Cancer Clinic Redesign: Opportunities for Resource Optimization.

Ambulatory cancer centers face a fluctuating patient demand and deploy specialized personnel who have variable availability. This undermines operational stability through the misalignment of resources to patient needs, resulting in overscheduled clinics, budget deficits, and wait times exceeding provincial targets. We describe the deployment of a Learning Health System framework for operational improvements within the entire ambulatory center. Known methods of value stream mapping, operations research and statistical process control were applied to achieve organizational high performance that is data-informed, agile and adaptive. We transitioned from a fixed template model by an individual physician to a caseload management by disease site model that is realigned quarterly. We adapted a block schedule model for the ambulatory oncology clinic to align the regional demand for specialized services with optimized human and physical resources. We demonstrated an improved utilization of clinical space, increased weekly consistency and improved distribution of activity across the workweek. The increased value, represented as the ratio of monthly encounters per nursing worked hours, and the increased percentage of services delivered by full-time nurses were benefits realized in our cancer system. The creation of a data-informed demand capacity model enables the application of predictive analytics and business intelligence tools that will further enhance clinical responsiveness.

Quality of telephone nursing services for adults with cancer and related non-emergent visits to the emergency department.

A quality improvement project was conducted to determine the quality of telephone nursing for patients with cancer symptoms. Eligible patients were ones who telephoned the nurse about cancer symptom(s) within four weeks prior to an emergency department (ED) visit not requiring hospital admission. Experienced oncology nurses extracting data indicated appropriateness of ED visits and opportunities for improvement. The Symptom Management Analysis Tool was used to analyze nurse documentation. For 77 patients, 87% ED visits occurred within four days of calls about symptoms (e.g., pain, breathlessness, constipation, diarrhea, nausea/vomiting) and 91% could have been managed by more complete telephone assessment and/or an urgent clinic visit. Quality of nurse documentation revealed few patients were assessed adequately (38%), received any symptom-specific medication review (49%), or were guided in self-care strategies (17%). There was low-quality telephone symptom management by nurses and a need for alternative options for patients requiring urgent face-to-face assessments. Our findings highlight a gap in use of guidelines for informing telephone symptom management.

A century of CAM in New Zealand: a struggle for recognition.

This paper highlights the emergence of complementary and alternative medicine (CAM) within New Zealand. The historical path of development and acceptance of CAM from 1908 will be outlined, with reference to the development of current legislation and government policy. Emphasis will be placed on rapid changes occurring over the last decade. Acupuncture, osteopathy, chiropractics and therapeutic massage are presented as examples of CAM development and practice within New Zealand. Appendix A represents those modalities currently practiced in New Zealand.

Acupuncture use for pre-birth treatment. A literature review and audit-based research.

Traditionally acupuncture at four points, Yanglingquan GB-34, Zusanli ST-36, Sanyinjiao SP-6 and Zhiyin BL-67, has been used for pre-birth treatments (Maciocia and West (eds.), Acupuncture in Pregnancy and Childbirth, Churchill Livingston, New York, 2000, pp. 559-575, Chapter 44). These points are specifically used to prepare the woman's body for birth, with an emphasis on preparing the cervix and pelvis for labour. Midwives in one District Health Board region in New Zealand who have had basic training in acupuncture techniques have been providing treatments for their clients prior to the estimated delivery date (EDD). A retrospective audit of the midwives practicing this technique was conducted to cover a 12-month period and a decrease in medical inductions and caesarean sections compared to the overall maternity report figures was apparent. The research was further informed by a literature review. This paper discusses both the audit and the literature review.