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N Mackay


To improve patient satisfaction, reduce hospital incurred drug costs and create bed capacity through a better managed system of co-ordinated care that avoids unplanned inpatient admissions for chemotherapy treatments using the OIS.


As part of the extension of the OIS to the inpatient setting, a process mapping exercise of service wide chemotherapy referrals was attended with key clinicians and administrators. This exercise reviewed patient admission trends, related drug costs and referral pathways across the service. The barriers to a systematic process of referral were identified, and a small team was established with the objective of avoiding patient chemotherapy admissions by utilising vacant outpatient resources. The OIS enabled the organisation of service wide chemotherapy referrals so that patient care could be provided in the appropriate location.


Timely access to patient information using a process supported by an OIS enabled opportunities for the appropriate co-ordinated management of cancer services chemotherapy referrals. A comparison of patients treated with outpatient chemotherapy regimens in the inpatient setting showed that in 9 months prior to August 2013, 235 patients were treated with outpatient regimens. In the 9 months following the changes, 166 patients were treated with outpatient regimens, a reduction of 30%.  The project was also able to measure a total of 89 bed days saved by avoidance of admission, resulting in increased bed capacity for the inpatient unit. Drug cost savings were also calculated for the hospital as outpatient treatment was paid federally through the PBS and not encumbered upon the hospital. A drug cost saving to the hospital of $35,000 was calculated for the 9 months following the changes.


The improved co-ordination of referrals for chemotherapy care throughout our service has improved inpatient bed capacity and reduced hospital incurred inpatient drug costs. In addition, the provision of care in the appropriate location aligned with reported improved patient experience.