Reducing Time to Chemotherapy Initiation in Patients Electively Admitted to a Hematologic Malignancy Service

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In a single-institution study reported in the Journal of Oncology Practice, Galeas et al found that intervention in key drivers in the care process could reduce the time to initiation of chemotherapy in patients with elective admission to a hematologic malignancy service.

Study Details

The goal of the intervention was to reduce median time to initiation of chemotherapy from 18.9 hours to 6 hours over 6 months. Interventions were developed by a multidisciplinary team of physicians, pharmacists, nurses, administrators, information technology analysts, pharmacy technicians, and physician assistants.

The first intervention was implemented on June 22, 2017; a column in the EPIC electronic medical record system was added to nurse multiprovider screens so that nurses could visualize when chemotherapy had been signed. The second intervention began on July 19, 2017; patients arriving at the hospital before 4 PM were to have laboratories drawn before admission. The third intervention started on July 28, 2017; physicians were notified to sign chemotherapy before their patients were admitted.  

Intervention Outcomes

The current report consists of an interim analysis of outcomes. During the first intervention cycle, covering 15 admissions, there was no change in time from signature to nurse release of chemotherapy. Median time to chemotherapy during this cycle was 21.9 hours.


  • Median time from admission to start of chemotherapy was reduced from 18.9 hours to 8.85 hours.
  • Time to receipt of laboratory results was reduced and proportion of admissions with chemotherapy signatures prior to admission was increased.

During the second intervention cycle, involving seven admissions, the median time to obtaining laboratory results from time of admission was reduced from 3.17 hours among 38 prior admissions to 0.00 hours. Median time to chemotherapy in this cycle was 24.9 hours.

During the third intervention cycle, covering 50 admissions, the proportion of admissions with chemotherapy signatures obtained prior to admission increased from 16% among 45 prior admissions to 37%. Median time to chemotherapy in this cycle was 8.85 hours (P = .005 vs 18.9 hours prior to intervention).

The investigators concluded, “By implementing new admission workflows, optimizing our use of the electronic medical record to communicate among providers, and improving preadmission planning, we were able to reduce our median time to chemotherapy for elective admissions by 53.2%. Improvement is still needed to meet our goals and to ensure the sustainability of these ongoing efforts.”

Adam F. Binder, MD, of Thomas Jefferson University Hospital, is the corresponding author for the Journal of Oncology Practice article.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.