Driving efficiency in oncology care: Tactical solutions for inpatient flow challenges.

Abstract

e13566 Background: Hospital compression limits access to timely care with a negative impact on patients. These pressures hinder ability to consistently deliver right care, emphasizing the need for inpatient capacity and flow. Key barriers were variable discharge planning, inefficient workflows, and inconsistent rounding patterns. Our goal, as the largest comprehensive cancer hospital, was to develop core tactical interventions for timely discharges, keep all access points open, and transform inpatient flow utilizing a multipronged system-based approach. Methods: Our strategy to streamline discharge workflows combined 3 core tactics: process redesign, technology integration, and role-based accountability. Our guiding principle was an accurate estimated discharge date (EDD) validated during multidisciplinary rounds, signaling discharge readiness. Our process redesign was a cohort approach (hematology, surgery and solid tumor) to an oncology-specific discharge checklist integrated into the electronic medical record that aligned incomplete discharge tasks with upcoming EDD. Role based accountability empowered advanced practice providers as discharge delegates with early rounding and discharge order. Clinical nurses monitored readiness and escalated barriers. Technology supported real-time performance dashboards for missed opportunities with feedback loop. Three key performance indicators were chosen to measure success: 1) accurate EDD one day prior, 2) provider placed discharge orders before 9AM, 3) team completed discharges before noon. Results: Over 12 months following the baseline period, EDD accuracy one day prior improved sustainably across all service lines. Early discharge order by 9AM improved in hematology from 8% to 52%, surgery from 24% to 54%, and solid tumor from 8% to 44%. Our discharges before noon in hematology improved from 6% to 46%, surgery from 12% to 46%, and solid tumor from 10% to 44%. In our opinion, this remarkable change in our KPIs marks a milestone not previously reached by any organization. Gains are durable beyond 12 months, sustained by dashboard monitoring and system level governance. Conclusions: A multipronged tactical approach proved successful in a coordinated, data-driven inpatient flow design that was both effective and sustainable. Interventions should be conducted synchronously, not in isolation. These tactics are replicable and scalable to other institutions. In conclusion, standardized workflows, role-based accountability, and technology-based performance reduced variation and sustained improvements. Results over time. Population Hematology Surgery Solid tumor Period % 9AM Orders % DC by Noon % 9AM Orders % DC by Noon % 9AM Orders % DC by Noon 12 Month Baseline Period 8% 6% 24% 12% 8% 10% 12 Month Intervention Period 18% 14% 29% 18% 17% 16% 12 Month Post Intervention Period 52% 46% 54% 46% 44% 44% 4 Month Sustainment Period 63% 57% 64% 55% 52% 55%