The patients had already made it through the hardest part of the morning. They had had their blood taken, seen the specialist and been told they were well enough for chemotherapy. Then they sat in the cancer centre of a large public hospital in New Zealand and waited for the drugs.
A survey of 62 of them found waits of between one and four hours. The average was 129 minutes.
The staff were stretched too. In the week before the change, nurses worked 61 hours of overtime between them. The pharmacy unit that mixed the drugs had a backlog of up to 340 minutes. Its days lurched, the researchers wrote, “with idle staff looking for work one minute, only to have to work overtime later.”
The cause was a rule. A patient’s drugs were made from scratch only after a specialist confirmed, that same day, that the patient could go ahead. Chemotherapy drugs are hugely expensive, and the rule was meant to keep from making doses nobody could use. It also meant phone calls back and forth between the two departments, and a pharmacy that couldn’t start on a patient’s drugs until the confirmation arrived.
For a four-week trial, the pharmacy made the drugs in advance, most of them the day before. The longest wait fell from four hours to 30 minutes, shorter than the shortest wait under the old system. Most patients didn’t wait at all. Nursing overtime fell by two-thirds. And the pharmacy, which had been the bottleneck, made 37% more items for the cancer centre than the workload projected from the week before the trial, without extra overtime.
The rule had been doing a job, though. Without it, the cost of wasted drugs rose from 0.4% to 4%. So the team brought the specialist check back for the most expensive drugs, about 10% of the total, and kept making the other 90% ahead of time. Waste fell back close to its old level. Nobody surveyed patients once this settled in, but working from the nurse manager’s account, the researchers later estimated the average wait at about 16.5 minutes.
A nurse manager arrived about six months after the new system began. He had come from a hospital in the UK, and he said he was “initially really surprised to see all the chemo waiting.” He had never seen anything like it.