Improving wait-times for radiation oncology intra-treatment visits


Purpose: AOPSS survey conducted in the Cedar’s Cancer Centre (CCC) waiting room showed that 63 % of patients wait longer than expected for their radiation intra-treatment visits. The purpose of this study is to objectify wait times at the CCC and identify factors affecting them. This data will be used to implement the first improvement as part of a Plan-Do-Study-Act (PDSA) cycle in an effort to decrease wait times, thereby improving patient satisfaction.

Materials and Methods: A management system in waiting rooms was used to obtain time stamp data from four samples (taken from August 4, 2018 to January 16, 2019). The outcome measure was time from check-in for appointment to beginning of intra-treatment visit. Employing a standard statistical approach, results were tabulated and stratified according to physician, time of day, day of the week and wait time experience. A root cause analysis was also performed.

Results: Baseline data from 1054 patients was analyzed, of which 10 patients with wait-times >5 hours were excluded. Median time from check in to beginning of intra-treatment visit was 46 minutes, mean 53 minutes. Almost all patients (94%) were seen within two hours, with the majority seen within one hour (63%). There was variation between wait times by treating physician, time of day and by day of the week. Wait-times vary between physicians, ranging from 38 minutes to 76 minutes. For check-ins after 7:00, wait-times tended to increase throughout the morning, from 16 minutes to a peak of 73 minutes. After that there was a steady decline during the afternoon to 10 minutes. The longest average wait times were encountered by patients who were checked-in on Monday (66 minutes) while the shortest occurred on Friday (39 minutes). A root-cause analysis showed coordinator unavailability, confusion with names of rooms, and poor communication between physicians and treatment machines to be amongst contributory factors to prolonged wait times.

Conclusions: Our analysis showed that 37% of patients wait >1 hour for their intra-treatment visit. The goal is to decrease this number to <25% within two months of implementation of new workflow and check-in process for the intra-treatment clinic. Lengthy wait times can be prevented using classic quality improvement methodology. As such, PDSA cycles will be used to implement a series of interventions, and changes in wait time will be tracked. For the first cycle of PDSA changes, we will act on three of the main contributory factors to prolonged wait times – we will aim to clarify signage in waiting rooms to decrease the likelihood of patients waiting in the wrong place, aim to increase communication between physicians and machines, and aim to have regularly scheduled intra-treatment visits rather than schedule them on the go so patients are less affected by coordinator unavailability. These results will be analyzed in two months time (after the first cycle of improvements) and presented at CARO.

In Radiotherapy and Oncology
John Kildea
John Kildea
Assistant Professor of Medical Physics
Tarek Hijal
Tarek Hijal
Associate Professor, Co-founder of the Opal Health Informatics Group