MS, RN, CPHON Children's Hospital Colorado Parker, Colorado, United States
Title: Utilization of EPIC’s Snapboard Tool to Level-Load the Center for Cancer and Blood Disorders Infusion Center Schedule
Abstract : The Center for Cancer and Blood Disorders wanted to optimize its infusion center schedule. Chart audits from December 2023, January and February 2024 revealed that an average 76% of patients were scheduled between 7:00 a.m. and 12:00 p.m. Further data collection showed the template was only 48% utilized. Patients scheduled before 12:00 p.m. had an average waiting room time of 15 minutes and an average time from arrival to first medication of 43 minutes.
By utilizing EPIC’s Snapboard tool, we will be able to level load (balance) the schedule: decrease average waiting room time by 10%, time from arrival to first medication given by 10%, number of patients scheduled before noon by 10%, and increase utilization of template by 10% 12 months post.
Utilizing a pre-post design we assessed the impact of implementing Snapboard scheduling. Implementation began in May 2024 and post data was collected monthly for 12 months post.
We focused on data-driven process improvement such as bottlenecks in morning schedules, delays in first medication given and percentage of template utilized in the afternoon. By identifying root causes of delays, utilization of EPIC reports and implementation of a decision tree, we optimized patient placement based on length of infusion and priority, monitored and adjusted scheduling algorithms based on real time feedback. Patient volume, staffing, renovations, exam room schedule, and pharmacy staffing were reviewed as audits each day to note if these factors increased times.
Post implementation showed average wait times decreased by 30% and time to first medication administration was 54 minutes (no improvement), number of patients scheduled before noon decreased by 1%, while appointment distribution improved by 3%. By encouraging schedulers to utilize afternoon slots, the 1300 hour was overbooked. We learned that utilizing session limits (limiting the number scheduled per hour) could also help balance the schedule.
