Background
The aim of the study was to identify sources of delays at the chemotherapy unit at Sir Charles Gairdner Hospital, WA which could be alleviated and improve patient care.

Methods
Patients were recruited in the waiting room of the Medical Oncology or Chemotherapy Outpatient Unit over two one week periods in 2012. Data was collected about time spent on tasks, treatment or waiting from patients and staff within the medical oncology outpatients, chemotherapy day unit, and pathology and pharmacy departments.

Results
Of 302 patients booked for outpatient chemotherapy 130 (43%) consented to take part in the study; median age 63 years and 69 (55.6%) female. The longest waiting periods for patients were from appointment time in outpatients until oncologist consultation (mean 39.7 minutes) and from chemotherapy appointment time until seated in the chemotherapy chair (mean 56.3 minutes). The mean waiting time within the Chemotherapy Day Unit was longer for patients with an oncology outpatient appointment earlier (96.5 minutes, 95% C.I. 78.1, 114.8 versus 60.0 minutes, 95% C.I. 47.9, 72.1). In a multiple regression analysis of the pharmacy drug production time (R2=0.28, F(4, 216)=20.85, p<0.00), time of day (β= 280.9, t=2.72, p=0.00), day of week (β= 173.5, t=5.32, p=0.00) and if drugs can be prepared ahead of time (β= -690.1, t=-6.63, p=0.00) were all statistically significant. Patient waiting times were only affected by same day medical oncology appointment (β= 35.1, t=3.23, p=0.00) using multiple regression (R2=0.11, F(4, 109)=3.54, p<0.01).

Conclusions
People who attend outpatient appointments on the same day as chemotherapy are spending 1.6 times as long waiting in the chemotherapy unit compared to those attending the chemotherapy unit only. The pharmacy production times for those only attending the chemotherapy unit likely demonstrate that preparation can be planned ahead and thus chemotherapy drugs are available when the patient is ready.