Background
The Nepean Blue Mountains Local Health District delivers cancer care across a large geographical region with the Nepean Cancer and Wellness Centre providing centralised outpatient services and a primary chemotherapy unit, supported by satellite chemotherapy units at Lithgow and Hawkesbury Hospitals, treating approximately 300 patients per week. Clinical support for these services is coordinated via a medical oncology registrar pager. This high patient volume generates frequent pager-based communication, contributing to workflow inefficiencies.
We aimed to develop a tool to support nursing decision-making, improve workflow, and maintain patient safety.
Methods
A service redesign approach was undertaken. Medical oncology registrar pager activity was audited using a purpose-built app, with data collected and analysed at monthly intervals over three months. Findings were presented at departmental meetings, where key stakeholders agreed on the development of a Clinical Decision Tool (CDT) using a co-design approach. Following implementation, a further three-month audit of registrar pager activity and survey of nursing staff tool experience was conducted to evaluate tool performance and its impact on clinical practice. Proportions were compared using Chi-squared testing.
Results
Baseline audit demonstrated that 66% of pager activity originated from the chemotherapy unit, with 33% of pages relating to routine blood test reviews. Following implementation of the CDT, the proportion of potentially avoidable pager interactions decreased from 68% to 44% (p = 0.04).
Eighteen nurses completed the post-implementation survey with an overall response rate of 72%. The majority strongly agreed that the CDT was easy to use (78%), that information was accessible (83%), that it improved confidence in clinical decision-making (83%), and that it supported safe practice (78%). Overall, 89% of nurses were very satisfied with the CDT.
Conclusions
Application of redesign methodology facilitated successful implementation of a CDT, supporting nursing decision-making while improving workflow efficiency in a high-volume cancer centre.