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Weng J, Mesko S, Chronowski G, Lee P, Choi S, Das P, Koong AC, French K, Aloia T, Ehlers R, Elrod-Joplin D, Kerr A, Smith R, Martinez W, Bloom E, Shah SJ, Ning MS, Liao Z, Herman J, Moningi S, Moreno AC, Nguyen QN. Optimizing Outpatient Radiation Oncology Consult Workflow by Using Time-Driven Activity-Based Costing: Efficiency and Financial Impacts. JCO Oncol Pract 2024; 20:732-738. [PMID: 38330252 DOI: 10.1200/op.23.00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/31/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Clinical efficiency is a key component of value-based health care. Our objective here was to identify workflow inefficiencies by using time-driven activity-based costing (TDABC) and evaluate the implementation of a new clinical workflow in high-volume outpatient radiation oncology clinics. METHODS Our quality improvement study was conducted with the Departments of GI, Genitourinary (GU), and Thoracic Radiation Oncology at a large academic cancer center and four community network sites. TDABC was used to create process maps and optimize workflow for outpatient consults. Patient encounter metrics were captured with a real-time status function in the electronic medical record. Time metrics were compared using Mann-Whitney U tests. RESULTS Individual patient encounter data for 1,328 consults before the intervention and 1,234 afterward across all sections were included. The median overall cycle time was reduced by 21% in GI (19 minutes), 18% in GU (16 minutes), and 12% at the community sites (9 minutes). The median financial savings per consult were $52 in US dollars (USD) for the GI, $33 USD for GU, $30 USD for thoracic, and $42 USD for the community sites. Patient satisfaction surveys (from 127 of 228 patients) showed that 99% of patients reported that their providers spent adequate time with them and 91% reported being seen by a care provider in a timely manner. CONCLUSION TDABC can effectively identify opportunities to improve clinical efficiency. Implementing workflow changes on the basis of our findings led to substantial reductions in overall encounter cycle times across several departments, as well as high patient satisfaction and significant financial savings.
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Affiliation(s)
- Julius Weng
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Shane Mesko
- Division of Radiation Oncology, Scripps MD Anderson Cancer Center, San Diego, CA
| | | | - Percy Lee
- Department of Radiation Oncology, City of Hope National Medical Center, Los Angeles, CA
| | - Seungtaek Choi
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Prajnan Das
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Albert C Koong
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Katy French
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Thomas Aloia
- Surgical Oncology, Ascension Health, Pearland, TX
| | - Richie Ehlers
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX
| | | | - Ashley Kerr
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Regina Smith
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Wendi Martinez
- Institute for Cancer Care Innovation, MD Anderson Cancer Center, Houston, TX
| | - Elizabeth Bloom
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Shalin J Shah
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Matthew S Ning
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Zhongxing Liao
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Joseph Herman
- Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY
| | - Shalini Moningi
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Amy C Moreno
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Quynh-Nhu Nguyen
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
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Mesko S, Weng J, Das P, Koong AC, Herman JM, Elrod-Joplin D, Kerr A, Aloia T, Frenzel J, French KE, Martinez W, Recinos I, Alshaikh A, Daftary U, Moreno AC, Nguyen QN. Using patient flow analysis with real-time patient tracking to optimize radiation oncology consultation visits. BMC Health Serv Res 2022; 22:1517. [PMID: 36514109 PMCID: PMC9745696 DOI: 10.1186/s12913-022-08809-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 11/08/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Clinical efficiency is a key component of the value-based care model and a driver of patient satisfaction. The purpose of this study was to identify and address inefficiencies at a high-volume radiation oncology clinic. METHODS AND MATERIALS Patient flow analysis (PFA) was used to create process maps and optimize the workflow of consultation visits in a gastrointestinal radiation oncology clinic at a large academic cancer center. Metrics such as cycle times, waiting times, and rooming times were assessed by using a real-time patient status function in the electronic medical record for 556 consults and compared between before vs after implementation of the PFA recommendations. RESULTS The initial PFA revealed four inefficiencies: (1) protracted rooming time, (2) inefficient communications, (3) duplicated tasks, and (4) ambiguous clinical roles. We analyzed 485 consult-visits before the PFA and 71 after the PFA. The PFA recommendations led to reductions in overall median cycle time by 21% (91 min vs 72 min, p < 0.001), in cumulative waiting times by 64% (45 min vs 16 min; p < 0.001), which included waiting room time (14 min vs 5 min; p < 0.001) and wait for physician (20 min vs. 6 min; p < 0.001). Slightly less than one-quarter (22%) of consult visits before the PFA lasted > 2 h vs. 0% after implementation of the recommendations (p < 0.001). Similarly, the proportion of visits requiring < 1 h was 16% before PFA vs 34% afterward (p < 0.001). CONCLUSIONS PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology consultation clinics, and implementing their findings can significantly improve cycle times and waiting times. Potential downstream effects of these interventions include improved patient experience, decreased staff burnout, financial savings, and opportunities for expanding clinical capacity.
