Prolonged patient wait times for blood tests at our Cancer Centre negatively impacted both patient satisfaction and staff workload. This issue was particularly pronounced in the uro-oncology department, where patients undergoing treatment for prostate cancers required frequent blood monitoring as part of their outpatient care. Delays in blood testing led to inefficiencies in treatment planning, patient frustration, and increased pressure on phlebotomy and clinical staff [1]. A key contributor to these delays was a breakdown in
communication: many patients did not check in at the front desk post-outpatient appointments, resulting in the phlebotomy team being unaware of their presence (Figure 1). Another possible cause identified could be at times clinicians not reminding patients to check in, exacerbating inefficiencies and prolonging waiting times.

Addressing these gaps was essential to improving patient flow and ensuring timely management of conditions affecting continence.

The project was structured around three Plan-Do-Study-Act (PDSA) cycles.

PDSA Cycle 1: Implemented visual reminder posters at key locations, such as reception and waiting areas, to direct patients to check in at the front desk before their blood tests. These posters were designed collaboratively with administrative and phlebotomy teams as well as clinicians. 

PDSA Cycle 2: Focused on consultant grade clinician awareness programmes through targeted emails and direct communication in multidisciplinary team meetings, emphasising the importance of informing patients about the check-in process during outpatient consultations. 

PDSA Cycle 3: Addressed sustainability by involving junior and middle-grade trainees alongside specialist nurses, enhancing awareness materials, and placing additional reminder posters within clinics. This cycle also explored incorporating information into new staff orientation materials. Quantitative data was gathered via weekly staff satisfaction surveys using Likert scales over a 13-week period [2]. The primary outcome measured was staff satisfaction regarding patient wait times, serving as a proxy for the project's impact on workflow efficiency. Secondary outcomes included qualitative feedback from patients and clinicians regarding the clarity and effectiveness of the interventions.

PDSA Cycle 1: Staff satisfaction increased by 12%, surpassing the initial goal of a 10% improvement. Introduction of posters enhanced patient compliance, reducing delays in phlebotomy (Figure 2). 

PDSA Cycle 2: An additional 14% increase in staff satisfaction was observed after clinician awareness programmes. Interviews with a clinician confirmed greater awareness of the check-in requirement, resulting in improved patient adherence (Figure 2). 

PDSA Cycle 3: Faced challenges in sustaining improvements, with an observed 11% decline in satisfaction. Factors influencing this decline included survey fatigue, inconsistent staff participation, and workflow disruptions during the holiday period. Run charts indicated positive trends following the first two cycles but lacked sufficient data points to confirm sustained statistical significance (Figure 3).

The QIP successfully reduced patient wait times and improved staff satisfaction through visual aids and targeted clinician awareness. The use of posters was an effective, low-cost intervention that significantly improved patient adherence to check-in protocols, while clinician awareness programmes were critical in ensuring compliance [3]. However, sustaining improvements remains a challenge. Future efforts will focus on embedding changes into electronic health systems, such as automated reminders for both patients and clinicians, ensuring long-term adherence. Integrating check-in prompts within electronic patient records (EPIC) and utilising automated text reminders are potential solutions for maintaining compliance. Expanding the interventions to other departments within the cancer centre is recommended to maximise impact. Presenting findings at consultant meetings and multidisciplinary team discussions could facilitate broader implementation across the trust.

This QIP underscores the power of simple yet strategic interventions in improving patient flow, staff satisfaction, and overall efficiency in a clinical setting. Through ongoing collaboration and refinement, these interventions have the potential to create lasting improvements in healthcare delivery.

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NOOR NHm et al. Empowering Patients through Informative Health Posters: Enhancing Understanding and Engagement. J Cardiothorac Vasc Anesth 2023; 37: 64.