Implementation of a Patient Assignment Process to Improve Nurse Efficiency and Ease of Use in the ATC

Background: Wait times for patients, especially those undergoing oncology treatment, can increase their stress and anxiety and have been associated with decreased satisfaction scores. Based on a nursing needs assessment, the ambulatory treatment center (ATC) nurses at the League City Houston area location (HAL) frequently had difficulty finding their patient assignment on the center’s electronic health record (EHR) patient list. This caused staff dissatisfaction and delays with starting patient treatment which resulted in low patient experience scores for 'extent appointments began on time.
Objective of project: The aim of this project was to increase patient top box scores for “extent appointments began on time” and increase staff satisfaction in ease of finding assigned patients in the ambulatory treatment center at the League City Houston area location.
Process of implementation: A nursing needs assessment was completed on the League City HAL ATC nurses via a Qualtrics survey that asked ease of finding assigned patients on the patient list, delays in patient care due to assignment process, assignment errors due to assignment process, transparency of charge nurse scheduling practices, fairness of assignment load, and frequency of 2+ C1D1 assignment in a day or C1D1+ transfusions in a day.
To address concerns from the needs assessment, an action plan was created to adopt the ATC TMC process whereby nurses are “assigned” a patient, placing them directly on an individualized nurse’s list in the electronic health record. The action plan also included sharing this process with other HALs for their adoption to create standardization across the institution.
Evaluation of successful practice: In November of 2023, the League City HAL ATC top box score for “extent appointments began on time” was 48.4. Intervention start date: December 2023, intervention end date: January 2024. Post-data: Date 1: February 2024, value: 64.1; date 2: March 2024, value: 64; date 3: April 2024, value: 63.6. Results of staff satisfaction data: “Ease of finding assigned patients on the patient list” increased 26% post intervention. Perception of “delays in patient care due to assignment process” decreased by 23%. Perception of “transparency of charge nurse scheduling practices” increased by 30%.
Relevance in clinical practice: Multiple studies have demonstrated a strong correlation between prolonged wait times and patient dissatisfaction. By conducting a needs assessment and determining where nurses were being impacted by inefficiencies in their patient assignment process, an action plan was developed that enabled them to see patients sooner and provide a timelier start to their treatment. Avoiding delays led to a superior patient experience as reflected in the improvement of top box scores for “extent appointments began on time” and staff satisfaction post-implementation.