Time-and-Motion Study in a Pediatric Radiation Oncology Department

Purpose/Objective(s): Anesthesia requirements add complexity in a pediatric hospital radiation oncology department. Reducing inefficiencies can translate to higher quality patient care. We performed a time and motion study following our facility remodel and equipment upgrade. Elapsed times for each step of radiation treatment were measured and we identified possible targets to improve time management throughout the process.Materials/Methods: In June 2013, of 15 patients receiving radiation treatment, 11 required anesthesia (median age 6). Four patients had brain tumors, 3 had rhabdomyosarcomas, 3 had neuroblastoma, and 1 had nasopharyngeal carcinoma. These patients had 102 treatments (96 were available for analysis). For each patient, we collected data from the electronic medical records from Radiation Oncology (Aria, Varian Medical Systems), Anesthesiology (CompuRecord, Philips Medical Systems), and a hospital-wide system (KIDS, Cerner). Data was collected from patient arrival until discharge from the 11 bed post-anesthesia care unit (PACU). Variables included nursing time in pre-anesthesia preparation, sedation and radiation treatment times in the linac vault, and nursing time in post-anesthesia recovery. Two independent observers performed quality assurance of the medical records by tracking 10% of treatments with timekeeping devices.Results: Of the 96 treatments, 48 were RapidArc, 35 were IMRT, 4 were 3D-CRT, and 9 electron beam. The mean time for treatment was 103 minutes (range 56-178). Patient preparation averaged 22 ± 17 min, sedation was 29 ± 9 min (of which, radiation treatment was 10 ± 7 min), and recovery 51 ± 20 min. The variability between timestamped events in the medical record and direct observation was least for Aria and CompuRecord (5 min), and greatest for KIDS (11 min).Conclusions: Radiation delivery can be accomplished quickly. The majority of treatment time was consumed by anesthesia. Outliers were examined for areas for improvement. Delays in preparation were the result of staffing capacity and inadequate inter-departmental communication and care hand off. Delays during anesthesia were attributed to unfamiliarity with new anesthesia and radiotherapy equipment, and less frequently with challenging patient setups or cases of acute respiratory depression. Inaccurate communication between nurses and parents resulted in prolonged stays in the PACU. These issues were exacerbated by the numerous staff: 4 NPs in pre-anesthesia preparation, over 20 anesthesia staff (9 MDs), and 8 radiation oncology staff (3 RTTs). Our time-motion study is the first conducted in a pediatric radiation oncology program and identified three main targets for improving efficiency: reducing time sinks, clear role-assignment, and direct communication to improve care coordination.

SSC13-03

Time-and-Motion Study in a Pediatric Radiation Oncology Department