A Multi-Center Time Study of Home Infusion Nurse Services During Therapy Initiation

Vollständiger Abstract

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Introduction Home infusion therapy is an established and growing model of care that allows patients to receive complex infusion treatments in the home setting. Successful initiation of home infusion therapy requires coordinated nurse, pharmacy, and prescriber involvement, particularly during the transition from referral to the first home visits. Although home infusion nurses perform a wide range of clinical and coordination activities, limited published data describe the time required to deliver these services or how nurse workload varies by therapy type. This multicenter descriptive observational time study quantified home infusion nurse time and task distribution during therapy initiation for anti-infective and intravenous monoclonal antibody therapies. Methods Data was collected from November 2024 through May 2025 by nurses employed by participating home infusion providers. Nurses self-reported time spent on patient-specific tasks using standardized tracking forms. Data collection began at referral and continued through the first required visits, including pre-visit activities designated as Visit 0 and the first 2 home visits when applicable. Nurse tasks were categorized as patient assessment and documentation, care plan development, vascular access device care and laboratory monitoring, education, care coordination and telephonic communication, drug administration, travel, and other work-related tasks. Travel time and drug administration time were analyzed separately to avoid duplication when nurses performed concurrent activities. Results The study included 44 patients served by 7 providers from the 5 U.S. regions: 28 receiving anti-infective therapy and 16 receiving intravenous monoclonal antibody therapy. Across the study period, nurses documented 309 tasks for anti-infective patients and 115 tasks for monoclonal antibody patients. A greater proportion of anti-infective tasks occurred before the first home visit, with Visit 0 accounting for 22.0% of all anti-infective nurse tasks compared with 5.2% of monoclonal antibody tasks. During Visit 0, care coordination and telephonic communication were the predominant activities, underscoring the importance of pre-visit nurse involvement in safe therapy initiation. Mean total nurse visit time, including travel and excluding drug administration, was 3.93 hours for anti-infective Visit 1, and 2.87 hours for Visit 2. For monoclonal antibody therapy, mean total nurse visit time was 1.27, 4.06, and 3.21 hours for Visits 0, 1, and 2, respectively. Mean round-trip travel time was 1.23 hours. Approximately 40% of nurse patient care time occurred outside the patient’s home for both therapy groups, reflecting care coordination, documentation, telephonic communication, and other non–face-to-face activities. Conclusion These findings demonstrate that home infusion nurse workload extends well beyond in-home infusion administration. Although anti-infective and monoclonal antibody therapies differed in task intensity and visit structure, both required substantial nurse time during therapy initiation. Objective measurement of these activities is essential to inform staffing models, productivity expectations, reimbursement policy, and resource allocation for sustainable, high-quality home infusion care.