Background: Sylvester Comprehensive Cancer Center (SCCC) at the University of Miami is an academic medical center in Miami, FL. SCCC developed its nurse navigation department in the 1990s with the breast cancer site–specific group. Today, 13 cancer site–specific navigation groups operate across 1 main campus and 8 satellite locations and service more than 20,000 new patients a year. Over the course, the average time for intake became variable between 24 hours to 2 weeks, and there was an inability to pull consistent metrics in the electronic medical record (EMR). These findings indicated the need to develop a comprehensive intake form in the EMR with the ability to capture nurse navigation metrics.
Objectives: SCCC will leverage its Epic EMR system to develop an intake form to standardize documentation, address accreditation standards, improve care team communication, and capture metrics specific to nurse navigation.
Methods: Initial development/build of the intake form began in November 2018 by reviewing literature and AONN+ nurse navigation metrics. A task force was developed with key individuals who participated in the development of the intake form, which included input from frontline staff, social work, executive leadership, and information technology. Organizational metrics included were time to patient intake, turnaround time for medical record collection and pathology acquisition, assessment of barriers to care, advance care planning, appropriate referrals to supportive services, and acuity. Acuity was determined using a combination of the Mitchell Cancer Institute acuity tool1 with the exclusion of the Patient Health Questionnaire-9 to align with current organizational workflows for distress screenings. A phased approach was utilized in training and dissemination of the intake form to all cancer site–specific groups.
Results: Implementation of the intake form began February 2020 and is ongoing. Based on preliminary reports, it has shown the importance of integrating information technology to be able to standardize nurse navigation documentation and workflows. It has also shown benefit in identifying areas of opportunity for process improvement regarding interdepartmental communication and productivity and provides 1 source of new patient information to the care team.
Conclusions: The success of the implementation of the SCCC navigation intake form underscores the need to utilize oncology navigation metrics in the EMR to coordinate high-quality, team-based multidisciplinary care and demonstrate program outcomes. Additionally, education and training were provided to nurse navigators to facilitate addressing advance care planning discussions and barriers to care, which support accreditation standards. Upon completion of implementation to all site-specific groups, additional reporting will be built into a customized dashboard. This will allow for oversight of the quality of care being provided and will allow management to make appropriate resource utilization decisions and additional staff position requests.
- Baldwin D, Jones M. Developing an Acuity Tool to Optimize Nurse Navigation Caseloads. Association of Community Cancer Centers. www.accc-cancer.org/docs/documents/oncology-issues/articles/ma18/ma18-developing-an-acuity-tool-to-optimize-nurse-navigation-caseloads.pdf. 2018.