The following article features coverage from the 46th Annual Oncology Nursing Society (ONS) Congress. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

A considerable amount of cancer care is delivered in the outpatient infusion setting, and demand and growth in this setting is likely to increase, explained Jeanette Pretorius, BSN, MBA, RN-BC, NE-BC, OCN®, moderator of a panel discussion on the development and optimal implementation of acuity tools in the outpatient infusion setting at the 46th Annual Oncology Nursing Society (ONS) Congress. “It’s not surprising that many outpatient infusion centers use some sort of acuity tool to calculate or predict their staffing needs,” Ms Pretorius said.

The infusion centers where the panelists worked varied in numbers of patients seen, nurse-to-patient ratios, and lengths of nursing shifts. When asked how acuity tools are used at her facility, Georgina Rodgers, BSN, RN, NE-BC, OCN®, director of Cancer Clinical Services, Cleveland Clinic Health System in Cleveland, Ohio, described using length of infusion as an indicator for acuity to balance patient-hours per nurse. Known factors about the treatment are considered, such as expected length of infusion time and nursing time required for the regimen.

Sandy Jellen, RN, OCN®, an infusion/charge nurse at the University of California San Diego Moores Cancer Center in La Jolla, California, uses a combination of length of treatment and the level of nursing care required for a given patient to address the concern of unbalanced nurse-patient assignments. “There are, of course, potential issues when using treatment length to score acuity because not all infusions are equal,” explained Ms Jellen.

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Regardless of specific approach, the use of treatment or visit length as a component of acuity determination was common across the panelists’ statements. An analysis at one center where Angela Rodriguez, MSN, CNS-BC, RN, OCN®, director of cancer care program at Kaiser Permanente in Santa Clara, California, had worked suggested that a subjective measure of acuity assigned to a treatment turned out to be highly correlated with length of time of treatment.

Guidance is provided to schedulers to develop sensible treatment plans. Schedulers use the acuity tool to fit patients into the schedule in a manner similar to a video game in which “you’re perfectly fitting in little cubes into appointment times,” explained Ms Rodgers. Panelists also mentioned that real-time updating can enable flexibility to be incorporated into scheduling.

Some key metrics for success with acuity tools included considerations such as patient satisfaction, staff satisfaction, reduction in medical errors, and staff turnover. In discussing the advantages and disadvantages of a primary nurse model for infusion centers, Ms Rodriguez noted the importance of nurse satisfaction. “If nurses are more satisfied in their jobs, then the patients will also have higher satisfaction overall,” she concluded.

Read more of Oncology Nurse Advisor‘s coverage of the 46th Annual ONS Congress by visiting the conference page.


Rodgers G, Jellen S, Rodriguez A. Patient acuity tools in the outpatient infusion setting: how to make them work for you. Oral presentation at: 46th Annual ONS Congress; April 20-29, 2021. Accessed May 3, 2021.