Factors and Costs Associated With Delay in Treatment Initiation and Prolonged Length of Stay With Inpatient EPOCH Chemotherapy in Patients With Hematologic Malignancies

Abstract

Reducing delays related to inpatient chemotherapy may reduce healthcare costs. Using a national database, we identified patients with lymphoma/leukemia with ≥1 etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone (EPOCH) chemotherapy claim and evaluated chemotherapy initiation delay (ID), >1 day from admission. Standard tests/procedures prior to initiation were evaluated. Among 4453 inpatient cycles, 19.7% had ID, odds ratio 2.28 (95% confidence interval: 1.83–2.85) with cycle 1 compared to cycle 2, and mean costs were higher in patients with ID than without ID (p < .0001). Prior to cycle 1, patients were more likely to undergo routine diagnostic procedures compared to subsequent cycles. Efforts to perform routine procedures prior to admission may reduce hospital length of stay and costs.

Clinical Process Optimization of Transfemoral Transcatheter Aortic Valve Implantation

“…Comparing the needed time for preparatory examination until TAVI procedure, we found a significant shorter duration from the day of admission to implantation in 2016/2017 (2014/2015: 9 days [7,13], 2016/2017: 6 days [3,10]; p = 0.001). The same tendency was seen for the time range from implantation to discharge (2014/2015: 9 days [7,11], 2016/2017: 7 days [6,12]; p = 0.001).…”

“…By the initiation of a special outpatient clinic on pre-and post-interventional care, we adhere to the structural, professional and personal requirements in order to perform the TAVI procedure. The reorganization of the outpatient clinic targeted the length of inpatient stay, in particular the preprocedural length of stay, that was often subsidized by healthcare providers until 2015 when the upper length of stay was exceeded [6,7,17]. The decrease in the preprocedural inpatient length of stay might reduce the risk of exceeding the upper length of stay, but due to the increasing complexity of procedures in a group of patients that is by definition older and severely ill with a high risk of complications such as postinterventional bleeding, prolonged intensive care unit stay cannot be completely avoided [18].…”

“…A potential surrogate for improved quality of care is the length of stay. Prolonged inpatient stays have already been shown to be associated with a higher risk of nosocomial infections, including pneumonia and urinary tract infections [3][4][5] and subsequent utilization of healthcare resources, as well as associated cost of care for the healthcare provider [6][7][8]. While some factors, such as patient age and severity of disease, were observed as independent predictors of prolonged hospital stays in patients undergoing TAVI [9], no model for the optimization of the inner clinical processing in TAVI exists so far.…”

Decreasing Time to Initiation of Chemotherapy for Patients Electively Admitted to a Hematologic Malignancy Service

“…[5][6][7] In addition to improving patient satisfaction with decreased wait times, decreasing LOS may reduce hospital-related complications [8][9][10] and the cost of care, not to mention reduce resource use. 11,12 As a result, using the Institute for Healthcare Improvement model for improvement 13 and as part of the ASCO quality training program, we developed a new workflow to decrease time to chemotherapy administration in patients who are admitted electively to an oncology unit.…”

Reducing Wait Time Between Admission and Chemotherapy Initiation

“…Longer LOS is associated with higher costs, increased risk for hospital-acquired conditions, and suboptimal use of resources. [1][2][3] Prolonged wait times also affect patient satisfaction. 4,5 Our study aimed to reduce the time to initiation of chemotherapy from patient arrival for scheduled admissions.…”