Capacity Prioritization Initiative Reduced the Wait Time for Port Placement and Facilitated Increased Volume of Port Placements at a Large County Health System.

DESCRIPTION OF THE PROBLEM Wait time from request to placement of ports in interventional radiology had increased from 14 to 27 days over a 4-month period. The goal of this project was to reduce the wait time by 15% within 4 months while accommodating additional volume. INSTITUIONAL APPROACH TO ADDRESS PROBLEM Capacity analysis revealed 2 bottlenecks: (1) inadequate provider capacity for preprocedural visits in interventional radiology clinic and (2) inadequate number of spots for port placement in the angiography schedule. The intervention consisted of: (1) 2 reserved slots in the attending physician's morning clinic schedule and (2) 3 daily guaranteed spots for port placement in the angiography suite. Both changes were integrated into the electronic medical record scheduling system. DESCRIPTION OF OUTCOMES After the intervention, per biweekly period, the number of port requests increased by 17% (Preintervention: 16.6 ± 3.1, Postintervention: 20.1 ± 4.1, P = 0.03), the number of completed clinic visits increased by 19% (Preintervention: 16.7 ± 5.1, Postintervention: 20.5 ± 3.6, P = 0.05), and the number of port placements increased by 19% (Preintervention: 16.9 ± 3.9, Postintervention: 21.0 ± 3.5, P = 0.02). The average wait time from request to placement decreased by 22% (Preintervention: 22.2 ± 4.4 days, Postintervention: 18.3 ± 3.4 days, P = 0.03), driven by a 49% decrease in wait time between request and clinic visit (Preintervention: 11.0 ± 2.3 days, Postintervention: 7.4 ± 1.0 days, P = 0.03). CONCLUSIONS Prioritization of clinic and angiography suite capacity, integrated into the electronic scheduling system, significantly reduced the wait time for port placement, even with significant increases in the volume of port requests.

[1]  F. Banovac,et al.  Association between Periprocedural Neutropenia and Early Infection-related Chest Port Removal. , 2019, Radiology.

[2]  Katsuhiro Kobayashi,et al.  Clinical Predictors of Port Infections in Adult Patients with Hematologic Malignancies. , 2018, Journal of vascular and interventional radiology : JVIR.

[3]  P. Gao,et al.  Impact of timing of adjuvant chemotherapy on survival in stage III colon cancer: a population-based study , 2018, BMC Cancer.

[4]  Muneeb Ahmed,et al.  Structured Reporting of IR Procedures: Effect on Report Compliance, Accuracy, and Satisfaction. , 2018, Journal of vascular and interventional radiology : JVIR.

[5]  M. Rosemann,et al.  Time to wait: a systematic review of strategies that affect out-patient waiting times. , 2017, Australian health review : a publication of the Australian Hospital Association.

[6]  J. Crispo,et al.  Interventions to reduce wait times for primary care appointments: a systematic review , 2017, BMC Health Services Research.

[7]  Sandra Scheidenhelm,et al.  Hardwiring Bedside Shift Report , 2017, The Journal of nursing administration.

[8]  S. Kirsa,et al.  Timely initiation of chemotherapy: a systematic literature review of six priority cancers – results and recommendations for clinical practice , 2017, Internal medicine journal.

[9]  N. Valsangkar,et al.  Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center , 2017, JAMA surgery.

[10]  Tarina Kwong Patient Access: Improving Wait Times in a Specialty Clinic , 2016, The health care manager.

[11]  F. Davidoff,et al.  SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process , 2015, BMJ Quality & Safety.

[12]  G. Cooper,et al.  The Impact of Delayed Chemotherapy on Its Completion and Survival Outcomes in Stage II Colon Cancer Patients , 2014, PloS one.

[13]  G. Hortobagyi,et al.  Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  D. Hughes,et al.  Central venous access: evolving roles of radiology and other specialties nationally over two decades. , 2013, Journal of the American College of Radiology : JACR.

[15]  Roger. T. Anderson,et al.  Effect on survival of longer intervals between confirmed diagnosis and treatment initiation among low-income women with breast cancer. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  Rena Toomey,et al.  Hardwiring change. , 2012, Nursing for women's health.

[17]  C. Fournier,et al.  Totally implantable venous access port systems and risk factors for complications: a one-year prospective study in a cancer centre. , 2011, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[18]  W. Mackillop,et al.  Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. , 2011, JAMA.

[19]  M. Gallieni,et al.  Vascular access in oncology patients , 2008, CA: a cancer journal for clinicians.

[20]  S. Stavropoulos,et al.  Relationship between chest port catheter tip position and port malfunction after interventional radiologic placement. , 2004, Journal of vascular and interventional radiology : JVIR.

[21]  J. Niederhuber,et al.  Totally implanted venous and arterial access system to replace external catheters in cancer treatment. , 1982, Surgery.