By Kathryn Ciccolini, DNP, AGACNP-BC, OCN®
As an oncology advanced practice provider, I saw a need to enhance the scheduling process for transplant and cellular therapy nurse coordinator visits at my institution. In response, I developed and implemented the following quality improvement (QI) project and successfully reduced scheduling error rates by 95%.
Our initial challenge was the lack of standardized scheduling for nurse coordinator visits. In our institution, all visits for office practice nurses, advanced practice providers, and transplant coordinators were scheduled under the generic label of “BMT nurse visits.” This led to confusion among the team, redundant chart reviews, and an inability to track coordinators’ workload metrics. With program growth and increasing visit numbers projected, change was necessary to optimize patient scheduling.
I engaged key individuals and teams involved in the scheduling process through a comprehensive stakeholder analysis. I collaborated with senior nurse leadership, office practice leadership, administrative staff, and the transplant coordinator team. By involving stakeholders at every level, we ensured that we had a holistic understanding of the problem and fostered a sense of ownership and commitment among all involved.
Project Development and Implementation
We used the Plan-Do-Study-Act (PDSA) quality improvement framework as a systematic approach to address the identified challenges. Our interventions involved:
- Process analysis: Identified gaps and resource constraints in the existing process.
- Standardization: Implemented standardized visit providers and types for each nursing group (coordinator, office practice nurse, and advanced practice provider). Established consistent start and end times, visit durations, and the ability to separate coordinator visits from physician visits on the same day.
- Education and communication: Instructed administrative and nursing groups, emphasizing the importance of the changes and their potential impact. Regular check-ins and an interim outcome analysis facilitated continuous feedback and improvement.
- Measurement and analysis: Leveraged electronic health record systems to create accurate metric reports on coordinator visits, enabling retrospective analysis and better staffing forecasting.
Sustaining the improvements required ongoing effort and collaboration. We reevaluated the plan, incorporated stakeholder feedback, and celebrated our successes. We found that continuous education and communication were vital to ensuring that the entire team remained engaged and committed to the new scheduling practices. By fostering a sense of empowerment and satisfaction, we created an environment conducive to delivering consistent, high-quality care.
Outcomes and Innovation
By streamlining a complex process, not only did we successfully reduce scheduling error rates from 20% to 1% over the course of 11 months, but we also standardized coordinator schedules, gained approval for separate coordinator visits from physician visits, and improved metric reporting and staffing forecasting.
Furthermore, nurses reported that it was easier to navigate their daily schedules, which enhanced their productivity and improved patient care. These findings highlight the importance of providing oncology nurses with optimal structure, fostering consistency, and supporting the healthcare team’s well-being.