Streamlining CRC Workflows: Understand the Challenges, Provide Solutions

Shruthi Bommireddy
January 3rd, 2017

Clinical Research Coordinators (CRCs) play a crucial role in ensuring research is conducted in a GCP-compliant manner at clinical research sites. They must balance multiple responsibilities while guiding the performance of clinical research activities. In many cases, processes could be streamlined to foster greater efficiency and quality in operations. In order to improve these processes, the challenges of a CRC’s current workflows must first be understood.

What I learned as a CRA

In my professional experience as a Clinical Research Associate (CRA), I gained many insights into the daily workflows and responsibilities of CRCs at research sites. As a CRA, I interacted with several CRCs at 12 individual sites. Through these interactions, I learned that CRCs are often busy throughout the day with numerous and varied activities, including:

  • Pre-screening subjects for the Principal Investigator’s review
  • Assisting with the recruitment of subjects
  • Planning and preparing for subject visits
  • Conducting subject visits while ensuring protocol compliance
  • Assisting with source documentation
  • Managing study supplies and Investigational Product (IP) accountability
  • Completing case report forms (CRFs) and resolving queries
  • Maintaining and updating several tracking tools for visits, finances, etc.
  • Submitting data and reports to the IRB/EC
  • Maintaining the Investigator Site file

Tasked with so many duties on a daily basis, CRCs may feel overwhelmed. In addition, many CRCs work on multiple protocols, making it all the more challenging for them to be efficient and compliant. A CRC’s role can be very demanding, time consuming, and stressful.

This is partially due to a lack of processes that help them function in a systematic and organized manner. The consequences of inefficient processes include CRCs spending many hours retrieving information, working extra hours to catch up on other important activities, not being adequately prepared for monitoring visits, and fielding potential compliance issues.

The typical day of a CRC

There are many instances throughout a CRC’s day where systematic processes could streamline operations and make his or her life easier. Here is a break-down of a typical day for a CRC:

  • Scheduling visits: A CRC takes about an hour or more when each subject is registered to calculate all the planned dates for the future visits (in the absence of Interactive Voice Response Systems (IVRS) providing that information). These dates (whether from IVRS printouts or manually calculated) are transcribed onto a paper grid or spreadsheet and reviewed on a daily basis. Many CRCs confess that there are occasional slip-ups as a result of their busy schedules and not having the subject contact information handy.
  • Protocol review: Given that a typical CRC works on multiple protocols, on the day before the visit, the CRC spends half an hour or more reading the protocol to take notes on what needs to happen in that particular visit.
  • Subject visits: During the subject visit, the CRC refers to these notes as the procedures are completed and the subject is taken to the PI for a consultation, during which assessments are made and the drug is administered.
  • Depending on the form of the drug, the CRCs spend at least 45 minutes calculating IP accountability percentages.
  • Source documentation: After the subject leaves, source documentation is completed and CRFs are entered with available data. Source documentation is completed based on the notes taken by the CRC during the visit. Many times the information is not transcribed accurately or thoroughly due to time constraints. CRF completion is often delayed and creates a lot of pressure on the days leading up to the monitoring visit.
  • Financials: At the end of the day, the finance tracker is updated, which takes about four hours or more of the CRC’s time per week. This is then sent to the PI for review. In spite of the PI reviewing it, there are usually discrepancies between invoiced and received amounts, which take additional time to reconcile.

In this environment, it’s difficult for a CRC to handle more than two subject visits per day. The time required for the above adds up to two to three hours per subject visit.

The solution

There is plenty of room for process improvement in the daily tasks of CRCs. Streamlining operations can reduce stress and help CRCs to be more productive and efficient. This can be done with the use of a clinical trial management system (CTMS), which can automate several of the activities CRCs manage on a daily basis. Below is a walk-through of the tasks associated with study activity when a CRC uses the CTMS solution, Allegro® CTMS.

  • Protocol setup: A CRC takes about an hour or two to set up the protocol in the CTMS. This is a one-time activity that is done at the beginning of the study. Protocol compliance information is provided in the context of the visit in the form of re-consent alerts, and protocol procedures are displayed in the exact order in which they need to be completed, eliminating the need to refer to a protocol prior to the subject visit.
  • Scheduling visits: Based on the setup, once a subject’s first visit is marked as occurred, all the planned dates for the future visits are automatically generated and the calendar on the homepage is populated. The CRC no longer manually calculates the visit dates or creates a visit chart. The calendar lists all the subject visits that are upcoming for the next seven days along with the information of the protocol, the subject ID, the visit number, and the subject’s contact information, making it easy to give reminder calls to the subjects. The calendar lists the visits across the protocols a CRC is handling so all protocol visits can be managed from one system instead of referring to multiple visit trackers.
  • Subject visits: During the subject visit, the CRC enters very minimal data on a single page–just five fields–that take as little as 30 seconds to fill out. This, in turn, accomplishes several tasks that would take hours to complete manually.
  • Using an integrated CTMS eliminates the need to maintain subject visit trackers and finance trackers, or check on lab supplies, or spend numerous hours on IP accountability calculations. It also helps in gauging the CRC’s readiness for a monitoring visit in terms of tracking CRF completion.

The numerous hours saved when a significant amount of the manual tracking is eliminated can be better used towards other tasks, such as source documentation, CRF completion and query resolution, IRB/EC submissions, maintaining the ISF and more. Increased efficiency of CRCs with regards to visit management will mean more attention is given to other important study related activities, thereby improving the quality of work at a site while creating a more manageable workload for CRCs.

Learn more about ways a CTMS can streamline tasks for CRCs and improve operational efficiencies at your clinical research site, download our free eBook, “How to Streamline Your Workflow with a CTMS: A Resource for Study Coordinators.”



2 thoughts on “Streamlining CRC Workflows: Understand the Challenges, Provide Solutions

  1. The article does not correctly sum up the time spent by CRC on various tasks- Eg the protocol setup in EDC is typically not done at site level unless it is an IIT.
    Also, the streamlining suggestions are not as time consuming as the rest of the job duties.
    A CRC job hoes much further than performing the tasks listed!
    And not being able to be prepared for monitoring visits and compliance issues etc is not an end result of not having streamlined processes but is dependent more on the CRC`s knowledge and organizational skills- if you provide them with the suggested streamlined processes, the issues mentioned will still be there unless you have a competent CRC.

    1. Hi Asma,

      Thanks for sharing your thoughts. I see your point; this certainly isn’t a comprehensive list of the numerous important responsibilities CRCs are charged with on a daily basis. I also agree that having the necessary skill set to effectively manage all of these tasks and perform them well is essential for the job. Do you have any suggestions for skills to look for when hiring, or methods for training CRCs to adequately streamline the processes listed above?

Leave a Reply

Your email address will not be published. Required fields are marked *