Webinar Transcript: How Nebraska Medicine grew infusion center volumes while keeping wait times under 10 minutes

At our winter 2021 Transform event, Becky Duchman, Director of Infusion and Treatment Services at Nebraska Medicine’s Buffett Cancer Center, discussed how her team partnered with iQueue to manage infusion center volumes, successfully growing them while keeping wait times short. Visit the Transform Infusion track page to hear the full talk. You can also read a blog summary here. 

Moderator: Becky is currently the director of infusion and treatment services at Buffett Cancer Center, Nebraska Medicine. Becky, thank you so much for joining us today. I will now turn the floor over to you to begin today’s presentation.

Becky Duchman is currently the Director of Infusion and Treatment Services at Buffett Cancer Center/Nebraska Medicine. Her background includes cardiovascular nursing and most recently, nursing leadership both in community and academic hospitals. Throughout Becky’s leadership career, she has had the opportunity to leverage predictive analytics staffing software to enhance operational workflows within both acute care and procedural settings.

Duchman: Thanks. Hi, I’m Becky Duchman and I’m excited to be here today with you guys to help everyone see how we were able to decrease our wait times to under ten minutes in our infusion centers at Nebraska Medicine. 

I’m the Director of Infusion Services for Nebraska Medicine and specifically for our Buffett Cancer Center. This next slide provides a little bit of background. I am a nurse by trade, specifically in cardiovascular ICU nursing. Most recently, though, my passion is nursing leadership. I’ve had experience in leadership for both inpatient and outpatient with the infusion centers that I’ve managed today. With that, I’ve also had the opportunity to leverage predictive analytical software, both in the inpatient setting and now again in the outpatient setting, with our partnership with LeanTaaS and the iQueue software we use.

A little bit about our agenda: our partnership with LeanTaaS over the last four years, some challenges that we’ve had before we partnered with iQueue and started really using their software in all of our infusion centers and the results that we’ve had as we’ve grown and can really use the software in a more robust fashion. We’ll also discuss a little bit about our tech preview partnership and the program that I’ve been able to take advantage of with LeanTaaS, and then some best practices to help your infusion centers as you decide what you want to do going forward as far as software analytics go. Then I’ll go over the next steps for each of our infusion centers, along with ours. 

This slide just gives you a little bit of an overview of the Fred and Pamela Buffett Cancer Center. We opened about four and a half years ago, July 2017. You can see here the clinical aspects of the building, along with the patient services that we offer. One thing I love to highlight on the slide is our Resource and Wellness Centers towards the bottom. This has been actually a really cool feature of this cancer center, especially as it comes to wigs. Believe it or not, we actually have people reach out to us from all over the country to either donate or ask if they can have a wig from our wig banks. We actually just had a patient from Massachusetts, a daughter of a mother that had just passed, who wanted to provide her mother’s wigs to our wig bank because she wanted to give back. I thought that was really cool, and really neat how we reach outside of the Omaha community for the rest of our cancer population, and the nation, really. 

Some fast facts for you. Since we opened, as you can see here, we’ve served over 15,000 patients at our Warner Cancer Hospital. The Warner hospital is our clinical aspect of the Buffett Cancer Center. And with that, too, we’ve seen over $185 million in grant funding since we opened the cancer center and have increased our patient enrollment by 140% in clinical trials. This is pretty phenomenal overall in just a small amount of time really. 

You can also see how many patients we’ve treated in our outpatient ambulatory clinics and how many physicians that we have either will be onboarding in the cancer center or have joined since we opened this particular site. 

Obehi Ukpebor (LeanTaaS): This is a quick overview of LeanTaaS and our iQueue platform. We have three core products that are commercially available in the market: iQueue for Operating Rooms, iQueue for Inpatient, and iQueue for Infusion Centers, which is our original flagship product that has been around the longest and powers almost 10,000 chairs right now across the country. That represents roughly over 15% of the infusion capacity in the United States being optimized by iQueue for Infusion. Across all three products, iQueue is being used at over 450 locations belonging to 120 health systems. The health systems we work with are well recognized, 13 of the top 20 in the US, and we’re also represented in 42 of the 50 states in the US, so only eight to go there.

Duchman: I’m bringing it back to Nebraska Medicine. Just wanted to show you guys some challenges we had before iQueue. I’m sure none of this is a surprise to anybody here. 

Again, not a surprise, but many of our nurses were missing lunch breaks on a regular basis due to the heavy load of patients that we saw in the middle of the day. We still have a peak patient volume, but it’s very much level-loaded, versus what it was in the past before we partnered with iQueue and optimized our templates with them. 

