Crosby DL, et al. - The opportunity to decrease length of stay (LOS), reduce costs in a hematology/oncology inpatient practice, and increase utilization of a new infusion suite adjacent to an inpatient (IP) unit were assessed. Decreased administration of high-cost chemotherapy in the IP unit, reduced LOS, and increased patient convenience were the results of the intervention of the experts. Moreover, improvement of patient services at their not-for-profit medical center will be supported by the significant revenue generated in the OP infusion suite.

Methods

• Define, Measure, Analyze, Improve, and Control was the Lean Six Sigma methodology followed.
• In order to explore regimens correlated with inpatient administration of high-cost medications, multi-disciplinary clinical teams worked with quality improvement subject matter experts.
• They identified the greatest opportunity to optimize cost reduction in the IP unit was rituximab-based regimens.
• A goal was set by the team to deliver rituximab as an outpatient (OP) procedure in the infusion suite following hospital discharge.
• They determined the baseline utilization of rituximab in the IP unit, revenue of the new infusion suite, and mean LOS for patients receiving R-EPOCH, a rituximab-based regimen.

Results

• As per data, there was a reduction in the percentage of IP rituximab administration by 56%, resulting in $355,506 of cost avoidance in the IP unit.
• Through the first nine months, the mean quarterly revenue in the OP infusion suite increased from $104,363 at baseline to $293,607 by shifting rituximab to the OP setting, which projects to an annualized improvement of $756,976.
• They noted a reduction in the median LOS for patients receiving R-EPOCH by 12 hours (p < 0.001).