Managing increasing patient numbers with decreased time slotsLauren Knight (Adelaide Radiotherapy Centre, Australia)

OverviewWhat do you do when the patient waiting list is being blown out, but you are unable to schedule any more patients into the day?• Machines fully booked • Staff hours stretched to the limit

The answer: find a way to treat more patients in less time

• Going from 10 minute slots, treating 30 – 40 patients a day to 6 minute slots, treating 50+ patients a day

• How we got there, what worked and what we learntPage 2

Where were we?• Siemens linear accelerators• 10 minute time slots• Patients booked in 10

minute increments• 1 x 10 minute catch up time

slot every hour

Page 3

What we knewWorking on the premise that patients took 12minutes to treat

• Existing time and motion studies supported this theory• Old paper diaries and old patient record systems worked on

10 minute slots but were not flexible enough to change• Hence the catch up slot• 1 hour (60 minutes) ÷ 5 patients = 12 minutes each• A patient with the 12.40pm appointment would always be

kept waiting in theory as they would not be treated until 12.48pm

Page 4

What was happening?• IMRT becoming more frequent = longer treatment times• Resulted in more 20 minute and 30 minute patient bookings• Less bookings could be made in our usual working hours

Page 5

What we wanted to achieve• Treat patients on time

• Remove the hourly 10 minute catch up slots

• Fit more patients in

• Still run on time

Page 6

What we found• IMRT patients were taking 15 minutes or 20 minutes• 20 minute bookings allowed too much time, yet 10 minute

bookings weren’t enough and would cause us to run late• Booking two 20 minute patients (who take 15 minutes)

together, overlapping to equal 30 minutes

Page 7

What we found• Booking nightmare!• Moving patient’s times became more difficult• Time consuming for unit managers checking the books• Bookings team constantly receiving override error

messages

Page 8

Finding a new approach• Collaborating with our peers• Shenton House (Joondalup, WA) site visit by three of our

radiation therapist leaders• Learn from their clinical experience with VMAT• Assess if 5 minute slots would be feasible

Page 9

The outcome• 5 minute slots may not work for us• Elekta machines now making up the majority of our linacs• Advancing treatment techniques: VMAT and DIBH• Patient treatment times no longer taking 15 minutes• Most techniques now measuring 12 minutes, 18 minutes, or 22-

24 minutes• 6 minute time slots were a better fit

Page 10

How we did it• Using IT experts and new technology we extracted data and

utilization reports to show how long each activity code takes to treat

• Assessed over several weeks, then averaged• Each activity was recreated in Mosaiq and given the time

required, in multiples of 6 minutes• Rolled out site by site across all four sites• These reports are also looked at periodically to assess any

changes • Most recently DIBH times were adjusted as staff become

more experienced with the technique and equipmentPage 11

Today• Elekta linear accelerators

running from 7am – 6pm• Treating 50+ patients a

day, in 6 minute time slots

Page 12

Lessons learnt• RT perspective

- Diligence in booking extra time for patients who fall outside the average time slots

- Good communication with bookings staff- Standardized set ups and immobilization to streamline

setting up the treatment room• Patient perspective

- Adapting to very exact 6 minute appointment times- Provided with more contact outside of the treatment room from

RT’s and nursing staff- Less waiting time due to the machine not running late as often- Reduced waiting list due to greater patient throughput

Page 13

Future developments• Group tumour sites• Some grouping already happens by default

- SRS/SABR on linac 1- DIBH and breast patients on linac 2

Page 14

Conclusion• Going from 10 minute slots and treating 30 - 40 patients a

day• Treating with IMRT, long beam delivery times• Machine running from 7am – 6pm with 10 minute catch up

slots

• Moving to 6 minute slots and now treating 50+ patients a day

• Treating with faster machines and more advanced techniques

• Machine running from 7am – 6pm• Patients have the flexibility to attend before or after work• Patients treated on time and without lengthy waiting lists

Page 15

Thank-you