And to that point with templates, the great thing about iQueue is we can customize those templates anytime we want. Those really help us with add-ons and unlinked appointments, meaning appointments that aren’t tied directly to a clinic appointment. We’ve been able to customize and really grow our templates in a way that’s helped us match our business and the volume growth for our infusion centers, which has been huge as far as creating an efficient level loaded schedule for both our patients and our nurses. 

Again, our main goal, which is again not going to be a surprise to anyone here, was to increase patient access and also allow our schedulers to overbook our regular templates much less every single day that they have to actually put an add-on on there. And also increased accurate accuracy of scheduling, because we have software that allows us to see the bigger picture versus a micro scale, where we were very siloed and just seeing each hour of each day in each of our infusion centers, and of course increasing our capacity without increasing chairs or nurse FTEs, which we’ve been able to do.

For one example here, our Warner treatment center our infusion that is the main hub of all our infusion centers at our Buffett Cancer Center location, we were able to between October 2020 and October of this year successfully increase our patient volume, our scheduled patient volume specifically by 12%, and our completed patient volume by 8% without increasing our chair capacity and or our nurse FTE staff capacity. 

So as you can see, even with our increased scheduled patient volume growth, which was 8%, we were able to decrease our wait times by 20%, to an average of only seven minutes. With that said too, with our peak rush hour times, we were also able to manage the wait times at about nine minutes, which was still a decrease from patient volume increase. 

At one of our satellite locations, Village Pointe, we saw a similar effect. We didn’t grow our volumes on that same timeframe, but we maintained our volumes. But we were also able to decrease our wait time by 28% or down to eight minutes, which again, despite the fact that we didn’t maintain our volumes, we were still able to decrease our wait times using the software. Again during the peak times, it remained the same, which also is attributed to the software’s ability to help us manage those add-ons and overbook requests and also help our schedulers get to our patients in a timely fashion. 

So in this slide, I wanted to overview our partnership with LeanTaaS, and what we’ve been able to accomplish together in that experience. Together we’ve been able to get valuable feedback, I’ve been able to provide it and also get the feedback when I’m using their pilot programs and new products that they are allowing me to preview. That experience has been really great, too, through the customer advisory board, and they really do take into consideration what the board provides, and gives us an ability to look at what could potentially become of the software as it grows and develops for us in the future.

Then also through this partnership they’ve been able to better understand our own challenges. While we have a lot of the same experiences and challenges as a lot of other infusion centers, I’ve really appreciated the fact that there are some things unique to each of our infusion centers and LeanTaaS absolutely takes those unique experiences into play as well when they develop the software and get our feedback. 

Also through our partnership we’ve been able to establish some really great partnerships and alliances throughout the nation. Most recently I’ve reached out to our partner at MDAnderson and we’re now discussing flow pool infusion nurses, then seeing how each of our programs will work and sharing those experiences with each other. And then lastly, our product design sessions, we’re able to look at what could be coming up and what could be done better or if there’s even a need for those product designs and the way that they’re built as they show them to us.

To build the tech design sessions, with the tech preview partnership I’ve been able to provide input and feedback on the Executive Summary pilot that has been rolled out recently. My feedback on this has been very positive. With this Executive Summary I’ve been able to save a lot of time trying to generate reports from the annual data that I could pull out of iQueue before but had to pull from different areas of the program itself. And then also, I could with, the click of a button, now easily see trends, as far as volume growth, wait times, as an example of some of the metrics and be able to do this on the fly. Even just as recently as last week, my VP boss had wanted me to grab some information for her really quickly before she had headed off to a chief executive meeting and I was able to pull up this executive summary and get the information she needed within seconds. So I’ve really appreciated being a part of this tech preview process with them with the Executive Summary. 

Some best practices that I would suggest as far as implementing the software in an infusion center, first and foremost is changing our culture about how we’ve always done things. These templates that are built, are built to get patients through quickly, decrease wait times, as you can see from this presentation itself, and to really be patient focused. However, that does mean that some of our scheduling practices had to change. So really just helping those schedulers understand why this is actually better for the patient and then showing them the data thereafter, why it is better, because the patient can get through more quickly without a lot of wait time, and also nurses that are more readily available to help them too because our templates are more level loaded and much more efficient. 

Also, working with teams, it’s been a little bit of a challenge trying to help people use the data from iQueue to drive their decisions in their day to day shifts. So many times I hear, you know, “well, I know Mondays are always really crazy. So I’m not gonna put this long infusion on this date.” And then it’s always like, “okay, well, let’s take a look at Monday, you know, what are the add-ons? What are the cancellations? Let’s really use that data that we can pull out of iQueue to really drive that decision rather than make one  based off feelings.” 

Those templates again, allow for add-ons in an efficient way that do keep workloads more manageable. So instead of, again “I feel like Mondays can be really crazy busy and I’m not going to put that add-on on that date.” “Well, let’s take a look again at the data, knowing that these templates are built to help us accommodate those add-ons no matter what the date, because they’re so customizable.” 

