(Management Case Study) Establishing a Health-System Infusion and Injection Strategy with Integrated Clinic Infusion Pharmacists

Purpose: Outpatient infusion center practices vary widely across institutions and sites of care. A clinic infusion interdisciplinary workgroup at VUMC identified ongoing barriers to the utilization of VUMC infusion sites including scheduling process inconsistencies, limited staff resources to organize and initiate therapy, and complex approval processes. This case describes a multi-phase strategy the workgroup used to overcome the identified barriers utilizing integrated clinic infusion pharmacists and provides knowledge on how to create a similar structure at other organizations.

Methods: This was a single-center, cohort, multi-phase, prospective study at a large, quaternary, academic medical center. Outpatient infusion administrations were included in this study if they occurred in the clinics with an integrated clinic infusion pharmacist and were targeted high-impact medications. Infusions were excluded if they were not within these clinics or were not one of the targeted high-impact drugs. Secondary outcomes included: time from order entry to first infusion; return-on-investment; increased utilization of various infusion centers; and clinic staff satisfaction. Outpatient infusion administrations were divided into two cohorts: a pre-implementation of integrated clinic infusion pharmacists cohort with outpatient infusions administrations from April 2021 to January 2022, and post-implementation of integrated clinic infusion pharmacists cohort with outpatient infusion administrations from April 2022 to January 2023.

Results: A total of 4586 outpatient infusion administrations were included in the study. As the integrated infusion pharmacists began working within the respective clinics, a statistically significant upward trend can be seen in the overall administration of high-impact medications (pre-implementation: 2177 infusions vs. post-implementation: 2409 infusions; p=0.009).

Conclusion: The implementation of an integrated infusion team can have a positive impact on patient access to infusion and injection therapy at entity owned infusion locations. This team can also increase the retention of outpatient infusion therapy with a positive return on investment.