(82) Use of a hematology transfusion vascular access triage nurse to provide efficiency in infusion center patient flow

Title: Use of a hematology transfusion vascular access triage nurse to provide efficiency in infusion center patient flow

Abstract : An urban outpatient hematology-oncology clinic with a 20-chair day hospital/infusion center serves a diverse population of children with cancer and blood disorders. Historically, transfusion-dependent patients with blood disorders would present for appointments without recent complete blood count (CBC) or blood crossmatch specimens already completed. This practice resulted in long appointment times with patients waiting for labs results and blood products. Patient flow was impacted with infusion chairs being occupied by patients who did not require nursing or medical care for several hours.

The purpose of this quality improvement project was to improve efficiency of patient flow through the day hospital, including a targeted decrease in non-productive infusion chair time.

This quality improvement project was based in a clinic with an average daily census of 100 patients. An average of 8-10 hematology patients are seen each day for infusions, medication trials, or transfusions. Average hematology patient length of stay prior to implementing this project was 6.7 hours. The implementation of this project included establishing a dedicated vascular access triage room for hematology patients where their IV access was obtained, lab specimens were collected, and initial nursing assessment was completed. Patients were then invited to wait in the waiting room or a play area until their blood products were ready for transfusion. When the blood product was ready for transfusion, the triage nurse escorted the hematology patient to the HDH and provided patient handoff to the HDH RN for transfusion. Outcome measurement for this project includes patient clinic length of stay (from appointment check in to check out).

This initiative has resulted in a decrease average length of stay of 3.2 hours from 6.7 to 3.5. This practice resulted in more available day hospital infusion chairs for patients in need of treatment in a timely manner and expedited overall clinic patient flow.