PV QA 4 - Poster Viewing Q&A 4
Purpose/Objective(s): Treatment disparities exist at safety net hospitals serving low socioeconomic populations due to limited resources. This study assesses whether high-dose-rate (HDR) tandem and ovoid (T&O) insertion in the ambulatory setting (AS) can improve workflow over insertion in the operating room (OR) for cervical cancer patients at a safety net hospital. A secondary analysis on nurse overtime was also performed.
Materials/Methods: This is a single institution retrospective review of women with cervical cancer treated with HDR brachytherapy at a high volume center. All women were implanted with T&O in either the OR (10/31/2016 – 2/1/2017) or AS (2/6/2017 – 8/7/2017) followed by CT simulation and treatment delivery in the radiation oncology brachytherapy suite. At this institution, the OR is located on the fifth floor of an adjacent building while the AS utilizes a newly opened procedure room within the radiation oncology department. Workflow efficiency was monitored through time logs that recorded the following: patient arrival and departure from the procedure room (OR vs. AS), CT simulation, plan approval, HDR delivery, and discharge from the clinic. Nurse overtime hours before and after the transition from OR to AS brachytherapy were organized by number of patients scheduled on each day: one, two, or three cases per day. T-test analyses were performed to identify differences in transport/recovery time from end of T&O insertion to CT, length of stay (LOS), and nurse overtime between the two groups.
Results: In the OR setting, there were 9 days with a single case and 3 days with two cases performed. The OR could not accommodate 3 cases per day due to time constraints. In the AS setting, there were 6 days with a single case, 7 days with two cases, and 3 days with three cases performed. Mean transport time from procedure to CT scan was significantly reduced in the AS phase compared to the OR phase (21 vs. 101 minutes, p < 0.0001). Mean length of stay (LOS) was shorter during the AS phase compared to the OR phase (6.62 vs. 8.333 hours, p < 0.0001). Although not reaching statistical significance, there was a trend toward decreased nursing overtime between the AS and OR phases (2.2 vs. 2.7 hours, p = 0.08).
Conclusion: Performing HDR T&O insertion in the AS, instead of the OR, was associated with an approximately five-fold reduction in transport time from procedure to CT plus a shortened LOS by nearly two hours. This increase in available time allowed for accommodation of three cases in a single day for the AS setting. Finally, bringing T&O brachytherapy into the AS opened up OR time for other surgical services at our safety net hospital. Further study is warranted to assess the impact on treatment disparities and cost-effectiveness in this setting.
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