- F1 Collaborative Efforts in Care Transitions From Breast Imaging to Clinical Oncology Navigation
- F2 Evaluating a Novel Patient Intake Model for Newly Referred Patients Seeking Cancer Care: An Evidence-Based Practice Project
- F3 Optimizing Navigation Efficiency: A Study of Oncology Partners’ Electronic Medical Records Access
- F4 The First Experience in Italy of Oncology Nurse Navigator in a General Surgery Unit
F1 Collaborative Efforts in Care Transitions From Breast Imaging to Clinical Oncology Navigation
Noora Aburaad, BSN, RN; Nicole Bravo, MSN, BS, RN, ONN-CG; Melissa Eades, BSN, RN, ONN-CG; Carol Kirton, MBA, BSN, RN, OCN, ONN-CG; Jennifer Pantleo, RN, BSN, BBA, CBCN
HCA/Sarah Cannon, Houston, TX
Background: A care coordination program was developed between a mammography provider and large healthcare system in September 2021. The care coordinator is a nonclinical staff member who serves to provide support to women undergoing breast biopsies. In addition, the coordinator ensures timely care coordination and a streamlined handoff process to an oncology breast nurse navigator for patients with positive biopsy results. Based on physician preference and with approval, the care coordinator facilitates a direct referral to the nurse navigator, who works with the patient after diagnosis to provide education, support, and connection with an oncology treatment team. The intention with this new process was to improve efficiency in workflow, standardize care transitions to clinical navigation services, enhance support offered to patients, and reduce fragmentation of care.
Objective: To create a collaborative process between a division of a hospital system and breast imaging partner. The goal was to examine the alignment of nonclinical coordinators and clinical oncology nurse navigators to create a seamless experience and transition for patients newly diagnosed with breast cancer. The project also delineated the clinical versus nonclinical roles of team members.
Methods: Data were compared between Q4 2021 and Q4 2022 to measure the referrals to navigation and the total volume of oncology patients navigated. Key stakeholders included administration, physician partners, care coordinators, and the oncology nurse navigation team. This collaborative team meets on a monthly cadence to improve communication and identify opportunities for improvement. An education and training series was implemented to enhance knowledge and understanding of roles, disease processes, treatment modalities, and support services needed in a breast cancer journey.
Results: Data compared following the integration of the nonclinical coordinators for Q4 2021 and Q4 2022:
- Referrals from nonclinical coordinators to clinical navigators increased by 56% year over year (YoY)
- Breast cancer navigation increased by 32% YoY
Conclusion: A successful workflow change was made to increase support available to patients throughout the breast care journey. These collaborative efforts, physician alignments, key tactics, and streamlined processes also resulted in successful overall program growth YoY. Due to the success of this project, there will continue to be an ongoing assessment for future opportunities to optimize the care transition process from imaging to clinical navigation support.
Return to TopF2 Evaluating a Novel Patient Intake Model for Newly Referred Patients Seeking Cancer Care: An Evidence-Based Practice Project
Roquinna Serna, BSN, RN1; Stella Fernandez, MSN, RN1; Morgan T. Nestingen, PhD, APRN1; Stephen Breazeale, PhD, APRN2
1Miami Cancer Institute, Miami, FL; 2Baptist Health South Florida, Miami, FL
Background: Cancer care facilities utilize oncology navigation programs to help cancer survivors navigate cancer care systems.1 However, patients require support before their first visit.2 In September 2022, Miami Cancer Institute (MCI) launched the pilot project, MCI Intake NOW (Nursing On-Demand Workflow), to streamline the intake process and improve scheduling-related outcomes.
Objective: The purpose of this evidence-based practice (EBP) project is to report the development and design of the MCI Intake NOW program and evaluate its effects on scheduling-related outcomes among individuals seeking to establish cancer care before institute-wide implementation.
Methods: MCI Intake NOW is currently in its third, and final, pilot phase before institute-wide implementation. We conducted the retrospective, quasi-experimental project from January to June 2023. Our pilot EBP project included newly referred individuals aged 18 years or older seeking to establish cancer care at MCI for the first time. We further limited this EBP project to patients whose intake process was completed via phase 2 or phase 3 of the MCI Intake NOW pilot because these phases recorded the same outcome metrics, making comparison possible. We extracted phase 2 and 3 data to reflect 2 months before and 2 months after implementation of the final phase of the pilot project. We assessed 5 outcomes—24-hour meaningful contact, scheduling lead time, intake turnaround time, intake lead time, and eligible to move up—using Student’s t tests, Mann-Whitney U tests, and chi-square tests.
Results: 24-hour meaningful contact was obtained on significantly more patients (n=39 [20.2%] versus n=220 [84.9%]); P and median intake turnaround time (7 days [range, 0-30 days] versus 5 days [range, 1-47 days; P=.008]) were significantly lower in phase 3. Median intake lead time was significantly lower (5 days [range, 0-24 days] versus 4 days [range, 0-30 days]).
Conclusion: MCI Intake NOW improved scheduling-related outcomes and outperformed many other cancer care facilities. In addition to improving scheduling-related outcomes within our facilities, MCI and the MCI Intake NOW outperforms many other intake and navigation programs. We believe that MCI Intake NOW is a model that cancer care facilities can use to improve their organizational workflows and streamline the intake process.
