Purpose/description: Due to distancing requirements forced by the COVID-19 pandemic, access was challenging in our hospital-based, five-bed pediatric infusion therapy center (PITC). This, accompanied by several other factors, contributed to a less-than-optimal patient experience, especially for patients who had clinic appointments and chemotherapy on the same day, but in different locations. Providers, patients, and families were vocal in sharing their dissatisfaction regarding convenience, location, and length of day with appointments(s) and infusion(s).
Prior to the pilot, pediatric patients were scheduled to have laboratory specimen collections, lumbar punctures, and clinic appointments in one location, and then were required to travel to the hospital based PITC to receive their 15-minute chemotherapy infusion. Depending on availability in the PITC, some patients would wait hours between appointments and their infusion, be admitted to the hospital, or receive their infusion in an adult infusion therapy center. Further, the clinic space and hospital based PITC are located 10 blocks from each other, adding inconveniences associated with travel and parking.
An interprofessional team was formed to evaluate current medications administered in the PITC and assess for feasibility of administration in our ambulatory care pediatric oncology clinic space. In this model, access would be opened for longer infusions to occur in the PITC by offloading infusions that were shorter in duration. Criteria such as duration of infusion, risks for adverse reactions, location of drug storage, and billing implications were assessed. Guiding principles were identified for the project, with patient safety identified as the top priority. Also prioritized was the provision of care for pediatric patients in pediatric locations.
Five chemotherapy drugs, two colony-stimulating factor medications, and three anti-emetics were originally selected as drugs that could be safely and efficiently given in the ambulatory care clinic setting.
Results/outcome: During phase I, 25 unique patients safely received a total of 52 chemotherapy infusions in the ambulatory care clinic setting. There were no patient events reported related to the infusion pilot. 100% of eligible patients received their infusion in the ambulatory care clinic location. The interprofessional team significantly reduced the number of pediatric infusions administered in the adult infusion therapy center. Due to the success of phase I, the team expanded access and the number of chemotherapy drugs to be infused as part of phase II. Nearing the end of phase II, 52% of available slots were utilized. Four chemotherapy drugs and one anti-emetic were added. In total, nine chemotherapy infusions can now be administered alone or in conjunction with a second chemotherapy infusion in the ambulatory care clinic setting
A limited trial of chemotherapy infusions was shown to be safely and efficiently administered in an ambulatory care clinic setting. The coordination of laboratory specimen collections, appointments, and chemotherapy infusions in one space was appreciated and preferred by patients and families. Offloading shorter infusions from the PITC to the ambulatory care clinic setting improved access for longer infusions in the PITC.