Improving Wait Times for Elective Chemotherapy Through Pre-Preparation: A Quality-Improvement Project at the National University Cancer Institute of Singapore

Cancer treatment occurs predominantly in the outpatient setting. Long wait times for chemotherapy lead to increased dissatisfaction, inefficient use of chemotherapy chairs, and compromised safety when delays result in treatment beyond operation hours. For patients who have undergone review with the necessary investigations by their oncologists on a prior day, a long wait time is more frustrating, because the sole purpose of their visit is for chemotherapy (termed elective chemotherapy). From February 2013 to September 2013, we conducted a clinical practice improvement program project to reduce wait times for elective chemotherapy and identified late submission of prescriptions, long drug preparation time, and pharmacy review of prescriptions as the main causes of delay in our center. We formulated a workflow to pre-prepare selected chemotherapy up to 1 day before appointments. Selection was based on shelf life, cost, recyclability, and need for premedication. Patients were triaged by telephone before their appointment before pre-preparation. Participation was voluntary, with patients required to consent for liability for cost in event of wastage. Average wait time for chemotherapy was significantly improved by 66% from 65.7 (median, 60; range, 5 to 301) to 22.4 minutes (median, 20; range, 0 to 80 minutes; P < .001). There were no wastages during this period, and treatment for elective patients could start as soon as the center opened if their drugs were pre-prepared the day before. Pre-preparation of chemotherapy, together with effective phone triaging, is an effective way to reduce chemotherapy wait time.