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The administration of chemotherapy in the outpatient setting has the inherent challenge of time constraints, thus requiring efficient use of nursing time. With the implementation of the Medicare Modernization Act, quantifying nursing time is necessary to obtain adequate reimbursement for the full range of services provided to patients by oncology nurses (Halpern. 2004). Tower Hematology Oncology Medical Group (THOMG) is a nine-physician private practice in southern California. The physicians and staff see an average of 150 patients a day in the office, including about 50-60 patients requiring treatment. The volume of patients and the diversity of treatments led us to develop a more efficient way to schedule patient visits. We developed a patient-classification system that we believe accurately addresses the patient care and staffing needs for our professional practice model.
Background
The implementation of diagnosis-related groups stimulated design of patient-classification systems in the inpatient setting by forcing healthcare providers to become more fiscally accountable for the cost of care. Early efforts to quantify repetitive tasks that could be standardized, measured, and timed led to a wave of attempts to measure the nursing time involved in patient care (Malloch & Conovaloff, 1999).
Since 1990. chemotherapy administration has shifted from primarily the inpatient setting to physicians' offices and the outpatient setting. In addition, changes have affected the complexity of chemotherapy administration, including
* An explosion of new chemotherapy agents
* Complicated treatment regimens and protocols that require multiple premedications
* Newer targeted therapies that cause infusion-related side effects, requiring closer monitoring.
As a result of this transition from inpatient to outpatient care, where time constraints have to be taken into consideration, a patient-classification system is essential for planning and providing safe and effective care. An abundance of literature addresses inpatientclassitication systems and staffing guidelines. However, very little has been published for the outpatient setting.
Defining the Problem: A Need for Scheduling Guidelines
In the summer of 2001. in our roles as the newly appointed nurse manager and clinical director at THOMG. we identified the pressing need for the implementation of a relevant patient-classification system that would improve scheduling of chemotherapy for patients in our busy ambulatory practice. Although data about patient wail times, nursing staff overtime, and patient and physician complaints had not been collected prior to...