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Poke-N-Go, Fast Track, Vitals: It's all about improved patient flow in the Infusion Clinic

Improving Operations in Chemotherapy is about cost control and patient satisfaction. While most approaches focus on software associated with LEAN production techniques, an often overlooked area is strategically obtaining the right equipment in the right places in the clinic.


The Origins of LEAN / Operations Research and Its Application to Chemo

Toyota's famous Production System (TPS) is credited with systematizing cost reduction. Relentless attention to detail, always questioning, continuously improving are some of its basic tenets (other aspects of the system are for a later blog post). Engineers were elevated over accountants; quality outcomes were valued over volume; factory floorplan was studied more than C-Suite decision making.

TPS owes a debt to Deming and his Quality System

As a vendor to Toyota when they arrived in the US to build vehicles, I immersed myself deeply in the manufacturing culture; as an engineer, it felt like home.

At TSK Products, we started applying this approach in earnest at Yale-New Haven as they got ready to build Smilow Cancer Hospital. Working hand-in-hand with the (Patient Service Manager (PSM) and her nurses on the floor, we adapted design to a very cramped temporary floor plan and created an overlap table on the infusion recliners to meet requirements. Many iterations later, we all agreed on Version 1. As time went on, table designs changed to meet new requirements for lunches, laptops, purses, and iPads. The big change occurred when facilities and patients demanded power in the recliners.

Working with our suppliers and one of the most knowledgeable people in the field (she will go nameless unless you call and squeeze her identity out of me), we a product designed for another area of healthcare and applied it to infusion. This solved a huge issue around patient satisfaction. As our customers' sites filled up, another issue rose to the forefront of concern: operational improvement. Some customers turned to scheduling programs to improve patient flow to reduce wait times. Some examined patient flow and looked to remove bottlenecks. Though we love computers and science, TSK Products turned its attention to applications where Fast Tracks (we loved the Poke-N-Go name at one facility).

TSK Products is a nurse run organization. From our start in 2000, we have focused on products that promote and maintain Safety and Comfort in Healthcare. When we heard from customers that Fast Tracks were stressing the lower backs of nurses, we turned again to equipment that could promote both prongs of our mission. We established requirements for our equipment selections and tried out various "chairs" that lifted the patient to the nurse's height, eliminating poor posture and improving ergonomics. Better back health, less physical exhaustion, improved attitudes helped make P/werPorts a success where used.

Moving Forward on Plan-Do-Check-Act to Make Chemotherapy even Faster

While back strain was avoided and safety improved in the clinic, our equipment did nothing for spikes in scheduling once a clinic was running at full census. Our wonderful height adjustable port flush / blood draw chairs were great at one function. We then turned our attention to making them multifunctional, allowing a clinic to use the Fast Track chairs for longer procedures like walk in hydration or early or late appointments, without compromising Safety or Comfort. This required a partnership we had not foreseen, but provided us with a product that we are 100% sold on.

With the Adeen, we are able to:

  • place patients into seating that is comfortable enough for the entire length of an infusion treatment

  • make a safer workplace for nurses with improved ergonomics

  • raise the patient hands-free to the desired height

  • have contoured cushions provide comfort

  • never lift a patient out of Trendelenburg again

  • have a weight capacity of 440 LBS. in a regular recliner

  • remove the back or seat to clean easily and completely

We're hoping that the Adeen helps us improve operations management in Infusion Clinics and produces the improvements in throughout and satisfaction we've seen so far.

And then, we'll be ready for the next challenge.

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