title: Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times.
abstract: OBJECTIVE
  The workflow and chemotherapy preparation turnaround times at an adult infusion clinic were evaluated to identify opportunities to optimize workflow and efficiency.
  
  
  METHODS
  A three-phase study using Lean Six Sigma methodology was conducted. In phase 1, chemotherapy turnaround times in the adult infusion clinic were examined one year after the interim goal of a 45-minute turnaround time was established. Phase 2 implemented various experiments including a five-day Kaizen event, using lean principles in an effort to decrease chemotherapy preparation turnaround times in a controlled setting. Phase 3 included the implementation of process-improvement strategies identified during the Kaizen event, coupled with a final refinement of operational processes.
  
  
  RESULTS
  In phase 1, the mean turnaround time for all chemotherapy preparations decreased from 60 to 44 minutes, and a mean of 52 orders for adult outpatient chemotherapy infusions was received each day. After installing new processes, the mean turnaround time had improved to 37 minutes for each chemotherapy preparation in phase 2. In phase 3, the mean turnaround time decreased from 37 to 26 minutes. The overall mean turnaround time was reduced by 26 minutes, representing a 57% decrease in turnaround times in 19 months through the elimination of waste and the implementation of lean principles. This reduction was accomplished through increased efficiencies in the workplace, with no addition of human resources.
  
  
  CONCLUSIONS
  Implementation of Lean Six Sigma principles improved workflow and efficiency at an adult infusion clinic and reduced the overall chemotherapy turnaround times from 60 to 26 minutes.
authors.affiliation: Matthew H. Lamm, Pharm.D., M.S., BCPS, is Lead Pharmacist, Department of Pharmacy, University of North Carolina (UNC) Hospitals-Hillsborough Campus, Chapel Hill. Stephen Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, is Associate Director of Pharmacy, UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC, Chapel Hill. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC. Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director, Department of Pharmacy, UNC Hospitals, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Lamm
authors.affiliation: Matthew H. Lamm, Pharm.D., M.S., BCPS, is Lead Pharmacist, Department of Pharmacy, University of North Carolina (UNC) Hospitals-Hillsborough Campus, Chapel Hill. Stephen Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, is Associate Director of Pharmacy, UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC, Chapel Hill. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC. Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director, Department of Pharmacy, UNC Hospitals, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC.
authors.forename: Stephen
authors.initials: S
authors.lastname: Eckel
authors.affiliation: Matthew H. Lamm, Pharm.D., M.S., BCPS, is Lead Pharmacist, Department of Pharmacy, University of North Carolina (UNC) Hospitals-Hillsborough Campus, Chapel Hill. Stephen Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, is Associate Director of Pharmacy, UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC, Chapel Hill. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC. Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director, Department of Pharmacy, UNC Hospitals, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC.
authors.forename: Rowell
authors.initials: R
authors.lastname: Daniels
authors.affiliation: Matthew H. Lamm, Pharm.D., M.S., BCPS, is Lead Pharmacist, Department of Pharmacy, University of North Carolina (UNC) Hospitals-Hillsborough Campus, Chapel Hill. Stephen Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, is Associate Director of Pharmacy, UNC Hospitals, and Clinical Associate Professor, Eshelman School of Pharmacy, UNC, Chapel Hill. Rowell Daniels, Pharm.D., M.S., is Director of Pharmacy, UNC Hospitals, and Executive Associate Dean of Clinical Practice, Eshelman School of Pharmacy, UNC. Lindsey B. Amerine, Pharm.D., M.S., BCPS, is Assistant Director, Department of Pharmacy, UNC Hospitals, and Assistant Professor of Clinical Education, Eshelman School of Pharmacy, UNC. lindsey.amerine@unchealth.unc.edu.
authors.forename: Lindsey B
authors.initials: LB
authors.lastname: Amerine
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D000554:Ambulatory Care Facilities; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D004339:Drug Compounding; D017598:Efficiency, Organizational; D006801:Humans; D007262:Infusions, Intravenous; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D057188:Workflow
chemical_list: D000970:Antineoplastic Agents