Our team was asked to examine the hospital discharge process in oncology, as time of day and length of stay were increasing. We began a five-week design sprint to discover the barriers to efficient bed-flow and the qualities required for innovative solutions.
We quickly discovered however, a relative and more important problem. Increased length of stay was decreasing overall bed availability, forcing elective chemotherapy patients to be routinely delayed and re-scheduled-- potentially adversely affecting dose regularity and intensity.
It was this larger problem that drove our work.
We interviewed an array of oncology providers to understand the barriers and potential opportunities for efficient discharge, and plotted the root causes of scheduling delays. We then crowdsourced staff ideas to address the causes for delays and began to ideate robust solutions to eradicate the issues.
Ultimately, we presented two solutions with the potential to decrease rescheduling and overall length of stay. We also provided prototypes to rapidly test and evaluate the solutions.
The first solution, an oncology admissions process, was proposed to perform three main functions:
- Load balance patient scheduling based on clinical priority and regimen
- Reduce in-bed delays by preparing patients before hospitalization
- Reduce overall bed demand by scheduling all potential mixed-outpatient treatments as such
The second solution, an urgent oncology evaluation clinic, was proposed to perform three main functions:
- Evaluate urgent patients
- Offer uncomplicated urgent patients an ideal and accurate level of outpatient care
- Allow for earlier hospital discharge
We proposed that these solutions could reduce urgent and emergent admissions to the hospital and ER, and decrease length of stay. We supplied a vapor test as an experiment to gauge real demand, surveying all clinicians who currently needed to admit urgent patients.
An RN has been hired to implement an oncology admissions process. In addition, leadership in Nursing Oncology ran our vapor test and has now implemented a pilot of the urgent evaluations center.