Making molehills out of a mountain: experience with a new scheduling strategy to diminish workload variations in response to increased treatment demands.

PURPOSE: A new scheduling strategy was implemented. Before implementation, treatments and planning computed tomography (ct) imaging were both scheduled at the same time. Maximal wait times for treatment are defined by the Quebec Ministry of Health's plan of action according to treatment aim and site. After implementation, patients requiring rapid treatment (priorities 0-3) continued to have their treatments scheduled at the same time as their planning ct; treatments for priority 4 (P4) patients were scheduled only after the treatment plan was approved. That approach aims to compensate for unexpected increases in planning workload by relocating less delay-sensitive cases to other time slots. We evaluated the impact on the patient experience, workload in various sectors, the care team's perception of care delivery, access to care, and the department's efficiency in terms of hours worked per treatment delivered. METHODS: Three periods were defined for analysis: the pre-transitional phase, for baseline evaluation; the transitional phase, during which there was an overlap in the way patients were being scheduled; and the post-transitional phase. Wait times were calculated from the date that patients were ready to treat to the date of their first treatment. Surveys were distributed to pre- and post-transitional phase patients. Care team members were asked to complete a survey evaluating their perception of how the change affected workload and patient care. Operational data were analyzed. RESULTS: We observed a 24% increase in the number of treatments delivered in the post-transitional phase. Before implementation, priority 0-3 patients waited a mean of 7.9 days to begin treatments (n = 241); afterward, they waited 6.3 days (n = 340, p = 0.006). Before implementation, P4 patients waited a mean 15.1 days (n = 233); after implementation, they waited 16.1 days (n = 368, p = 0.22). Surveys showed that patients felt that the time it took to inform them of treatment appointments was acceptable in both phases. No significant change in overtime hours occurred in dosimetry (p = 0.7476) or globally (p = 0.4285) despite the increased number of treatments. However, departmental efficiency improved by 16% (p = 0.0001). CONCLUSIONS: This new scheduling strategy for P4 cases resulted in improved access to care for priority 0-3 patients. Departmental efficiency was improved, and overtime hours did not increase. Patient satisfaction remained high.

[Clinical case of the month. Superficial angiomyxoma]. / Le cas clinique du mois. Angiomyxome superficiel.

Some cutaneous neoplasms are seemingly harmless, but they may prove to be problematic due to their propensity to invade or to recur. We present 2 cases of superficial angiomyxoma.

Molluscum contagiosum may affect primarily the epidermis without involving hair follicles.

Lesions of molluscum contagiosum occur on palms and in skin tags. Their origin in places where there are no hair follicles proves that the epidermis itself may be infected by the causative poxvirus. The central umbilications of lesions are therefore not necessarily related to acrotrichia.

Growth and regression of molluscum contagiosum.

The spontaneous evolution of molluscum contagiosum was studied on autoradiograms after incorporation of tritiated thymidine. Three patterns of distribution and intensity of labeling were distinguished and interpreted as three successive stages in the evolution of the lesions, corresponding to growth, steady-state, and regression. The association of an inflammatory cell infiltrate with the traumatic disruption of the infected epithelium may occur during any of the three stages. It is concluded that spontaneous regression of molluscum contagiosum may depend upon two distinct mechanisms that belong to spontaneous noninflammatory and traumatic-inflammatory processes.