Organizing and implementing a multidisciplinary fast track oncology clinic.

Area of Science:

• Oncology
• Health Services Research
• Healthcare Management

Background:

• Gastrointestinal malignancy patients require multidisciplinary care, often leading to sequential appointments and prolonged waiting times.
• Existing hospital structures can create bottlenecks, delaying diagnosis and treatment initiation.

Purpose of the Study:

• To evaluate the impact of a fast track clinic (FTC) on reducing waiting times for patients with gastrointestinal malignancies.
• To assess the effectiveness of a combined top-down and bottom-up implementation strategy for a new outpatient clinic model.

Main Methods:

• A fast track clinic (FTC) was established within the existing hospital framework, integrating patient-centered care principles.
• A hybrid implementation strategy combined a top-down mandate for interdepartmental cooperation and resource allocation with bottom-up physician-led brainstorming for operational planning.
• Care coordination was enhanced through specialist-led consultations, dedicated nurse coordinators, and consideration of patient preferences and comorbidities.

Main Results:

• Patient influx to the FTC tripled since its 2009 implementation.
• Average waiting time for initial appointments decreased from 2-4 weeks to 6 working days.
• Time from diagnosis to treatment initiation was reduced from 12-14 weeks to 17 working days.
• These improvements were achieved through resource reallocation without increasing overall hospital resources.

Conclusions:

• A combined top-down and bottom-up approach effectively facilitated interdepartmental collaboration and established a shared vision for patient-centered care.
• The FTC model enhances information exchange among specialists via co-location and a shared electronic health record.
• The FTC represents an organizational change that improves efficiency and patient outcomes within the existing hospital structure.