Reducing Radiation Oncology Package Time and Key Elements for its Optimization

Purpose: To discuss the importance of patient "total package time" and subsequently the Radiation Oncology-specific package time represented by the time from the Radiation Oncology consult to the completion of radiation therapy. This work also demonstrates some key interventions within our clinic that can drastically reduce patient "package times" within Radiation Oncology clinics.

Methodology: The patients treated over the last two years were reviewed for critical timepoints within their radiation therapy workflow. The average times were compared for populations of patients after two interventions: commissioning a newer, faster planning system (RayStation) and implementing a patient management and accountability system called SmartClinic. RayStation was placed into clinical use in September 2020. The first clinical SmartBoard managing patient flow from consult to beginning treatment was activated fully in March of 2021, emphasizing meeting deadlines and accountability. Utilizing Mosaiq and Epic records, data were recorded for two years of HN patients before 7/30/2021 (IRB 2010-0252) about the critical time points for Radiation Oncology package time: initial consult, simulation, ready for treatment, first treatment, and final treatment. The data was then analyzed based on whether the patient treatment was before or after RayStation or SmartClinic implementation. General statistics were then run assuming normal distributions on the number of days between each time point and the overall radiation package time from consult to final treatment. The mean time between each time point was compared from after each intervention to before any intervention entirely.

Results: The analysis included 112 patients, 54 treated before any intervention, 39 after RayStation but before SmartClinic, and 19 after SmartClinic implementation to July 30, 2021. The mean elapsed time only mildly changed for patients after RayStation implementation but before SmartClinic but was not statistically significant. However, after combining the RayStation intervention with SmartClinic in March 2021, elapsed time decreases are notable in every analyzed category. The mean differences in the "Consult to First Treatment," "Simulation to First Treatment," "Simulation to Treatment Completion," "First Treatment to Treatment Completion," and "Total Radiation Oncology Package Time" had statistically significant mean reductions of 13.4, 4.2, 13.3, 9.0, and 22.9 days, respectively(p = 0.002).

Conclusions: Package times are essential for patient outcomes, and through interventions of new tools and technology combined with emphasizing accountability, patient package times can be reduced dramatically.

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