Improving the quality of palliative care for ambulatory patients with lung cancer.
OBJECTIVE
Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time and energy in organisational aspects of care that could be better used in direct interaction with patients.


METHODS
Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding satisfaction with working conditions.


METHODS
Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care.


METHODS
Waiting time and time wasted during consultations; calmer working situation at the clinic; satisfaction among patients.


METHODS
Rescheduled patients' appointments, automated retrieval of blood test results, systematic reporting in patients' files, design of an information leaflet, and refurnishing of the waiting area at the clinic.


RESULTS
Interventions resulted in increased satisfaction for patients and staff, reduced waiting time, and reduced variability of waiting time.


CONCLUSIONS
Direct observation, focus groups, questionnaires on patients' satisfaction, and measurement of process time were useful in systematically improving care in this outpatient clinic. The description of this experience can serve as an example for the improvement of a microsystem, particularly in other settings with similar problems.
von Plessen
Christian
C
Department of Thoracic Medicine, Haukeland University Hospital, N-5021 Bergen, Norway. christian.von.plessen@helse-bergen.no
Aslaksen
Aslak
A
D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D006785:Hospitals, University; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D009664:Norway; D016522:Oncology Service, Hospital / Q000592:standards*; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010166:Palliative Care / Q000592:standards*; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care / Q000379:methods*; D011788:Quality of Life; D013997:Time Factors; D014850:Waiting Lists