Infusion Immediate Care: Improving Hematology/Oncology Practice Quality through Expanded and Timely Access to Infusion Care
Authors: Barnes Melissa , Villa Christina , Crump Brenda , Field Donna , Chai Seungjean , Mesa Ruben A. , Desai Payal , Pal Sridhar , Gray Jennifer , Ragon Brittany Knick 
Published: December 2024

Background: Caring for patients (pts) with hematologic and oncologic diagnoses, especially those with myeloid malignancies, requires significant outpatient infusion resources. In 2020, a day hospital platform integrated into our existing infusion center, sharing resources and staff from infusion and supportive oncology, was piloted at our center. Following a Plan-Do-Study-Act (PDSA) cycle, the need for a standalone care center to offer supportive non-chemotherapy treatments was identified as a strategy to provide more timely access to non-chemo services and to increase access to valuable and limited chemotherapy infusion chairs. Over 60% of visits to the day hospital were for hematology pts for pain and symptom management, management of fevers, or blood product transfusions. With prior studies demonstrating that transfusions occupy at least twice as much chair time relative to an average chemotherapy session, our pilot confirmed that access to transfusion support that does not limit chemotherapy chair time is paramount for the care of hematology/oncology (hem/onc) pts. In an effort to improve timely access to outpatient infusion services for chemotherapy and non-chemotherapy infusions, we established a standalone Infusion Immediate Care clinic (IIC) uniquely designed and optimized for expedient non-chemotherapy infusion care.

Methods: An interdisciplinary team was formed to develop the IIC, including administrative and clinical leadership from physicians, advanced practice providers, pharmacy, nursing, and finance. Standard operating procedures were established by clinical experts in hematology, oncology, supportive oncology, and Sickle Cell Disease (SCD) for the delivery of same-day supportive care, including blood products, electrolytes, fluids, growth factors, intravenous medications for symptom management, workup and initial management of neutropenic fever, and dedicated SCD services, including crizanlizumab, that were previously limited in the outpatient setting. A space was designated and designed to meet the needs assessed by the expert panel. Teammates were hired and oriented throughout the oncology care continuum, including staff without prior oncology experience. For nurses without prior chemo certification, support was provided to obtain this. Education was provided to all clinic staff to ensure pts were directed to the appropriate location. Following go-live, pt volumes, infusion chair time, pt and staff satisfaction, demographics, and treatments were tracked through ongoing PDSA cycles to determine needs and future growth opportunities.

Results: Since opening 11/2023 to 7/10/24, 2,409 pts have been managed in the IIC. Though all hem/onc pts have access to the IIC, 1,823 (75.8%) had hematologic diagnoses, with a majority having acute myeloid leukemia, myelodysplastic syndromes, and myeloproliferative neoplasms. With an established SCD pathway, 46 pts with SCD have been seen in the IIC. Over 1,491 blood products have been provided. Only 41 (1.7%) pts were admitted to the hospital, with 20 pts directly admitted and avoiding the Emergency Department. Opening the IIC independent from the infusion center has saved 3,700 hours of infusion chair time at our center. Secondary to increase in available chair time for chemotherapy, select chemo regimens, such as EPOCH, were moved from the inpatient setting to the outpatient infusion center, improving inpatient bed availability. With appointments available for supportive services in the IIC, shortened inpatient stays have been observed. Clinic teams have reported fewer hours spent scheduling outpatient infusion-based care and coordinating same day treatments at regional sites. Median time from initial time of call to the IIC for a patient at our center to time of appointment in the IIC was 57 minutes, improved from prior time to same day appointments in the infusion center.

Conclusions: The designation of a non-chemotherapy infusion for hem/onc pts has effectively streamlined same-day supportive care needs and has increased timely infusion access for chemotherapy. Increasing access to outpatient infusion services has decreased inpatient admissions and duration of stay. With a creative and inclusive approach to previous care barriers, there has been a demonstrable improvement in the quality of care for our pts due to the implementation of the IIC, observed most especially in pts with myeloid neoplasms.