Improving Theranostic Clinic Flow at a High Volume Specialized Cancer Center

Purpose: Nuclear Imaging physicians have long been involved with diagnostic and therapeutic treatment (theranostics) with radioactive iodine. Newer Lutetium 177 therapies provide unique challenges to clinic workflow and need to be coordinated with patients coming exclusively for imaging. We examined clinic flow to find areas of improvement with the goal of decreasing patient dwell time by 10% from September to December 2023.

Methods/Materials: Nuclear Medicine clinic front desk staff, technologists, nurses, managers, physicians, and patients were interviewed to find causes of delays, dissatisfaction, and decreased efficiency as part of the stakeholder analysis. These were then analyzed to determine targets for improvement. Prior improvements included finding new clinic space for patient consultation as they require more clinic time for infusion, observation, and imaging, and dedicating one attending physician to therapy patients to minimize daily interruptions.

Results: A few areas of improvement were identified in the areas of patient consultation and imaging time. For this cycle, we focused on the consent process. Theranostic patients are usually on a standard therapy regimen with four or six doses of the same radiopharmaceutical. In our clinic, patients and physicians had to sign a separate consent form for each cycle, a repetitive task that is not standard across institutions or required by our hospital policy. We created a new consent form that included the full treatment regimen as well as new patient education resources. This did not significantly decrease the average consultation time, as patients have different needs and questions, but allowed physicians and technologists to focus on patient care than repetitive paperwork.

Conclusions: The recent approval of theranostic agents led to a change in Nuclear Medicine clinic needs, with increasing demand for physician consultation time with patients, clinic office space and scanner time. As theranostics continue to be an integral part of Nuclear Medicine, we will need to optimize patient care and clinic efficiency. In this cycle, we were able to eliminate a source of redundancy identified by patients, technologists, and physicians.