Introduction
Iron sucrose remains a top expenditure in Fraser Health Authority (FHA),
a large health authority in Canada. In order to ensure the safe and
appropriate use of iron sucrose prescriptions, a standardized order set
(SSO) was pilot tested at three FHA sites including Burnaby Hospital
(BH), Eagle Ridge Hospital (ERH) and Mission Memorial Hospital (MMH) in
November 2020. While improvement in appropriate iron sucrose usage was
not demonstrated in the brief audit period, the SSO led to unexpected
and substantial reduction in wait times at one hospital (ERH). Since
that time, the SSO has been updated based on the aforementioned audit
and because of the addition of iron isomaltoside to formulary. This new
SSO intended for both inpatients and outpatients was implemented for
regional use on September 1, 2021 and contains both iron sucrose and
iron isomaltoside. The belief was that iron isomaltoside would lead to a
reduced wait times because fewer appointments are required. In FHA,
50-70 % of intravenous iron is administered in the outpatient setting.
Iron isomaltoside requires one or two outpatient appointments whereas
iron sucrose generally requires three. We questioned why ERH had a
reduction in wait times prior to the addition of iron isomaltoside and
hypothesized that it had something to do with the development and pilot
testing of a SSO.
This survey was intended to understand how iron infusion referrals are
triaged, determine outpatient iron infusion wait times and identify what
other services can impact iron infusion wait times in FHA hospital
outpatient clinics. This would help clarify if reduction in wait times
occurred because of the SSO.