NS-66: Project to improve volume of treatment and satisfation-PIVOTS, a quality improvement project

Background The Huntsman Cancer Institute Multiple Myeloma (MM) Program is the primary referral center for the Intermountain West. Over the past 5 years, our Program has experienced a 40% increase in patient volumes, an increase to 4 MM physician providers, and significant expansion of the clinical trial portfolio and clinical/trial support staff. Our previous care model was inefficient and did not optimize the independence of our advanced practice clinicians (APC). Previously, we relied on a traditional “resident model” in which APCs staffed every patient with the attending physician. Our provider group hypothesized that utilizing a more contemporary clinical model would improve clinical efficiency and Relative Value Unit (RVU) generation and enhance job satisfaction for all members of our clinical team while maintaining high patient satisfaction scores. This model, called Project to Improve Volume of Treatment and Satisfaction or PIVOTS, is focused on 4 fundamental pillars including: 1) Modifying physician and APC clinic templates to optimize daily clinic volumes; 2) Establish specific “divisions of labor” for patient follow-up; 3) Standardization of post-autologous transplantation follow-up and disease reassessment; and 4) Standardization of new and return patient clinic notes. The main objective of this project is to fundamentally change our care model to better support our patients and optimize the productivity and moral of our team. Design and implementation Physician templates includes seeing all new patients, follow-up visits with disease reassessments and treatment modification, and per patient request. APC templates shifted to the RCO Model (Revlimid maintenance, Cruising patient, and Outpatient transplant) and acute issue and day 1 treatment visits. Clinic note templates for new, return, and acute patient visits were constructed as a team over the 6 months prior to starting the project Metrics A 12-month period from May 2021 – April 2022 has been specified and the following metrics have been defined pre- and post-PIVOTS implementation. RVU generation will be collected for all providers over this 12-month timeframe and descriptively compared to per provider metrics from the prior 2 years. University Qualtrics and Patient Experience has developed and implemented all job satisfaction surveys that will be completed by all staff (MA, RN, APC, physician) at 3, 6, 9, and 12 months. Patient satisfaction scores and comments are collected per institutional standards. Research productivity for all members of the MM Program will be collected pre- and post-PIVOTS implementation and will include abstract submissions, grant funding, and manuscript production. Results The PIVOTS project will be instrumental in defining a new standard for structuring a dedicated myeloma clinic to improve clinical and academic productivity and job satisfaction without compromising a high-quality patient experience.