And then also just being flexible. It’s just great having iQueue be flexible with us. As an example, most recently over the last year, another one of our satellite infusion centers has grown quite a bit as far as their volume. We also moved into a newer infusion center that allowed us a little bit more room. But then the nursing scheduling had to change so we were able to work with iQueue change those schedules and templates to better get more patients through without increased wat times as well. So I really appreciate how flexible iQueue is and how many times we can change templates to really customize what we need in each infusion center. 

So for some future state or next steps in our partnership with LeanTaaS. We do plan to add some fast track chairs to one of our satellite infusion centers, based off the data that they were able to provide us. That was so incredibly helpful when we went in front of the Business Committee to justify the pro forma. That, number one, was incredibly helpful and something I could have never done before iQueue. Also they will help us partner when we go to get patients scheduled into those chairs to create an efficient process and get patients through both those chairs and our legacy chairs that we have right now, which will accommodate longer infusions. 

Then again on the same lines, accommodating continued growth and expanding, especially as we expand our Fast Track chairs in this particular infusion center I just referenced. But that’s a very concrete example versus our other examples, where we still have volume growth in existing chair templates and able to increase our capacity to serve more patients. 

And then also, looking forward to partnering with LeanTaaS to better understand how we can schedule our nurses based off acuity metrics rather than just volume alone. Today we do not have an acuity system and we’re really looking forward to seeing how we can develop that with iQueue and the software that they provide to even create a more efficient scheduling experience for nurses and our patients.

Moderator: Thank you Becky and Obehi for this fantastic presentation. Now we’d love to take some questions at this time. If you have any questions for our presenters today, please chat them into the Q&A box now. 

Now let’s get started with our first question that has come in for Becky. Becky, how do you get buy-in from your staff on iQueue implementation?

Duchman: As I touched on before, it’s a lot of changing the culture of how you’ve always done things to how we can do it better. I think the number one piece that has really helped us change the culture on how we schedule patients, and that includes people within infusion and outside of infusion, and case managers that that can touch our templates, is really just showing them the data to help them better understand how even though this may not seem as patient-focused if you have to make them wait a few more minutes between a clinic and an infusion appointment, help them understand why it is. 

Again, those decreased wait times are the perfect data metric to share with those teams to help them understand. It may feel good for them to get patients scheduled for an infusion minutes after a clinic appointment. But what they don’t see on the back end is those patients are just waiting in our waiting room longer then. So that’s really been huge to help those teams understand that while it may not seem that way, because you haven’t done it that way before or  this is how we’ve always scheduled patients and it seems so patient friendly, here’s why it isn’t and here’s the data that shows why it is. So that’s really been a big part of it. And just reminding people that really just are resistant to change if that’s the right way to put it, helping them understand that this really is patient friendly and patient focused. We are putting patients first and again, driving it back to that data. 

Moderator: Thank you so much for the insight there, Becky. Now another question. you know how your centers have particularly short wait times, can you share best practices specifically around managing patient wait times?

Duchman: And I’d say the number one thing with that is just repetition and helping our schedulers really follow those templates. If they feel like there’s an issue with the template, for example, “gosh, I keep getting overbook requests for zero to 30 minute appointments”, and in fact this just happened at one of our infusion centers, just making leadership aware of it so we can talk with iQueue and say “hey, you know, we are really seeing a huge increase in our overbook requests for zero to 30 minutes.” Because that data is also captured in iQueue and you can really see where your overbook requests are in and schedule them out. And if you do see, definitely if the data is showing you see an increase in a particular type of overbook request, they will work with you without hesitation to change that template to accommodate more of those requests, increasing the efficiency of that template itself. So it really is about repetition and data, again, kind of bringing it back to that and reminding people about the patient focus piece of it.

Moderator: That’s great. Thanks so much for sharing, Becky. And another question that has just come in is how do you encourage leadership to make decisions based on data and not on gut feeling or anecdotal evidence?

Duchman: The hallmark of that, again, is about repetition. I know that seems very repetitive, ironically, but it really is. It has been really successful to just gently remind those that are the end users of those templates themselves to just, you know, “hey, what does that data show you? If you really know or think or feel that certain days are a certain way, let’s just take a look and see what the historical trends have been.” I mean, we’ve been on iQueue for three and a half years now, so we have quite a bit of data to go from and really focus on to see what makes the most sense. 

