1. Operational Improvement of the Day Hospital of the Cardinal Bernardin Cancer Center J. Cronin, R. Flaska, L.Flemm, A. Natonton, and Day Hospital Staff

2. Opportunity Statement In addition to patients receiving treatments in the Day Hospital, a daily average of 25 Cancer Center patients were also seen for central line lab draws and maintenance flushing. This led to extensive wait times for all patients, including those whose treatment would be based on lab results. The average wait time for a patient having a lab draw was 38 minutes. Our goal was to decrease patient wait times for central line lab draws and maintenance flushing.

3. Most Likely Causes Patient Issues: High patient volume Unique needs of cancer patients, particularly the elderly and pediatric populations Time needed to address central line problems, such as clots, displacements, potential infections Patient frustration with wait times Environment Issues: No dedicated area for central line blood draws Staff Assignments: Nurses providing care to treatment patients would be interrupted to perform central line blood draws Nurse and Service Representative frustration with conflicting priorities

4. Solutions Implemented Dedicated Space: Obtained room next to phlebotomy lab for central line blood draws Secured necessary furniture, equipment and supplies Linked new computers for specimen labeling Dedicated Staff: Assigned Day Hospital RN for central line blood draw area Added Service Representative position to support both the Central line blood draw and Cancer Center Radiology areas

5. Solutions Implemented Process Defined new process for lab draws and maintenance flushing Created process flow diagram Developed documentation tools for staff Provided education on the new process for Phlebotomy and Day Hospital team members Piloted and revised the process Patients: Conducted a patient satisfaction survey Provided education to patients on the new process

6. Patient checks in with Service Representative Directed to seating by room Service Representatives labels, prep and times charge ticket and puts ticket in queue for RN If <3 patients waiting Call in next patient, access line If >4 patients waiting Call Day Hospital Charge Nurse If blood return is present, draw specimens/ flush line No blood return after trouble shooting Notify Day Hospital RN Direct patient with charge ticket to Day Hospital Document need for TPA on ticket Patient without scheduled treatment leaves Patient with scheduled treatment given timed charge ticket & checks in at Day Hospital for treatment RN at end of day brings charge tickets & charting to Day Hospital, & assesses need for restocking area RN documents care provided, prints charting & completes charge ticket RN documents care provided

7. Patient satisfaction with wait times has improved significantly

8. Wait times for central line lab draws have decreased significantly

9. Analysis Having dedicated space and staff for central line lab draws has improved wait times and patient satisfaction Impact on patient flow in the Day Hospital Improved patient privacy Additional 1 or 2 chairs now available in the Day hospital for treatment patients Turnaround time has decreased for patients whose treatment is dependent upon same day lab results Fewer staff interruptions

10. Next Steps Ongoing monitoring of the wait times and patient satisfaction Investigate possible reasons for late arrivals and no show patients Create dialogue for Service Representatives to address early and late arrivals