type of schedule?
BOBBIE JEAN CURKOVIC:. Yes, absolutely. We have this issue, and, again, this is another reason that prompted the way we assign patients for fast track, mid track, and long track. And this is the variable that we cannot solve because patients will come in and see the doctor. They may be presenting with symptoms that require a dose to be reduced for their chemotherapy. They may need symptom management care on top of their chemotherapy. So there’s lots of things that can happen from the point when they get their labs done and to when they see that doctor. And other variables too could be– the patient could be running behind as well. So there’s lots of variables, and this fast track, mid track, and long track patient assignment has helped us combat these variables and still move these patients through.
OBEHI UKPEBOR: And also, just to add to that, this is also a problem that we see across many of the centers we work with, and we align provider and clinic schedules better. That’s at the core. So sometimes we’d evaluate it– so it’s how well is the infusion and clinic schedule aligned. When your schedulers did a book each individual appointment blindly of the other, are you able to get schedulers to look at both schedules and lock down both appointments at the same time? Certain providers tend to run longer or run later than certain providers. Are schedulers aware of who those providers are, and are they using a different scheduling guide for those providers?
So it’s pretty much how can we just be smarter about coordinating the two. It’s like if you have connecting flights, you’re not going to give yourself only 30 minutes to connect. You’re going to miss a flight, right? So it’s how are we better planning for those delays in clinic as well and making sure that both schedules are aligned. Do you use the allocation or assign on the fly? So they use the allocation right now, and then assign on the fly to the team of– to the nurses within the team. Right, Bobbie Jean?
OBEHI UKPEBOR: So allocate to a team and then when the patients come, then they’re assigned a nurse within that team.
BOBBIE JEAN CURKOVIC: Correct. But the other thing too is there are a lot of add-ons throughout the day, and so that nurse allocation tools allows us to see where we might have some spacing in between the patients being scheduled and when they actually arrive so that way we’re able to see who can take that patient at that time.
OBEHI UKPEBOR: Oh, yeah. Oncology care model alignment. So yeah, if you can send an email, I think we can follow up on that, Carlene. I’m interested to see that oncology care model. OK. Next question here– actually, we have about five to 10 more minutes– payment model with Medicare. OK. So more clarification on that question, do you guys participate in oncology care model, payment model with Medicare? I think that’s probably something we want to follow up on. Right, Bobbie Jean?
BOBBIE JEAN CURKOVIC:. Yeah, we’ll do that.
OBEHI UKPEBOR: How many pharmacists do you have for the Infusion center per day?
BOBBIE JEAN CURKOVIC: So we have one pharmacist in the cancer center, but our chemotherapy is actually mixed in an oncology pharmacy in the hospital, and it’s couriered over to us.
OBEHI UKPEBOR: Do you have patients who have their transfusions held same day that may not meet parameters when their labs are drawn the same day? If so, how does this work with the pre-assign nurses?
BOBBIE JEAN CURKOVIC: Yeah, that definitely happens and it’s just hit or miss depending on what their labs come back as. And if so, then on our assignment sheet, we would note that that nurse had a cancellation, so then if we have an add-on, we would simply interject that add-on into her assignment.
OBEHI UKPEBOR:. Now, just not sure what the clarification or the question is, but is LeanTaaS building something special for that? So we have the iQueue allocation tool that’s on there already. It’s available to every iQueue allocation customer or every user. So I’m not quite sure. Maybe we can clarify that question. How does your pharmacy coordinate with the treatment areas? Can they see iQueue templates? And do you have a dedicated pharmacy?
BOBBIE JEAN CURKOVIC: Yes. So no, our pharmacists cannot see the iQueue templates, but they can see the schedule. And so when we release the OK to treat, them that’s the cue that goes into a pharmacy queue to let them know we’re ready for the next step. And we do not have a dedicated pharmacy for the Infusion room. We do have a dedicated area in the pharmacy in the main hospital that does mix our chemotherapy, and it’s couriered over to us.
OBEHI UKPEBOR: And just to follow up on that question, can pharmacy see the iQueue templates, yes. It’s easy. We just have to give them access. And typically, we do pool pharmacy to review templates for some centers. And we do that for a number of reasons, but the primary reason is we want pharmacy to look at the template and say, hey, are you guys starting treatments too early? Are you putting that slot at 8:00 AM when I know my fluids are not going to be up and ready by 8:30? Are you giving us 10 starts in the 9:00 AM hour when I only have one person mixing drugs and there’s no way I’m going to be able to give you 10 drugs in that hour?
So yes, pharmacies are able to do the templates, and we try and engage them as much as possible. And in cases where a pharmacy doesn’t get a chance to see the templates early on, we do follow up in subsequent meetings and revise the templates. The templates are not always set in stone. There’s something we always revise to make sure they meet you demands because things change. Do you have– we answered that already. How is new patient education performed at your facility?
BOBBIE JEAN CURKOVIC:. That’s something that if– they can email me directly, and I’ll be happy to answer as well.
OBEHI UKPEBOR: OK. Perfect. OK. So we’ll just take a couple more questions here. RN assessment test charting– could you share your. RN assessment test charting that is done for each patient? So yeah, if we follow up with– yeah, go ahead.
BOBBIE JEAN CURKOVIC: Yeah. If they want to email me, I’ll be happy to share what we do.
OBEHI UKPEBOR: Do you encourage pre-chemo labs before scheduling patients? And what about insurance authorizations before scheduling this way?
BOBBIE JEAN CURKOVIC: So we definitely encourage it, but it does not happen frequently. It’s something that we would like to happen more frequently, but it doesn’t. Primarily due to transportation issues that some of our patients have, so they’re not able to come. And plus, a lot of people travel from all over to come here, so they’re not always in the area to be able to do that.
OBEHI UKPEBOR: Perfect. All right. So there are many, many more questions. We’re just going to take two more. I’m just going to pick two more from the list so we can give everyone five minutes back. Our nurses like to look up their patients, so they’re resistant to assign on the fly. Did you have a large nursing practice change when you adopted iQueue?
BOBBIE JEAN CURKOVIC:. Not necessarily when we adopted iQueue, but we did have a culture change when we moved to one template instead of assigning nurses to one POD. It took a lot to get them to be able to work on either POD and also care for all patients because prior to that, they were siloed and were used to working on a particular POD with a particular type of patients and particular doctors. But our volumes were uneven, we weren’t able to do that. When we stopped pre-assigning patients, that created a lot of anxiety. And so now, we do pre-assign for the long track infusions, but all the fast track and mid track infusions, they are not pre-assigned.
OBEHI UKPEBOR: All right. So thank you all. I see you guys have been great participating on the chat, like Q&A. I see some people have been answering questions for people. This is great. This is awesome. We here at LeanTaaS hope we can do more of these and just make sure there’s a platform for you guys to communicate your ideas and just pick up on each other’s brains.
So we’re going to end here. Thank you all for joining. Again, Bobbie Jean, thank you. Thank you, thank you very much for doing this. And we hope you guys stay well, stay safe, and just email us if you have any more questions. Again, it’s firstname.lastname@example.org, and then we’ll be sending over a summary of everything to you guys by to tomorrow, OK? All right. Thank you, everyone.
BOBBIE JEAN CURKOVIC:. Thanks, everyone. Have a good day.