Evaluation of daytime chemotherapy process optimization based on the PEDALS Model_West China Medical Journal

Authors：

FENG Qunying ^1,2 , LIU Weidong ³ , TIAN Jingyu ^1,2 , WU Haijun ² ,  YANG Zhiyou ^1,2

1. Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China;
2. Outpatient Chemoradiotherapy Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China;
3. Day Surgery Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China;

Corresponding?author：

YANG Zhiyou, Email: yzhiyou126@126.com

Keywords：

PEDALS model; daytime chemotherapy; process optimization

DOI：

10.7507/1002-0179.202601097

Video：

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Objective To investigate the efficacy of PEDALS-model-driven ambulatory-chemotherapy workflow optimization in reducing non-therapeutic waiting time and simplifying procedures, and to assess its impacts on chemotherapy service efficiency and core surgical indicators brought by pathway adjustment. Methods We identified workflow bottlenecks through on-site observation, whole-process time tracking, and interviews with patients and staff. An optimization plan was designed and implemented based on the six components of the PEDALS model. The total whole-process in-hospital time was compared between the pre-optimization period (June-December 2023) and post-optimization period (June-December 2025) to evaluate the effect of process optimization. Changes in surgical case volume and drug-cost ratio in surgical wards from 2021 to 2025 were also analyzed to assess the effect of pathway adjustment on resource allocation. Results A total of 122 patients were included, with 61 patients before and after optimization. Before optimization, the patient satisfaction was 96%; after optimization, the patient satisfaction was 100%. After optimization, the total duration from consultation to settlement for patients in all departments decreased from 332.5?min to 266.8?min, the outpatient waiting time was shortened from 18.7?min to 5.6?min, and the settlement duration dropped from 26.2?min to 8.8?min. Following the pathway adjustment, the surgical case proportion in surgical wards rose from 20% to 92%, whereas the drug-cost ratio decreased from 75% to 9%. Conclusions The PEDALS-guided process optimization shortened patient waiting times and improved the efficiency of daytime chemotherapy. The pathway change (shifting chemotherapy patients from surgical wards to outpatient care) freed up bed capacity and improved the surgical case mix. Together, these two stages offer a practical reference for daytime chemotherapy management in public hospitals.

Citation： FENG Qunying, LIU Weidong, TIAN Jingyu, WU Haijun, YANG Zhiyou. Evaluation of daytime chemotherapy process optimization based on the PEDALS Model. West China Medical Journal, 2026, 41(8): 1338-1342. doi: 10.7507/1002-0179.202601097 Copy

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1. 吳琪, 范伯男, 李巖. 2022 全球癌癥統計報告分析解讀: 中國與世界癌癥疾病負擔與流行趨勢[J]. 診斷學理論與實踐, 2025, 24(2): 135-145.
2. Qiu H, Cao S, Xu R. Cancer incidence, mortality, and burden in China: a time-trend analysis and comparison with the United States and United Kingdom based on the global epidemiological data released in 2020[J]. Cancer Commun (Lond), 2021, 41(10): 1037-1048.
3. 詹麗莉, 李蘭, 張黎, 等. 基于行動研究法的流程優化在縮短日間手術患者術前禁飲禁食時間中的研究[J]. 華西醫學, 2025, 40(10): 1629-1634.
4. 王丹, 李晨雄, 莫陶欣, 等. 基于文獻計量學的我國日間化療研究現狀分析與思考[J]. 中國衛生質量管理, 2025, 32(11): 32-36.
5. 赫賽楠, 邵兵. 368 例泌尿外科日間手術患者就醫體驗及照護需求調查研究[J]. 臨床護理雜志, 2024, 23(2): 10-13.
6. Jen WY, Chan ZY, Lee YM, et al. Reducing chemotherapy waiting times in the ambulatory setting of a tertiary cancer centre using a design thinking approach[J]. Cancers (Basel), 2023, 15(18): 4625.
7. 徐東, 蔡毅媛, 陳江蕓. 實施科學的前世今生(下篇)——理論、范式和特點[J]. 協和醫學雜志, 2024, 15(3): 686-693.
8. 茅艇華, 張冬梅, 吳友成, 等. 實施科學范式在區三級醫院心臟術后患者譫妄預防及控制中的應用研究[C]//上海市護理學會. 第六屆上海國際護理大會論文匯編(下). 上海市同仁醫院, 2024: 692.
9. 馬戈, 朱華潔, 夏琦琦. 平臺式日間化學治療中心建設經驗分享[J]. 華西醫學, 2023, 38(2): 295-299.
10. 蔡秀忠, 楊佳麗, 曾曉華, 等. 日間化療中心 PIVAS 抗腫瘤藥物試驗資源優化配置的六年混合研究[J]. 中國處方藥, 2025, 23(17): 30-34.
11. Dos Santos M, Lequesne J, Dugué AE, et al. Optimisation of chemotherapy prescription and preparation in an ambulatory unit: validation of the OPTIMA program[J/OL]. Eur J cancer care, 2019, 28(3): e13015. DOI. org/10.1111/ecc.13015.
12. Neto SBCL, Enriquez-Martinez OG, Grippa WR, et al. Nutritional status of patients with neoplasms undergoing ambulatory chemotherapy and associated factors[J]. Nutr, 2025, 17(1): 168.
13. Moore C, Strong D, Childress J, et al. Ambulatory infusional cancer chemotherapy: nursing role in patient management[J]. J Infus Chemother, 1996, 6(4): 164-170.
14. 汪呂慧, 左靖芳, 陳小芳. 基于 HFMEA 方法優化日間化療病房工作流程的研究[J]. 護理學報, 2024, 31(12): 26-31.
15. 袁芳, 馮勤, 錢援芳, 等. 基于有限時間理論的日間手術全流程護理清單的構建與應用[J]. 中華護理雜志, 2024, 59(10): 1226-1232.
16. 肺癌手術日間化管理中國專家共識 (2024 年版)[J]. 中國肺癌雜志, 2024, 27(6): 405-414.
17. 日間手術病房“平急結合”管理模式專家共識[J]. 華西醫學, 2024, 39(2): 173-177.
18. 孟楠, 李紅敏, 王倩, 等. PDCA 循環法在提高日間手術占比中的應用研究[J]. 中國衛生標準管理, 2024, 15(20): 40-44.
19. 劉遠立, 張勇. 改善腫瘤醫療服務的中國實踐[M]. 北京: 人民衛生出版社, 2025: 383.

West China Medical Journal

Evaluation of daytime chemotherapy process optimization based on the PEDALS Model

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