Background: An inpatient oncology unit had consistently low patient satisfaction ratings regarding patient education. A literature review showed that health literacy and patient education continue to be a challenge across ages, education levels, and socioeconomic status.1,2 This review suggested to unit staff that more tailored teaching methods were needed to address knowledge deficits of oncology patients, particularly first-time patients navigating chemotherapy, biotherapy, central lines, and/or tubes, drains, and tracheostomies. The methods utilized to increase patient health literacy will be outlined below.
Definitions: FOCUS-PDCA: Method of quality improvement. LOS: Length of stay. HCAHPS: Healthcare Consumer Assessment of Hospital Provider Systems is a patient satisfaction survey.
Methodology/Plan: Staff utilized FOCUS-PDCA methodology to frame interventions based on desired outcomes, which included:
- Improved HCAHPS scores referring to patients’ perception of readiness for discharge and perception of education received
- Decreased LOS
- Decreased unplanned hospital readmissions
- Increased relationship-based care
All 40 patients on Inpatient Solid Oncology Service had access to the interventions throughout their stay. As patients often had multiple hospitalizations for scheduled chemotherapy, the number of patients involved in this 6-month pilot varied.
Implementation: Management selected 3 experienced RNs to collaborate on the project (a fourth was added later in the pilot). These RNs were referred to as “Resource 2” or “R-2.” They would not take patient assignments; rather, they would serve as additional staff to coordinate care and provide education. RNs worked with unit director to identify goals and develop interventions, which included education binders for incoming patients and specifically tailored education sessions with individual patients in their rooms, documented in the EMR. Education was supplemented by R-2 staff throughout patient’s stay. R-2s attended daily interdisciplinary rounds with MDs, case managers, and social workers and provided earlier identification of potential discharge barriers or complex patient dynamics that might lead to increased LOS. R-2s provided discharge phone calls within 72 hours of discharge to troubleshoot gaps in discharge plan, home care, supply requests/receipts that could lead to readmission. Promoted relationship-based care by rounding on oncology patients housed on non-oncology units to address needs, reach out to care coordinators less familiar with oncologic issues, and ease patient anxiety.
Outcomes: Compiled data from the period when R-2s were assigned in staffing, August 2017-February 2018.
- HCAHPS scores re: “nurses listened carefully” and “explained things in a way you could understand” met or exceeded benchmark in 5 of 6 months, an improvement over previous nonintervention quarters
- LOS decreased by 0.5 in the intervention quarters, the lowest average LOS in nearly 2 years
- Discharge callers provided medication education, helped patients fill prescriptions, and corrected problems with home care agencies, thereby assisting with outpatient clinic workflow and call volume
Conclusions: Data indicated that goals were achieved during the intervention period, demonstrating a correlative (though not causative) relationship between interventions and outcomes. R-2s changed clinical practice through tailored patient care with uninterrupted education, as well as postdischarge follow-up for continuity of care. The R-2 role was discontinued after its pilot time frame (6 months) due to unit and hospital budgetary constraints, which did not allow for an additional full-time RN to be staffed for 7 shifts per week. However, the RNs who filled the role continue to discuss how the interventions can be more seamlessly incorporated into daily nursing workflow for ongoing quality improvement on the unit.
References
- Simmons RA, Cosgrove SC, Romney MC, et al. Health literacy: cancer prevention strategies for early adults. Am J Prev Med. 2017;53:S73-S77.
- Berger O, Grønberg BH, Loge JH, et al. Cancer patients’ knowledge about their disease and treatment before, during and after treatment: a prospective, longitudinal study. BMC Cancer. 2018;18:381.
