Rethinking infusion staffing metrics to address the complexity of modern hematology-oncology therapies.

62 Background: Efficient and adequate infusion room staffing is critical for timely care and optimal resource use. Traditional staffing models—based on patients-per-nurse ratios—originated during an era of traditional chemotherapies and often fail to reflect the complexity of modern oncology therapies. The rise of biologics, immunotherapies, oral oncolytics, and cellular therapies (e.g., bispecifics, CAR-T) has introduced wide variability in infusion duration, monitoring needs/intensity, and toxicity management. This study evaluates infusion staffing using a service-time–based model. Methods: We analyzed 12 months of healthcare claims data from a diverse, multi-state, multi-site oncology practice network, examining infusion types, durations, services/activities, and nursing tasks. Chair time was defined as total time a patient spent in the infusion chair; nursing time included both face-to-face (securing venous access, administering injections/infusions, etc.) and non-face-to-face care (e.g., documentation, preparation, triage, scheduling, telephonic management, etc.). Staffing needs were calculated using cumulative daily chair and nursing times. A qualitative review with nurses and managers assessed perceived workload and staffing challenges. Results: Across 90 clinics and 1,150 daily encounters (range: 650–1,520), 37% of services were anti-cancer therapies. Average chair time was 2 hours (range: 0.33–7.75), with 75% spent on drug administration and 25% on related services (patient evaluation, vital signs, initiation of therapy, venous device access, monitoring, preparation, waiting, etc.). Average services per treated patient was 2.2 (range: 1–7), with majority therapeutic services. Average nursing time per patient was 1.4 hours (range: 0.35–4.9), with 66% face-to-face time. 72% of face-to-face time was spent on infusion (intravenous) services, and 22% on injection (subcutaneous or intramuscular) services. The average patient encounters per nursing FTE was 5.7 (range: 1.5–11). Patients receiving anti-cancer therapies required 1.4 hours of nursing time vs. 0.9 hours for therapeutic-only services. Surveyed nursing leaders reported increased cognitive load and burnout when staffing was based solely on patient counts, especially on days with higher-acuity therapies and newer therapeutics. Conclusions: The conventional 8-10 patient-per-nurse metric is insufficient to accurately quantify nursing workload in oncology infusion centers. Higher acuity, complexity, monitoring needs, skill sophistication, and increase in associated activities necessitate more nursing time per patient. Ensuring safe and sustainable staffing, and high-quality patient care in the era of precision oncology requires an acuity-based staffing solution. A service-time–based model offers a more dynamic approach to aligning staffing with real-time infusion demands.