Oncology Rounds

Infusion center insights: Can in-house lab and pharmacy drive patient throughput?

by Aasheen Qadri and Emily Heuser

Infusion center ancillary services, especially lab and pharmacy, affect staff efficiency and patient throughput. We collected data from more than one hundred infusion centers to learn how they're offering access to these services and the impact that can have on patient wait times.

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Completing blood draws the day before infusion associated with shorter patient wait times

Lab testing often contributes to long infusion center wait times—so it's not surprising that an increasing number of facilities ask us about the effect of moving pre-chemo blood draws to the day before a patient's infusion appointment. Our survey showed that this scheduling shift can have a significant impact—in fact, the median wait time is 15 minutes less (45 minutes total from patient check in to infusion start) at facilities with pre-chemo blood draws compared with those who only do day-of blood draws (60 minute wait time).

Although 46% of survey respondents indicated that some percentage of their patients complete their pre-chemo blood draw the day before their infusion appointment, there wasn't a single response from an infusion center indicating that 100% of patients come in the day before. For the majority of infusion centers, the timing of the pre-chemo blood draw can vary or is done the day of the infusion center appointment—likely due to both patient convenience and physician comfort. However, we've heard from many programs that patients were understanding—and many even found it more convenient in the long run. Cancer programs should work with the care team to determine which patients would be good candidates for day-before blood draws and even survey patient interest in this strategy.

Dedicated oncology pharmacy can decrease turnaround time and increase patient throughput

Realizing how critical pharmacy is to infusion center operations, the vast majority of survey respondents had a dedicated in-house pharmacy, including 75% of academic medical centers (AMCs), 91% of teaching hospitals, and 67% of community hospitals. Surprisingly, facilities with an in-house pharmacy aren't necessarily larger or seeing more patients per day than those without a dedicated pharmacy. 

As expected, dedicated oncology pharmacies demonstrate quicker turnaround times.

Facilities with an in-house oncology pharmacy also had a higher average chair utilization rate. This is likely the result of more efficient patient throughput.

In regards to pharmacy staffing, pharmacy technicians were more often responsible for mixing chemotherapy drugs than pharmacists.

59% of respondents indicated that pharmacy technicians are the primary staff member responsible for mixing chemotherapy, compared with 22% who selected pharmacists and 1% who selected RNs and pharmacy technicians together. The percentage of respondents relying on pharmacy technicians to do this has increased substantially from 39% of respondents in 2015. Hopefully, this increase indicates a shift towards top-of-license practice for pharmacists and pharmacy technicians.

Learn more about top-of-license practice with our Build the High-Value Cancer Care Team.

Dedicated oncology lab not associated with faster processing or patient wait times

Only 46% of the surveyed infusion centers have a dedicated oncology lab. Of these facilities, the time from when a blood specimen is received in the lab to when the results are sent to the infusion center averaged 40 minutes. Surprisingly, this timeframe did not differ from facilities without a dedicated lab. A majority of surveyed teaching hospitals and AMCs had dedicated oncology labs in their infusion centers, while most non-teaching hospitals did not.

Charting the cancer patient journey—from diagnosis to survivorship

In this infographic, we've complied our top findings from the 2019 Cancer Patient Experience survey, so you can better understand patient priorities and preferences for care.

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