Optimizing Oncology Capacity as Patient Volumes Increase

In this interview with Pharmacy Times, Donna Berizzi, DNP, RN, OCN, NEA-BC, associate chief nursing officer of the Cancer Service Line at Johns Hopkins Medicine, discusses strategies for managing high patient volumes and expanding ambulatory oncology care. Berizzi explains that historical data and AI-enabled scheduling can help teams anticipate demand, identify bottlenecks, balance capacity, and reduce unpredictable workload changes that contribute to nursing stress. She emphasizes that these technologies support—but do not replace—clinical judgment or limit scheduling flexibility. Through AI-enabled scheduling, workflow redesign, and advance clinical verification, Johns Hopkins increased weekday ambulatory oncology volume by 16% without adding chairs, operating hours, or clinic days.

Pharmacy Times: What operational strategies can centers use to optimize infusion chairs and nursing capacity without compromising patient safety or care quality?

Donna Berizzi, DNP, RN, OCN, NEA-BC: I think the importance of that question is that when you look at a patient’s visit through the lens of each individual team member, you gain a better understanding of everything that goes into the appointment. I view it from a nursing perspective, whereas the pharmacy views it from a different perspective. Do they have the right technicians? Do we have the appropriate number of hoods? Is there a drug shortage? Considering all these perspectives is incredibly helpful.

I also think patients need to understand that when unexpected delays occur, everything we do is viewed through a quality and safety lens. This needs to be explained to patients because they may not know what happens behind the scenes or understand the level of care coordination required for their appointments. That understanding can make a significant difference.

High patient volume is not always controllable, and we are accustomed to that. However, if we continue to prioritize safety and quality, we will add time to a patient’s appointment when necessary because that quality and safety component must remain the priority.

Pharmacy Times: With high patient volume identified as a leading contributor to burnout, how can better scheduling and capacity management reduce pressure on infusion teams?

Berizzi: To reiterate, the important distinction is that high patient volume is not always controllable. We are working hard to move anything that can be moved into the outpatient ambulatory setting for patient comfort and safety and to alleviate pressure on inpatient units. Although I may not be able to change the high volume, I can address the variability, unpredictability, and mismatch between demand and capacity.

High patient volume is a reality in oncology. Even freestanding cancer hospitals will tell you that they do not have enough inpatient beds. Therefore, the patients who are hospitalized represent the sickest members of our patient population. At Johns Hopkins, it is extremely important to move as much care as possible into the ambulatory setting.

We are moving autologous and allogeneic transplantation, chimeric antigen receptor (CAR) T-cell therapy, and bispecific T-cell engager (BiTE) therapy into the ambulatory setting. We begin as much cellular therapy as possible in the ambulatory setting and have created an umbrella of support and resources around that patient population. If a patient requires urgent admission, we have a bed available. If a patient needs to be evaluated but we do not want them to go to the emergency department, they have access to our Oncology Evaluation and Treatment Center, which is open 24 hours a day, 7 days a week. It is essential to ensure that these resources are available to patients.

Among our survey respondents, 29% identified high patient volume as a leading contributor to burnout, whereas 40% identified last-minute shifts or adjustments in assignments and patient templates as major contributors to nursing stress. This is extremely important because when patient demand is heavily concentrated during certain hours, the effects extend across the entire infusion area.

We carefully evaluate our scheduling and rely heavily on historical data, which LeanTaaS iQueue uses to help us build our templates. We are working toward more consistent daily operations and eliminating days that routinely extend beyond regularly scheduled hours. Predictability gives people back a sense of control, which matters for nursing well-being and retention, as well as for all the other multidisciplinary team members who contribute to well-run daily operations.

Pharmacy Times: What role can AI and advanced technology play in forecasting demand, managing capacity, and preparing for unexpected resource constraints?

Berizzi: Again, I want to emphasize the value of historical data, which places LeanTaaS iQueue above any other scheduling platform I have used. As cancer care delivery becomes more complex, data-driven decision-making is crucial. We are caring for more patients with increasingly complex needs, and a growing amount of cancer care is shifting to the ambulatory setting.