I think one thing that I can give us an example most recently, especially with the holidays being right upon us, is we have in one of our infusion centers, the main hub Warner Treatment Center is a 24/7 infusion center. After hours we care for our cancer patients as an urgent care environment. During the day, we’re open holidays and weekends, of course – you know, it’s “How do we schedule for the holidays? This is what we’ve always done. You know, we’ve always scheduled X amount of nurses for a holiday.” Well, are we ending up with too many nurses? Let’s look at the data. Let’s see what our patient volumes traditionally have been on Thanksgiving. Do we really need 10 nurses? Or do we only need the five or six? So it’s just gently reminding, you know, getting past that “I feel.” Let’s look again, what makes sense, using the data.

Moderator: That’s great. And I think that’s really helpful feedback for our audience today. And now I know you mentioned scheduling, a last question for you, Becky, how do you deal with last minute add on appointments?

Duchman: Again, it kind of comes back down to just reminding our scheduling team to use those templates the way they are built, because they are built to accommodate add-ons. And all as I understand, all based off that predictive and analytical software that is built into our templates on the backend. So even though again, a particular Monday might feel very busy, and just no way we could if we could take one more add=on for the day. You know, again, looking at the data, we are now on a real time data feed with iQueue, we have been for several months now. And that’s been incredibly helpful too, to just say “if I’ve got this little add-on coming in, it’s noon. Instead of having to base off base all of my decisions off historical data on a Monday at noon, I can now look at my templates in real time within iQueue and see, it looks like we’ve got a lot of open chairs opening up with some cancellations we didn’t expect and here are the times that it’s looking like we could potentially get this patient based off real time data, versus just historical data.” So I think that added real time data layer has been extremely helpful. And again, has also contributed to our decreased wait times for patients.

Moderator: Wonderful. Thank you so much, Becky, for sharing those answers to our Q&A today. Now I’m going to turn the floor over to Obehi, I have a few questions for you as well. First one is how are wait times calculated and where does that data come from?

Ukpebor: In iQueue, we calculate wait times as the time from when a patient’s scheduled appointment time is to the time when they’re seated in a chair. However, if a patient checks in after their appointment time, we take the check in time as the start of their wait. That way we’re not penalizing people for showing up too early or late. Where does this data come from? Check- in and chair-in timestamps, among many other timestamps, they’re documented in the EHR, and then they’re sent to iQueue either in real time or through a daily data extract every morning. Check-in is typically captured by a front desk staff, when the patient arrives while the chair-in is typically captured by a medical assistant or nurse, when the patient is roomed or seated in a chair.

Moderator: Now, how scalable would you say this technology is? Does it work for both small and large infusion centers?

Ukpebor:  The answer is yes. The iQueue solution is actually quite scalable. Centers we work with widely vary in size, from small eight to ten chair sites to over 60 or 70 chairs. The optimization algorithm takes into account your chair size, your operating rooms, number of nurses, including the one-to-one patient time required, as well as many other factors to build this optimal schedule for your unique setup. And we’ve seen pretty decent results, on both sides of small and large achievement centers.

Moderator: Thanks, Obehi, and now we have time for a couple more questions here today. Someone asked, does it matter what EHR I have,  and how is iQueue able to work with any EHR and EMR system?

Ukpebor: So no, it doesn’t matter which EHR you have. One of the things that we actually pride ourselves on is being EHR. agnostic. Well, some EHRs are slightly more challenging than others to work with. But we do have a very patient and experienced data onboarding team that work very closely with your IT teams to extract the necessary data that’s required. 

And talking about the data there. There are three main categories. There’s your core scheduling data, like your appointment ID or appointment time. There’s the patient flow details, like the check-in and chair-in timestamps, and then there’s treatment details like your medication name, the medication start time and end time. The majority of centers capture all three categories of this data. So it’s typically now a matter of writing some queries to extract and send the data and setting up a continuous data feed. Once the templates are ready, it’s then working again with your EHR field teams to set up the templates as needed in your own environment.

Moderator :That’s very helpful for our audience today. And now, the last question. Do the schedulers need to learn the iQueue application in order to schedule appointments or can they simply work within their existing scheduling workflow?

Ukpebor: Do schedulers need to learn the iQueue application, or can they work within their existing workflow? No one likes multiple systems. Everyone just wants everything to be in one place. One of the benefits of iQueue is that your schedulers do not have to work in multiple systems. You know, they can continue to work within their existing scheduling workflow. As mentioned earlier, the templates are actually built in your EHR. The only thing that will look different is that, on the schedule, there’ll now be specific recommended slots at specific times for each appointment duration group. You know, giving schedulers better guidance on when to book appointments. But no, the templates are built in your EHR and you don’t have to go to a different system, it’s the same scheduling workflow.

Moderator: That’s wonderful, Obehi. Now unfortunately, that is all the time we have for today. I do want to thank our speakers Becky and Obehi for taking the time to chat with us today. And I also want to thank LeanTaaS for sponsoring this event. Have a great day.