Discussion about how to treat more patients in less time, maintaining the highest quality.

1. Managing increasing patient numbers with
decreased time slots
Lauren Knight (Adelaide Radiotherapy Centre, Australia)

2. Overview
What do you do when the patient waiting list is being blown out, but you
are unable to schedule any more patients into the day?
• Machines fully booked
• Staff hours stretched to the limit
The answer: find a way to treat more patients in less time
• Going from 10 minute slots, treating 30 – 40 patients a day to 6
minute slots, treating 50+ patients a day
• How we got there, what worked and what we learnt
Page 2

3. Where were we?
• Siemens linear accelerators
• 10 minute time slots
• Patients booked in 10 minute
increments
• 1 x 10 minute catch up time slot
every hour
Page 3

4. What we knew
Working on the premise that patients took 12minutes to treat
• Existing time and motion studies supported this theory
• Old paper diaries and old patient record systems worked on 10
minute slots but were not flexible enough to change
• Hence the catch up slot
• 1 hour (60 minutes) ÷ 5 patients = 12 minutes each
• A patient with the 12.40pm appointment would always be kept
waiting in theory as they would not be treated until 12.48pm
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5. What was happening?
• IMRT becoming more frequent = longer treatment times
• Resulted in more 20 minute and 30 minute patient bookings
• Less bookings could be made in our usual working hours
Page 5

6. What we wanted to achieve
• Treat patients on time
• Remove the hourly 10 minute
catch up slots
• Fit more patients in
• Still run on time
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7. What we found
• IMRT patients were taking 15 minutes or 20 minutes
• 20 minute bookings allowed too much time, yet 10 minute bookings
weren’t enough and would cause us to run late
• Booking two 20 minute patients (who take 15 minutes) together,
overlapping to equal 30 minutes
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8. What we found
• Booking nightmare!
• Moving patient’s times became more difficult
• Time consuming for unit managers checking the books
• Bookings team constantly receiving override error messages
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9. Finding a new approach
• Collaborating with our peers
• Shenton House (Joondalup, WA) site visit by three of our radiation
therapist leaders
• Learn from their clinical experience with VMAT
• Assess if 5 minute slots would be feasible
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10. The outcome
• 5 minute slots may not work for us
• Elekta machines now making up the majority of our linacs
• Advancing treatment techniques: VMAT and DIBH
• Patient treatment times no longer taking 15 minutes
• Most techniques now measuring 12 minutes, 18 minutes, or 22-24
minutes
• 6 minute time slots were a better fit
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11. How we did it
• Using IT experts and new technology we extracted data and
utilization reports to show how long each activity code takes to treat
• Assessed over several weeks, then averaged
• Each activity was recreated in Mosaiq and given the time required, in
multiples of 6 minutes
• Rolled out site by site across all four sites
• These reports are also looked at periodically to assess any changes
• Most recently DIBH times were adjusted as staff become more
experienced with the technique and equipment
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12. Today
• Elekta linear accelerators
running from 7am – 6pm
• Treating 50+ patients a day, in 6
minute time slots
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13. Lessons learnt
• RT perspective
- Diligence in booking extra time for patients who fall outside the
average time slots
- Good communication with bookings staff
- Standardized set ups and immobilization to streamline
setting up the treatment room
• Patient perspective
- Adapting to very exact 6 minute appointment times
- Provided with more contact outside of the treatment room from RT’s
and nursing staff
- Less waiting time due to the machine not running late as often
- Reduced waiting list due to greater patient throughput
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14. Future developments
• Group tumour sites
• Some grouping already happens by default
- SRS/SABR on linac 1
- DIBH and breast patients on linac 2
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15. Conclusion
• Going from 10 minute slots and treating 30 - 40 patients a day
• Treating with IMRT, long beam delivery times
• Machine running from 7am – 6pm with 10 minute catch up slots
• Moving to 6 minute slots and now treating 50+ patients a day
• Treating with faster machines and more advanced techniques
• Machine running from 7am – 6pm
• Patients have the flexibility to attend before or after work
• Patients treated on time and without lengthy waiting lists
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16. Thank-you