Results
The survey was sent to thirteen people at eleven sites (RCH was omitted
after two unsuccessful attempts to obtain a contact name). There were 12
responses, however the response from MMH stated only the site name and
no other answers therefore it was omitted. Of the eleven complete
responses from eight different hospitals (response rate of 73%), there
were three sites with two respondents. The remaining six responses were
from six different hospitals. No responses were received from FCC and
RMH.
The definitions of an urgent referral varied from site to site (Table
1). Some factors in assigning urgency to a referral include a hemoglobin
value, prescriber assigning an urgent status to the prescription, an
upcoming procedure or delivery date, a ferritin value or evidence of
symptoms of iron deficiency or anemia. Hemoglobin threshold values
varied from 80 to 100 g/L as a definition of an urgent referral.
Non-urgent referrals were defined based on the hemoglobin value at three
sites, with one site stating a value of greater than 90 g/L. If a
prescriber stated a referral was non-urgent and the ferritin levels were
additional factors; the ferritin level cut-off for a non-urgent referral
was not specified by the survey respondent. Two sites stated that there
is no triage process so infusions are administered on a first come,
first served basis. Missing information on a referral automatically
designates a referral as non-urgent at one site.
If a referral was considered urgent, an infusion appointment is booked
within the same week or at the very most within 1-2 weeks in FHA. Non
urgent wait times varied from same week booking to up to 3 months after
the referral was received. Most sites stated that these were typical
wait times with the exception of ARHCC and ERH where there was usually a
longer wait time (Table 1). ERH noted a significant reduction in iron
infusion wait times from three months to same week booking; it is
important to note is that this wait time reduction coincides with the
implementation of the pilot SSO.
Factors contributing to longer wait times for iron infusion appointments
included missing referral information, limited patient availability, and
limited appointment availability (only a particular designated time of
day or designated day of the week for iron infusions) and lack of human
resources to triage referrals. In addition, if the patient’s referring
physician is not available by phone due to holidays or outside of office
hours, the patient’s appointment is delayed. Since most outpatient units
have a policy that the referring physician is the attending physician,
they must be available by phone in case there is an adverse reaction.
Aside from iron infusions, respondents stated that their outpatient
units provide a multitude of services that require urgent appointment
times that may require scheduling ahead of non-urgent iron infusion
referrals (Appendix 2). Anticoagulation Program, Community IV Program,
minor procedure, minor procedure recovery, bloodwork from central venous
catheters, and phlebotomy patients receive care in these same outpatient
units. In addition, patients rely on timely treatment with intravenous
products such as blood, electrolyte infusions, hydration, immune
globulin G, and medications for non-oncological indications at these
units.