Background: The moment a patient is diagnosed with cancer their entire world changes; cancer is not the same for any patient. For a multisystem hospital in northern Kentucky, cancer care delivery needed a complete overhaul, and they called upon nurse navigators to lead the way.
Objectives: To establish a disease site–specific oncology patient navigation (OPN) program in which nurse navigators walk with patients through their entire care continuum, thus reducing the time from diagnosis to treatment, emergency department visits, and hospital admissions while improving the overall patient experience.
Methods: Organizational support allowed a multidisciplinary team to build a disease site–specific OPN program in April 2020. Utilizing LEAN methodology, they eliminated waste and created opportunities for all disciplines to examine workflows and create standard processes. The entire care continuum was assessed and designed to create the ideal process for each patient.
Clearly defined roles were created for oncology nurse navigators (ONNs), focusing on ensuring constant patient support throughout all stages. Starting in October 2020, ONNs began navigating lung cancer patients, and in February 2021, gastrointestinal (GI) patients were added. Multidisciplinary teams huddled weekly for open communication regarding cases, needs, and updates. New ONNs had an orientation designed from the Academy of Oncology Nurse & Patient Navigators (AONN+) Orientation Checklists and the Oncology Nursing Society Oncology Nurse Navigator Core Competencies.
ONNs worked with information technology to develop documentation within the electronic medical record to fit the needs of the program, including the ability to track metrics for referrals and caseloads.
Results: The ONN caseloads for thoracic patients average 159 active patients; GI averages 114 active patients. During the last 9-month period that thoracic and GI ONNs have received referrals, there has been an average increase of 18 referrals per week.
Prior to the OPN program, data from the Cancer Registry showed that the national median time from diagnosis to treatment is 36 days (thoracic patients) and 30 days (GI patients). Within the last 9-month period for patients with an assigned ONN, the median time for thoracic patients is 15 days and 21 days for GI patients, demonstrating a 41% and 70% reduction, respectively.
In a 6-month period prior to the OPN program, there were 6 preventable lung cancer admissions within 30 days of chemotherapy. In a 6-month period postimplementation, there were 11. In a 3-month period prior to the OPN program there was 1 preventable GI admission, and in 3 months postimplementation there were 5. Admission data for these time frames may be impacted by COVID-19, but the OPN program has not shown an impact in reducing these admission rates.
Conclusions: Referrals to ONNs continue to increase as awareness continues to grow. The OPN program decreased thoracic patients’ time from diagnosis to treatment by 21 days and GI patients’ time by 15 days. The impact on preventable admissions is unclear and will continue to be tracked for process improvement. AONN+ navigation metrics will be used to evaluate the program and prove return on investment. This will help secure additional nurse navigators and foster continued improvement in patient outcomes, experience, and return on investment.
Sources
Academy of Oncology Nurse & Patient Navigators. Navigation Metrics Toolkit. https://aonnonline.org/images/resources/navigation_tools/2020-AONN- Navigation-Metrics-Toolkit.pdf. 2020.
Oncology Nursing Society. 2017 Oncology Nurse Navigator Core Competencies. www.ons.org/sites/default/files/2017-05/2017_Oncology_Nurse_Navigator_Competencies.pdf.
St. Elizabeth Healthcare Cancer Registry Data.
