Development of Productivity Standards for Ambulatory Infusion Suite Nurses Within a Multi-Entity Health System
Authors:   Johns Hopkins Care at Home, Zhao Jennifer , Sherman Brian , McCracken Ashley , Watkins Stephanie , Rusinko Kristopher 
Published: February 2025

Introduction: A productivity metric that infusion sites measure to gauge operations is chair capacity, which is a direct reflection of physical chair utilization based on the inputs of total time patients occupy chairs and total time the chair is available (i.e., hours of operation multiplied by chair count). Although a convenient metric, it does not capture all relevant information, and there is a need to identify standard metrics that account for infusion nurse workload. Minimal literature currently exists that describes specific methods for obtaining more accurate clinician-focused capacity metrics that could better track productivity and staffing needs for successful operations. The purpose of this project is to identify metrics that will account for clinician-focused capacity and use them to create an operational tool that ambulatory infusion suites (AISs) can utilize to relay productivity and business standards.

Methods: Two time studies were conducted across 3 AIS locations within our organization: (1) an inperson time study of 7 nurses observing of all performed tasks (including both clinical and non-clinical care) over approximately 52 hours; and (2) an electronic time study looking at electronic health record (EHR) appointment reports (infusion therapy, appointment length, patient check-in time, and discharge time) over a 1-month period (n=407). Data from the 2 time studies were used to develop and validate metrics and metric parameters for an infusion nurse productivity scorecard.

Results: From the in-person time study, 50 distinct tasks were identified and grouped into categories (Operations, Direct Patient Care, Indirect Patient Care, Medications, Documentation, Communications, and Other). Assuming an 8.5-hour workday, nurses were estimated to spend similar amounts of time in Communications (76.5 min), Direct Patient Care (81.6 min), Documentation (86.7 min), and Indirect Patient Care (96.9 min). Amongst individual tasks, patient chart checks (40.8 min), and appointment scheduling (35.7 min) occupied the most time. Analysis of patient encounters from EHR informed proposals to shorten, extend, or make no changes to appointment lengths for different treatments. The productivity scorecard comprised specific tasks, allotted points, and goal number of points for nurses to achieve daily. Testing of the scorecard via retrospective grading on 5 full-day time studies determined 15 points’ worth of tasks a day for a nurse to be considered “productive.”

Implications/Conclusions: The time studies highlighted trends and potential areas of improvement in AIS nurse workflow, scheduling, and resource needs. The creation of the operational scorecard tool will allow AIS management to better evaluate productivity during business performance reviews. Adoption across all infusion centers within our organization would be ideal; however, it is unclear if operational differences at non-studied AIS locations may affect standards and should be tested prior to universal adoption. Additionally, this project specifically focused on infusion nurses, and further research is needed to identify similar items for other AIS personnel (e.g., pharmacists, medical assistants). Overall, capacity within AIS should be measured by both physical chair utilization and clinician-focused consideration. Development of a tool that accounts for personnel capacity will better inform operational limits and opportunities.

Keywords: ambulatory infusion suite, time study, nurse productivity