Improving Waiting Times for Radical Radiotherapy Treatment of Nasopharyngeal Cancer Based on Logistics Re-engineering

CCY Lee, ACK Cheng, NKH Lam, DCW Chan, LCY Lui, CC Yau

Hong Kong J Radiol 2010;13:181-8

Objectives: Waiting time for radiotherapy is an important quality indicator for oncology services, and particularly so in the radical treatment for head and neck cancers where timing impacts treatment outcome. Reducing the waiting time for treatment is therefore

highly desirable in nasopharyngeal cancer, which is the commonest head and neck cancer in this locality. Using existing resources, we aimed to reduce waiting time for such radiotherapy, whilst maintaining the quality of services. By identifying important bottlenecks in service delivery, we reengineered workflow logistics to tackle radiotherapy waiting time holdups.

Methods: The changes in workflow were implemented in two phases. Phase 1 entailed: (i) Setting of a target deadline for radiotherapy commencement, measured from the first consultation. (ii) Prioritising magnetic resonance imaging appointments. Phase 2 entailed: (i) Earlier referral from regional ear, nose and throat departments upon endoscopic diagnosis of nasopharyngeal cancer. (ii) Booking of workup procedures immediately upon receipt of a referral letter (i.e. before the first visit). (iii) Seeing all newly referred patients within 2 weeks. Waiting times data for the period before, during, and after implementation of these logistic changes were compared.

Results: Data from 177 nasopharyngeal cancer patients showed a significant improvement in the waiting times for treatment after implementation of the logistic changes (diagnosis to treatment: 54 days vs. 38 days, p < 0.001). There was also a reduction in waiting times for critical workup procedures and a reduction in patients being referred out to other centres for treatment. These measures did not appear to impact on the waiting times for radical treatment of other cancers.

Conclusions: Logistical re-engineering is feasible and effective in reducing waiting times for radical nasopharyngeal cancer treatment.







結果:新工作流程實施後,大大縮短了共177位病人接受放射治療的輪候時間,從確診至治療的時間由54天縮短至38天(p < 0.001)。安排重要檢查程序的輪候時間也較短,亦有較少的病人須要被轉介至其他中心接受治療。此外,新工作流程並沒有影響其他癌症病人的輪候根治性放療的時間。