Continuous Improvement at The Reading Hospital and Medical Center

Increasing pressure on the nation's hospitals to cut costs while improving quality has resulted in process-focused initiatives that reduce patient wait time, increase patient satisfaction, improve clinical outcomes, and streamline clinical pathways. One hospital that has made significant inroads

Result: Average patient wait time for infusion was reduced from 4 hours to 90 minutes.

toward this higher level of both care and caring is The Reading Hospital and Medical Center in Reading, PA -- one of Tunnell Consulting's committed continuous improvement clients.

To begin its process, the hospital launched pilot continuous improvement activities on a number of fronts, among them, the chemotherapy infusion pathway. Toward that end, we helped the hospital establish and facilitate a Chemotherapy Infusion Team given the challenge of reducing chemotherapy patient wait time, increasing overall patient satisfaction, and cutting patient length of stay. Through process mapping, creative brainstorming, and quantification of key quality attributes using statistical tools such as control charts and histograms, the team netted significant improvements.

To ensure buy-in to process changes, we involved people from all affected hospital functions in the project: Admissions, Medical Staff, Nursing, Pharmacy, Finance, Radiology and Housekeeping.

The results were impressive: The team not only defined critical changes in the chemotherapy infusion process, but also designed implementation plans that could bring these changes to fruition -- often the hardest part of any continuous improvement effort. Here are some of the problems encountered and the solutions designed:

Patient Wait Time
Patients at the hospital were waiting an average of 4 hours after admission before receiving their first, or only, chemotherapy infusion. By refining existing procedures, the team defined a coordination plan that would alert key departments a day in advance of a patient's arrival. Pharmacy could begin preparing required documentation and infusion materials; nursing could adequately prepare for special patient needs; and housekeeping could be ready for arrivals. The Result: Average patient wait time for infusion was reduced from 4 hours to 90 minutes.

Patient Length of Stay
Because of extended wait times, some patients were spending an additional day in the hospital. By reducing time lags at the beginning of therapy and between treatments, the hospital was able to measurably reduce length of stay. The Result: 10% of patients were discharged one day earlier than scheduled, 25% of patients were discharged early enough in the day to make their room available for another patient, and 10% of patients were identified as possible out-patient candidates.

Patient Care Quality
It was decided that chemotherapy patients would be best served by nurses specifically prepared for their care. Instead of admitting such patients throughout the hospital as had been the previous practice, the new admissions process allowed the hospital to admit patients to the same unit, one staffed by such specially prepared nurses. Patients now arrive to this unit both earlier in the day and on a staggered schedule, allowing more timely treatment. The Result: Patients receive even higher quality, efficient care from a specialized staff 100% of the time.

Patient Satisfaction
When last surveyed, chemotherapy patients were reporting a far greater level of satisfaction with their care, with 100% of them intimately affected by the changes.

Staff Satisfaction
Due to the involvement of all affected groups, transition to the new process was seamless. A recent survey revealed unanimous staff buy-in to the new procedures.

Tunnell Consulting has been pleased to be involved in such important work, and congratulates The Reading Hospital and Medical Center for rising to the challenge of our new health care era.

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