Background and Importance Excessive waiting time is one of the main causes of patient dissatisfaction in oncologic daily care unit (DCU). Lean management, dose banding, advanced prescription and automatisation are usually used in our hospital to improve patient care pathway. In our adult DCU (>26 000 patients/years), patients have to wait for their treatment less than an hour.
Aim and Objectives The aim of this work is to reassess the time of availability in this DCU and to identify the factors influencing this time.
Material and Methods It is an ambispective monocentric study in which human factors (n=2), equipment factors (n=7), organisational factors (n=4), productivity factors (n=16) and time-related factors (n=6) were recorded randomly between September 2021 and April 2022 (i.e. 15 days studied). Data were also extracted from CHIMIO® software and from our institutional ‘LEAN tool’ for real-time monitoring of patients in oncologic DCU, in order to calculate time between the prescription of the day and the dispensation of the treatment.
Results The average number of patients and preparations manufactured per day were respectively 105 (+/-7) and 146 (+/-12); 52% of these preparations prepared the day before. The average number of preparations not prescribed in advance is 49 [18-62] (34%) for an average number of 31 patients [14-43] (30%). The average time to availability was 54 min (+/- 16) with a median of 60 min. On average, 12 [0-24] patients per day waited more than an hour after the prescription with a maximum waiting time of 360 min.
Four days (27%) were identified with an average dispensing time greater than 60 min. During these critical days, a percentage of anticipated preparations less than 50%, with a high number of prescriptions (>30 patients) and particularly before 9:45 a.m. or between 12:00 and 14:00 p.m. were observed. We noticed also a higher productivity ([174-214] preparations), the lack of coordination (2 of 4 days), or additional productions (analgesic syringe preparations).
Conclusion and Relevance Main impacting factors seem to be human factors and productivity. Time to availability became an essential quality indicator of our compounding anti-cancer unit. This study showed that our working procedures are efficient for a majority of patients, but not for all.
Conflict of Interest No conflict of interest
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