Purpose: To accommodate the increasing volume of patients scheduled for infusions at the Comprehensive Transplant Center(CTC) Infusion suite. It began as a two chair unit with one fulltime registered nurse. Due to increase in clinical trials and high risk transplant patients since fiscal year 2015, the two-chair infusion suite was no longer adequate to meet patient needs. Patients waited for several days to weeks for availability. Contributory factors such as patient tardiness, schedule conflicts and medication delivery delay has led the team to come up with strategies to increase efficiency.

Methods: Strategies were needed to create a systematic approach to scheduling. The addition of two chairs, a fulltime RN and a dedicated scheduler was necessary to support increasing patient volume. The load was divided between two nurses. A scheduler was hired to facilitate all infusion requests including obtaining orders, securing authorizations and monitoring the schedule. Infusion RNs were responsible for reviewing all drug use policy focusing on safe medication administration. Each infusion was stratified into time blocks. Time blocking took into consideration the amount of time to pre-medicate patients to circumvent allergic reactions. Also the gradual increase in titration of medication. The scheduler arranged the long infusions first. Then shorter infusions fill the gaps or are scheduled at end the day. Also implemented, calling each patient prior to infusion day to ensure timely arrival. Another strategy streamlining the process was to complete the intake and obtain intravenous(IV) access within ten minutes of arrival. Thus giving ample time to pre- medicate as needed. A newly purchased Accuvein® assisted in accurate IV placement to save time and improve the patient experience. The transplant pharmacist communicated directly with the IV pharmacy leading to shorter turnaround time for delivery.

Results: After implementing these strategies we saw a rise of 524% in the total number of infusion patients treated from FY 2014 to FY 2017.

Conclusion: Significant growth was observed in the CTC Infusion Center. There were 287 patients in FY14 and 1507 in FY17. A substantial increase in the number of patients that were able to receive timely infusions. Streamlining staff responsibilities, appropriate scheduling by time blocking and enhanced communication with patients and pharmacy were the most effective strategies implemented.

CITATION INFORMATION: Estrada J., Tyrell M., Choi J., Jagolino J., Jordan S. Innovative Strategies to Accommodate Increased Patient Volume in an Outpatient Transplant Infusion Center Am J Transplant. 2017;17 (suppl 3).

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