Ironing out the problem of outpatient infusion wait times: look for
process improvements first
Abstract
Rationale, aims and objectives: Iron sucrose remains a top expenditure
in Fraser Health Authority. Audit data from an iron sucrose standardized
order set (SSO) pilot coupled with the addition of iron isomaltoside to
formulary resulted in the implementation of a regional SSO. Survey
objectives were to clarify how iron infusion referrals are triaged,
determine iron infusion wait times and identify what other services can
impact wait times prior to regional SSO implementation. Method:
Information was collected from a web-based survey sent to outpatient
unit staff at all 11 sites within the health authority Results: Survey
response rate was 73%. Urgent and non-urgent referral definitions
varied and included laboratory parameters, prescriber specification,
consideration of procedure dates and evidence of symptoms. Urgent
referrals wait times are usually within the same week and non urgent
wait times varied from same week booking to up to 3 months. Outpatient
units provide a multitude of services that require urgent appointment
times that may require scheduling ahead of non-urgent iron infusion
referrals. Outpatient clinics deal with multiple other clinical reasons
other than iron infusions which contribute complicate the triage and
booking process and can lead to long wait times. Wait time reduction
could be the result of utilizing a SSO that displayed all the
information required by clinic staff and streamlined the booking process
rather than the addition of iron isomaltoside to formulary. Conclusions:
With the implementation of a regional SSO the iron infusion referral
process may be simplified, thereby shortening appointment wait times. It
is recommended that comparable information regarding iron infusion wait
times be collected after these changes in practice.