Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Debra Arnow, DNP, RN, NEA-BC
• Committee Member Name & Credentials:
  Ty Williams, DNP, RN, ACNP-BC, FNP-BC, CNE

DNP Project Abstract

Improving Clinical Workflow in the Ambulatory Oncology Setting: A Quality Improvement Proposal

Purpose
This quality improvement proposal analyzes current literature to determine if reduced length of stay and decreased wait time in the ambulatory setting can improve patient satisfaction for adult cancer patients.

Methods
Voice of the customer feedback is obtained via survey and focus groups. Current and future state process maps are designed with input from those team members closest to the point of care who have the best understanding of the current clinical workflow. A root cause analysis is performed and identifies the potential causes of increased length of stay and wait time.

The Model for Improvement framework is utilized to focus on the strategy of the quality improvement proposal and the Plan-Do-Study-Act cycle will focus on the tactics needed to implement the change and evaluate which of the proposed changes will be successful in the ambulatory oncology setting.

Data collection will include median and interquartile range data, electronic health record data time stamps for patient registration and the administration of first drug and patient survey data related to wait time pre and post-implementation.

Results
Successful outcomes of this quality improvement proposal will achieve a decreased length of stay of up to 25% from patient registration to the administration of first drug displayed by a run chart with target. Increased patient satisfaction with wait time of up to 20% will be measured by the percent of 'very good' survey responses displayed by a bar graph with pre and post-implementation results.

Implications for Practice
Clinical workflow quality improvement activities should include evaluation of the cost of care related to length of stay in the ambulatory setting. Clinicians should maximize the use of digital tools to enhance the efficiency of clinical workflow in the ambulatory setting.