Artificial intelligence (AI) and advanced technology are particularly valuable when they help solve operational issues, such as forecasting patient demand, identifying bottlenecks, balancing capacity, and creating more predictable workflows. This is what can happen when AI is used in partnership with a company such as LeanTaaS and its iQueue platform.

However, AI does not make decisions or replace nursing judgment, nor does it make clinical decisions. It does not increase workload, even though it may initially appear that way. It is not a rigid scheduling system, it does not eliminate flexibility for add-on appointments, and it is not a staffing reduction tool. Instead, it helps teams prepare.

It is important to demystify AI for nursing staff because they may hear that it is going to replace individuals. For nurses, AI is not replacing anyone; it is making our jobs more efficient.

Pharmacy Times: As more cancer centers plan to expand services, how can leaders increase patient access while working within existing staffing, pharmacy, and physical-space limitations?

Berizzi: I think growth cannot rely solely on adding more space, chairs, or staff. You must examine how care is delivered, think differently about where it is delivered, determine how capacity is used, and consider how resources are shared across the cancer service line.

The report highlights that 65% of cancer centers are planning to expand services, which is an enormous percentage. Additionally, 61% identified patient flow and scheduling as their greatest operational challenges. These findings show that there is a significant opportunity to improve access by optimizing the capacity we already have.

Improving patient flow, implementing better scheduling and advanced clinical verification, preparing medications in advance, and strengthening coordination among nursing, pharmacy, clinicians, practice nurses, and operational teams can help eliminate avoidable variability and make better use of existing chairs and space.

At Johns Hopkins, we use a combination of artificial intelligence–enabled scheduling, workflow redesign, and advanced clinical verification across 6 sites that provide ambulatory oncology care. Our weekday volume increased by 16%, from approximately 257 to between 299 and 300 patients per day. We added no chairs, hours, or clinic days.

You can add clinic days, but that often means opening an entire building. You are not adding only nurses; you are also adding schedulers and greeters. Therefore, you must consider the bigger picture and determine whether that is the best financial decision. This is a powerful example of how capacity can be managed through operational design instead of physical expansion.

I would love to add another building, but we are in the middle of a city and do not have room to expand. A cancer center in a more rural area with ample space may have that option, but we must also consider where patients receive care.

One of our local hospitals in Washington, DC, is approximately 40 miles away, but traveling between Washington, DC, and Baltimore can take a long time. We therefore evaluated which programs we could bring to the Washington, DC, site. We examined patients’ zip codes, where they lived, and where they wanted to receive treatment. Based on that information, we began increasing the availability of certain regimens in that area.

For example, we have been treating patients undergoing autologous transplantation in the ambulatory setting at Sibley Memorial Hospital for the past 18 months. Implementing that program required a substantial effort, but eliminating the need for patients to spend 1½ hours traveling on the Beltway for an appointment has been a game changer.

This approach reinforces the importance of treating patients where they live. At the end of the day, they can return home. They may need to come back the next day, but they can sleep in their own beds and eat their own food. That makes an enormous difference.

We have applied this approach to cellular therapy, bispecific treatments, and other complex therapies. We evaluate specific patient pathways and determine where those pathways could be offered outside our largest hospital so that patients can remain in their communities. That has made an enormous difference.

Viewing care through a cancer service line lens also allows leaders to think beyond the capacity of a single location and consider the bigger picture: Where is the best place for each patient to receive treatment?

We have also separated laboratory appointments from clinician visits. If a patient is willing and able to have laboratory testing completed the day before treatment, we can review the results and complete verification in advance. When the patient arrives for treatment the following day, we are ready to proceed, and the wait is almost negligible.

However, efficiency cannot come at the expense of the workforce. We cannot increase throughput without considering treatment complexity, nursing workload, and pharmacy capacity. These elements can no longer be viewed separately. We must evaluate them collectively as one multidisciplinary team.