Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2019


Doctor of Nursing Practice (DNP)

Primary Advisor

Cathie E. Guzzetta, PhD, RN, FAAN; Mary-Michael Brown, DNP, RN; Quiping (Pearl) Zhou, PhD, RN


Background: Outpatient oncology clinics are complex environments. The multi-step, sequential nature of oncology treatment contributes to delays. Prolonged wait time impacts patient compliance, satisfaction, and staff satisfaction.

Objectives: To assess throughput in the outpatient pediatric oncology clinic and explore staff’s assessment of throughput and their opinions of what might be improved.

Methods: Our descriptive-comparative study used retrospective reviews to measure four time intervals for 312 visits at our mid-Atlantic outpatient clinic. Patient and appointment factors were explored. Mean interval times were calculated and differences impacting throughput were analyzed using ANOVA. Prospective survey data were obtained from 22 clinic staff and themes were identified.

Results: The shortest interval was check-in to triage (18.49 ± 18.21 minutes) while the longest was from receiving laboratory results to treatment initiation (136.73 ± 77.98 minutes). Throughput was significantly shorter for appointments consisting of provider visit and laboratory studies only compared to visits involving infusions and blood product transfusions (p < .001). Throughput for 8:00-10:00 a.m. appointments was significantly longer than 2:01-6:00 p.m. appointments (p = .013). Staff respondents reported throughput was suboptimal. Common problems identified were appointment noncompliance, laboratory workflow, triage and front desk bottlenecks, physician timeliness, fellow workflow, and “saving seats”.

Conclusions: Delays occurred at each clinic intersection but were significantly longer with early clinic appointments and infusion and transfusion visits. Staff highlighted problems at each clinic juncture and overarching problems that caused inefficiencies. We identified priority areas to be addressed via targeted interventions in a structured action plan to improve clinic efficiency and throughput.

Open Access




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