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Affiliation(s)
- Shane Mesko
- grid.505404.0Scripps MD Anderson Cancer Center, Division of Radiation Oncology, San Diego, California USA
| | - Julius Weng
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - Prajnan Das
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - Albert C. Koong
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - Joseph M. Herman
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - Dorothy Elrod-Joplin
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - Ashley Kerr
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - Thomas Aloia
- grid.240145.60000 0001 2291 4776Institute for Cancer Care Innovation, MD Anderson Cancer Center, Houston, TX USA
| | - John Frenzel
- grid.240145.60000 0001 2291 4776Institute for Cancer Care Innovation, MD Anderson Cancer Center, Houston, TX USA
| | - Katy E. French
- grid.240145.60000 0001 2291 4776Chair, Patient Informatics, MD Anderson Cancer Center, Houston, TX USA
| | - Wendi Martinez
- grid.240145.60000 0001 2291 4776Institute for Cancer Care Innovation, MD Anderson Cancer Center, Houston, TX USA
| | - Iris Recinos
- grid.240145.60000 0001 2291 4776Institute for Cancer Care Innovation, MD Anderson Cancer Center, Houston, TX USA
| | - Abdulaziz Alshaikh
- grid.240145.60000 0001 2291 4776Institute for Cancer Care Innovation, MD Anderson Cancer Center, Houston, TX USA
| | - Utpala Daftary
- grid.240145.60000 0001 2291 4776Institute for Cancer Care Innovation, MD Anderson Cancer Center, Houston, TX USA
| | - Amy C. Moreno
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX USA
| | - Quynh-Nhu Nguyen
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX USA
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Weng J, Mesko S, Das P, Chronowski G, Lee P, Choi S, Koong AC, French KE, Aloia TA, Ehlers RA, Elrod-Joplin D, Kerr A, Smith R, Martinez W, Shah SJ, Ning MS, Herman JM, Moningi S, Moreno AC, Nguyen Q. Optimizing outpatient oncology consult workflow using time-driven activity-based costing: Efficiency and financial impacts. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9 Background: Clinical efficiency is a key component of value-based healthcare, patient satisfaction, staff burnout, and institutional operational capacity. The objective of this study was to identify clinic inefficiencies using time driven activity-based costing (TDABC) and evaluate the implementation of a new clinical workflow in high volume, outpatient radiation oncology clinics. Methods: We conducted an IRB-approved quality improvement study in the Gastrointestinal (GI), Genitourinary (GU), and Thoracic Radiation (TRO) Oncology departments at a large academic cancer center and four additional network sites (HALs). TDABC methodology was used to create process maps and optimize consult workflow. Patient encounter metrics were captured utilizing a real-time status function in the electronic medical record (Epic Systems). Anonymous patient satisfaction telephone surveys were administered to patients at the HALs. Hourly wages were determined based on 2021 U.S. Bureau of Labor Statistics. Pre- vs post-implementation metrics were compared using the Mann-Whitney U test. Results: Consult data for 1328 patients pre-intervention and 1234 post-intervention across all sections was included. Median overall cycle time was reduced by 21% in GI (19 min, p < 0.001), 18% in GU (16 min, p < 0.001), and 12% in HALs (9 min, p < 0.001). The median interval between rooming and being seen by the attending physician decreased by 13% in GI (7 min, p < 0.001), 16% in GU (9 min, p < 0.001), 21% in TRO (10 min, p < 0.001), and 9% in HALS (4 min, p < 0.005). For each consult, there was a median financial savings of $29 for GI, $24 for GU, $5 for TRO, and $14 for HALs per consult. From patient satisfaction surveys (95/177), 99% of patients reported their providers spent adequate time with them, 85% reported their appointment began on time, and 91% reported being seen by a care provider in a timely manner. Conclusions: TDABC is a successful method to identify opportunities to improve clinical efficiency. Implementing workflow changes based upon these findings led to substantial reduction in overall encounter cycle times and patient wait times across multiple departments. Furthermore, patient satisfaction was high and there were significant financial savings with the new workflow. These findings may also have implications for reducing staff burnout and expanding clinical capacity across the magnitude of clinical enterprise.[Table: see text]
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Affiliation(s)
| | - Shane Mesko
- Scripps MD Anderson Cancer Center, San Deigo, CA
| | | | | | - Percy Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Seungtaek Choi
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Richard A. Ehlers
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Nassau Bay, TX
| | | | | | | | | | | | | | | | | | | | - Quynh Nguyen
- University of Texas MD Anderson Cancer Center, Houston, TX
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