Greater capacity, stronger care: how UCSD Moores Cancer Center reduced infusion patients’ no-show rate by up to 50%

With its high patient volume and mission to deliver comprehensive cancer care “from bed to bench” for each patient, University of California San Diego’s (UCSD) Moores Cancer Center prioritizes its capacity to accommodate patients safely and effectively at every step.

Originally established in 1978, Moores Cancer Center currently handles 80,000 outpatient visits annually, and approximately 120 chemotherapy appointments per day through an aggregate of 65 infusion chairs. 

From 2018 going into 2020, a significant challenge Moores Cancer Center faced was growing its capacity for infusion treatments. The organization began working toward this goal first by expanding its facilities, including supporting monoclonal antibody treatments for COVID on a large scale. But optimizing these spaces was hindered by the day-to-day struggle for nurses, other providers, and staff to maintain efficiency and proactively coordinate care. In 2021, addressing these problems became the next priority. 

Nurses at Moores did not have the option in their EHR to schedule patients by appointment duration, or acuity, only by standardized slots. Scheduling templates were not based on historic data or patterns and so did not easily accommodate patient flow for a given center. Too many patients tended to arrive for the same preferred mid-morning appointment times, then proceeded on to individual care journeys through linked services in labs, clinics and the pharmacy, inevitably hitting unforeseen issues and treatment roadblocks that in turn blocked progress for other patients. Nurses across departments were not able to communicate with each other effectively given the patient loads, and were too focused on delayed patients to manage newly-arrived patients. The situation resulted in overwork for nurses and long wait times for patients. 

High levels of cancellations and no-shows further complicated scheduling, as the lack of coordination made it difficult for nurses and staff to take advantage of freed resources on the fly.  Before launching operational improvement initiatives in their infusion center, UCSD found a range of 1-5 hours of daily canceled appointments, which created a loss of revenue and underutilization of nurse and chair time. This amounted to 16-18% of same-day cancellations compared to a national average of 10-11% for infusion centers of a similar size. They also noted 40% of those same-day cancellations involved lab appointments, a pattern infusion leadership could leverage in its operations strategy moving forward. 

 

Improving daily operations for better overall capacity: data-driven infusion scheduling and optimized arrival times 

To ensure they were fully using the expanded infusion capacity they had invested in at Moores, UCSD looked to deploy a tool that would help schedule patients based on expected treatment length and nurse availability, while simultaneously capturing a patient acuity score. They also needed to determine the optimal number of patients to arrive within the same window and be managed throughout their linked appointments. 

Early in 2020, UCSD launched iQueue for Infusion Centers, an AI analytics platform that uses historic data to build suggested scheduling templates and predict likely cancellations, to address their daily challenges. Through the data-driven functions of iQueue, UCSD hoped to improve workflow for nurses and staff at Moores and support their mission of quality care for patients, while using iQueue metrics to identify growth areas as they iterated improvements.

 

Technology insights deliver more predictable infusion scheduling and stronger patient interaction

UCSD Moores launched LeanTaaS’ iQueue for Infusion Centers in February 2020. As they deployed the solution, which leveled the midday schedule “peak”, they also found data to support the need for two changes to nurse positions to shape scheduling further and support optimal chair and personnel utilization. 

As the highest rate of cancellations were for shorter appointment durations, a Licensed Vocational Nurse (LVN) track scheduling resource was established to accommodate procedures that fit this category, like labs, blood product transfusions, hydrations, and shorter infusions. Moores moved 14 appointment slots per day onto this track, freeing 40 hours worth of appointments to the main schedule. With this adjustment that kept shorter appointment times in their own ecosystem, same-day cancellations dropped to a rate of 11% on weekdays and 8% on Fridays and weekends. 

The second position, the Nurse Liaison (NL) role was created to develop a more comprehensive workflow treatment plan review. NLs reviewed patient treatment plans up to four days before an appointment to determine whether or not the infusion appointment was still the most viable and effective option for that time period, and whether the patient’s oncologist had cleared them for the treatment. In the days leading up to the appointment, NLs discovered reasons for potential cancellations including hospice referral, insurance issues, a lack of follow-up from the patient’s MD, and a need for more time before the next infusion treatments. With this knowledge, NLs could work with patients to reschedule or help deliver the support they needed, and under this system same-day infusion cancellations at Moores decreased to as low as 8.7% in March 2022.

Further, from September 2021 to April 2022, no-show rates declined by 32%, suggesting a more transparent relationship with patients, and overall volume of daily completed appointments increased by 14% during the same period, showing markedly improved utilization of Moores’ extensive facilities. These improvements, established through better nurse-patient interaction that revealed the solutions to capacity challenges, could not have been made without data and projection from iQueue. Beyond expanding its capacity, Moores Cancer Center enriched its patient experience. 

To hear the whole USCD Moores story, view the free webinar here. 

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