Bridging the Silos: Utilizing the Lean Model Rapid Improvement Event to Improve the Mobilization Process

The procedure for mobilization has been standardized and was thought to be coordinated well between the various departments.  Upon instituting a clinical trial utilizing plerixafor for patient and healthy donors on the same day as pheresis, we were presented several opportunities for improvement of our patient experience as well as our communication between departments.  In the clinical trial, Plerixafor is given in an infusion center 4 hours prior to apheresis.  During this 4 hour break, the patients left the infusion center but were noted to have side effects such as fainting or explosive diarrhea.  This left the patient/donor with no medical connection and the pheresis department feeling ill informed about the patient/donor.  The transplant team at a large comprehensive cancer center identified the need to hold a rapid improvement event (RIE) related to our mobilization procedures.  An RIE is a tool utilized within Lean Management Principles.  It is typically a 3-5 day meeting that brings frontline workers together to identify creative solutions for a focused problem.   We called our RIE “Creating the ideal donor/patient experience” with the goal to improve the donor/patient experience as well as improving interdepartmental communication.

A systems engineer was called to be the RIE team leader.  The team included representation from pheresis, transplant nurse coordinator, both sites of infusion and leadership.  The group spent 4 hours identifying the problems surrounding mobilization. Areas identified as needing improvement included; the mobilization orders, the handoff process between the infusion center to the pheresis department and back, the consistent evidenced based education for patient symptoms related to mobilization as well as several minor logistical communication processes.  The team then was assigned “homework” and reconvened on several occasions.

Outcomes of the RIE:  Patients now stay within the infusion center until they are ready to go to pheresis and at that time they are escorted by an MA after being deemed stable; the development of a formal written handoff for the pheresis department from the infusion center; the creation of new mobilization orders that are significantly easier to understand by all areas; the development of a quick reference sheet for nurses outlining typical side effects and interventions specific to the mobilization period.  Most importantly, we have had no patients incur side effects outside of medical care since initiating this process.  We continue to review our process and make changes on a regular basis.