JOPHON CNE (2023 May/Jun) - Pediatric Chemotherapy Infusions in Outpatient Examination Rooms: A Novel Patient Care Approach-ARTICLE: JOPHON CNE (2023 May/Jun) - Pediatric Chemotherapy Infusions in Outpatient Examination Rooms

ARTICLE: JOPHON CNE (2023 May/Jun) - Pediatric Chemotherapy Infusions in Outpatient Examination Rooms

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This process paper describes a novel model for delivering short pediatric chemotherapy infusions in outpatient clinic examination rooms rather than in a hospital-based Pediatric Infusion Therapy Center (PITC). At the authors’ tertiary academic medical center, COVID-19 distancing restrictions reduced PITC capacity by 40% and intensified existing problems such as long, tiring appointment “itineraries” and the need to place children in less-preferred settings (e.g., inpatient units or an adult infusion center). The project aimed to improve patient/family satisfaction and reduce total appointment time without compromising safety.<br /><br />A multidisciplinary team (nursing, pediatric and adult pharmacy, physicians, operations, and health-systems engineering) selected low-risk, short-duration infusion therapies appropriate for clinic-room administration and redesigned the workflow so that patients could see their specialist and, if indicated, receive the infusion in the same exam room—eliminating travel between outpatient and inpatient campuses.<br /><br />A two-phase pilot was conducted. Phase 1 (3.5 months) included 5 medications/6 therapies; 25 patients received 52 infusions. After interim review, Phase 2 (5 months) expanded to 11 medications/18 therapies; an additional 24 patients received 132 infusions. Nurses (RN care coordinators) completed chemotherapy education/competency validation, rooms were equipped with PPE and spill kits, and documentation/billing were audited.<br /><br />Across the 8.5-month pilot, 49 unique patients received 184 infusions (most commonly vincristine). All efficiency metrics improved: average appointment itineraries were shortened by about 1.03 hours, including for visits with or without lumbar puncture. Safety was maintained: no infusion-related incidents were reported, comparable to pre-pilot PITC rates. The pilot also reduced pediatric infusions occurring in non-preferred locations (notably the adult infusion center). Satisfaction surveys showed strong preference for the new approach (93%), citing convenience, less fatigue/anxiety, and avoiding moving between buildings. The program was approved for ongoing operations, with noted limitations including small scale and focus on short, low-risk therapies.

Keywords

pediatric chemotherapy

outpatient infusion model

exam room infusions

Pediatric Infusion Therapy Center (PITC) capacity

COVID-19 distancing impact

workflow redesign

multidisciplinary quality improvement

short-duration low-risk therapies

appointment time reduction

patient and family satisfaction