Background: The OCC manages over 24,000 chemotherapy patient visits/year. Over time the number of patients, complexity of treatment and staffing requirements increase. Barriers to efficient delivery of chemotherapy include: same day (as clinic visit) treatment, missing MD orders, manual appointment scheduling and poor communication between chemo nurses and pharmacists during drug preparation. These issues were addressed by (1) non-same day chemotherapy, (2) MD orders expected day prior to treatment, (3) development of two web-based tools for chemotherapy scheduling and communication. Methods: Two independent process reviews were undertaken confirming system inefficiencies. The move to non-same day chemotherapy was implemented. An electronic Chemotherapy Appointment Reservation Manager (CHARM) was developed and linked to the computerized physician order entry (CPOE) system, and reminders were sent to MDs with outstanding orders 72, 48, and 24 hours pre-chemotherapy. The tool was developed to facilitate staff communication during chemotherapy preparation. Data relating to each process improvement was collected pre- and post-implementation. Results: Over 300 of the more than 400 chemotherapy regimens were reviewed for nurse assessment, medication preparation, and in-chair infusion times, with the results used to build the algorithms for CHARM. With the move to non-same day chemotherapy over 80% of patients are treated on a non-clinic day compared with 40% pre-implementation. With CHARM the average number of patients booked/day went from 68 to 100, a 47% increase. Currently, 90% of physician orders are entered by 2pm the day before treatment. Use of the communication tool resulted in an 89% reduction in phone calls between the nurses and pharmacy. 36% of patients started treatment +/- 30 min of scheduled time in both time peroids. Conclusions: OCC introduced several innovative approaches to improving the safe delivery of chemotherapy to cancer patients. Patient volumes have increased while communication around care delivery has improved. The approach allows ongoing research and development to improve workflow and communication.