Discussion
What hasn’t been considered is most outpatient units treat patients with
a multitude of conditions that require consideration for urgent
appointments for services ahead of iron infusions. Some iron infusion
patients require appointments urgently while others do not. To further
complicate matters, some hospitals do not have a designated unit for
outpatient care and these services are provided in busy emergency
departments.
The survey results helped explain the unexpected result of decreased
wait times with the implementation of an SSO even before the addition of
iron isomaltoside. What we learned was that clinic staff schedule
appointments based on urgency, which is determined based on information
available in referrals. Iron referrals are triaged by clinic staff based
on multiple pages of information provided by the prescriber; a complete
prescription, laboratory data, consultation reports on underlying
medical conditions, consent for health care, allergy documentation, as
well as prescriber and patient contact information is required. Clinic
staff have to scour these lengthy referral packages for the relevant
information; any missing information can result in a delay of treatment.
It is possible that the first iteration of the SSO provided clinical
staff with all the information they needed for triage and thereby
streamlining the booking process. This is likely what led to reduced
wait times at ERH. It is therefore possible the latest iteration of
regional SSO will also lead to reduced wait times for the same reasons.
Having pertinent information readily available on the SSO may have
helped improve work flow. In other words, an improvement in the process
reduced wait times and had nothing to do with the addition of a costly
new formulation of IV iron.
The addition of iron isomaltoside to formulary may not have a major
impact on overall clinic wait times since iron wait times are tied to
how busy the hospital is, not how many other iron infusion referrals
there may be. For example, a non-urgent outpatient iron infusion
referral patient may have a wait time based on patients who are
requiring urgent blood transfusions, phlebotomies, antibiotics, or minor
procedure recovery.
Prior to addition of medications to formulary in the future, it may be
valuable to consider if process improvements (e.g. carefully designed
SSOs) would help with wait times.