Oncology Rounds

Including clinical trials in the infusion center calculus

by Emily Venner and Mallory Kirby

Understanding the implications of treating clinical trial patients is a priority for the majority of infusion centers—77% of facilities surveyed for the 2019 Infusion Center Volumes, Staffing, and Operations Benchmark Generator report treating patients who are enrolled in clinical trials. We identified several trends impacting infusion centers providing care for clinical trial patients, specifically regarding volumes, staffing, and patient throughput metrics.

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AMCs have a significantly greater volume of clinical trial patients than other cohorts

In general, infusion centers with high patient volumes are more likely to treat patients on clinical trials. As expected, of those facilities treating clinical trial patients, academic medical centers (AMCs) and PPS-exempt cancer hospitals tend to treat significantly more clinical trial patients than other types of infusion centers. They average eight clinical trial patients per day, or almost 12% of daily patients, while all other facility types average only one clinical trial patient per day, representing 2-3% of patients.

Nurse staffing mirrors clinical trial patient volume

Infusion centers with a greater proportion of clinical trial patients tend to dedicate more nurses per day to those patients, though the nurse-to-patient ratio decreases as the volume of clinical trial patients increases. Within the national cohort, infusion centers dedicate two nurses to clinical trial patients daily, while AMC and PPS-exempt hospital infusion centers dedicate four. Nurses at infusion centers with low clinical trial patient volumes likely also take on responsibility for other patients, rather than being solely dedicated to them. For example, clinical trial nurses at AMC and PPS-exempt hospital infusion centers cared for an average of 3.5 clinical trial patients per day, while the national average among all surveyed facility types is only one clinical trial patient per dedicated nurse.

Address workflow inefficiency and gaps in nursing knowledge to better manage clinical trial patients

One AMC doubled down on its goal to improve clinical research in the infusion center—and saw an encouraging improvement. As volumes of clinical trial patients in the infusion center increased, staff noticed that infusion nurses struggled to meet the stringent trial requirements of their care, such as adhering to a strict three-minute window to start medications to reduce clinical deviations for the research study. Program leadership identified two main problems: nursing workflow inefficiencies and gaps in knowledge of research methodology.

To better manage clinical trial patients, the AMC's infusion center transitioned to an acuity-based staffing model and dedicated two research pods of eight chairs to clinical trial patients. The nursing leadership recognized that there was also a need for more comprehensive training on clinical trials. Traditionally, they delivered research training during a workshop that contained an overwhelming volume of information. To improve nurse education, the program transitioned to twelve 1.5 hour sessions each Thursday morning, with a weekly debrief to ensure retention of information.

After instituting these two changes, the program experienced a substantial improvement in providing care for clinical trial patients. As health systems increasingly grow their networks and prioritize clinical trial accrual, unique challenges of treating clinical trial patients in the infusion center are well-worth considering.

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