References
- Simpson K. The state of access and the healthcare experience for patients with cancer. Oncology Issues. 2023;38(1):41-49.
- Kagan SH, Morgan B, Smink T, et al. The oncology nurse navigator as “gate opener” to interdisciplinary supportive and palliative care for people with head and neck cancer. J Oncol Navig Surviv. 2020;11:259-266.
F3 Optimizing Navigation Efficiency: A Study of Oncology Partners’ Electronic Medical Records Access
Doris Bailey, BSN, RN, OCN; Nicole Bravo, MSN, BS, RN, ONN-CG; Michelle Eck, BA; Dawn Hawkins, MSN, RN, OCN; Sarah Ochieng, BSN, RN, OC
Sarah Cannon Cancer Institute, Nashville, TN
Background: Cancer is a complex disease that requires a multidisciplinary team approach with coordination of multiple specialties. The oncology nurse navigator is an essential team member whose role it is to provide individualized education and resources to the patient throughout the care continuum. Real-time access to electronic medical records (EMRs) is essential for the navigator to be knowledgeable about the plan of care, facilitate coordination of timely care, and be able to monitor adherence to the cancer treatment plan. A variation in EMR access inspired an audit of currently available accesses and the processes of obtaining access.
Objective: To assess oncology nurse navigators’ existing level of access to oncology partners’ EMRs. A tool to track navigators’ EMR access was created for navigation leadership to utilize during the onboarding process and implement a standardized approach for requesting access. This tool includes data such as navigator and facility details, oncology physician or surgeon partners, access status, and specific points of contact.
Methods: A pulse survey was administered to 169 navigators from all the divisions within the Sarah Cannon enterprise. The survey comprised questions regarding the current level of access to oncology partners’ EMRs, how access was obtained, and whom the navigator contacts to request records.
Results:
- A total of 108 navigators responded to the survey, a response rate of 64%
- 61% of navigators surveyed have varied levels of access
- 32% contact (call and/or email) partners to obtain records more than twice a week, 19% contact partners daily
- 33% wait several days to a week for information, 30% wait at least 1 business day
- 77% receive incomplete information and occasionally need to reach out again
- Oncology partner care team member(s) contacted for records
- 82% nurse or medical assistant
- 51% receptionist
- 15% call center
- 14% physician
- Themes drawn from comments expressed by survey respondents included navigators having access enabled them to proactively remove barriers to care, provide relevant resources and education, coordinate communication among physicians, and allowed them to accurately document care events
Conclusion: Our study showed that navigators who have EMR access felt they were a more cohesive member of the team, had the additional resources to proactively coordinate care, and were able to improve treatment compliance. Conversely, navigators who do not have full access felt that there was a significant amount of time spent on requesting medical records from various office personnel, as well as relying on a patient’s recollection of information. Having real-time access to medical records improves navigation workflow efficiency and lessens information request burden on both the navigator and the oncology partners’ practice. Through the audit of navigators’ access, a dashboard tool was created to give an overall view of available and needed accesses and highlighting opportunities of physician relations. Proposed next steps would be presenting the dashboard to navigation leadership for review, suggesting incorporating the tool into the onboarding process, and implementing a standardized approach for requesting access.
Return to TopF4 The First Experience in Italy of Oncology Nurse Navigator in a General Surgery Unit
Ilenia Merlini, RN; Federica Fulgenzi, RN; Cristina Brunetti, RN; Salomone Di Saverio, MD, FASC
General Surgery Madonna del Soccorso Hospital, AST AP
Background: The role of the oncology nurse navigator (ONN) is the specialized offering of personalized care to oncology patients to help them throughout the healthcare system. In our general surgery unit in Italy, we started such a project in January 2023, aiming to enhance the diagnostic-therapeutic and assistance pathway of each oncology patient.
Objective: Primary outcomes are the reduction of time interval between the first patient contact and each phase of the diagnostic and therapeutic pathway. Secondary outcomes are the assessment of the number and frequency of contacts between the patient and the ONN, as well as of the quantity and type of procedures organized, and patient satisfaction assessment.
Methods: A prospective cohort study has been conducted with a control group represented by the parameters measured in 2022 for the oncology patients treated in the same surgical unit not followed by an ONN. Both groups consisted of 30 patients. Contacts have been recorded within a dedicated cell phone number. A Patient Satisfaction With Cancer Care questionnaire has been completed, given to the patients in a blinded way by a third party to avoid biases.
Results: The study group included 30 cancer patients; 18 had colorectal cancer, 6 had liver metastasis, and 6 had pancreatic cancer. Average time from first contact to the primary diagnostic test was 8 days versus 20 days in 2022 (control group). All patients underwent multidisciplinary team (MDT) discussion, and time to MDT was not different between the 2 groups. Five patients were considered not fit for surgery, and the average time of referral to a medical oncologist was 2 days in the study versus 10 days in the control group. Twenty-five patients were fit for up-front surgery, and the average time from first contact to surgery was 23 days after ONN establishment versus 45 days in the control group. Each patient had on average 10 phone calls with the ONN. For patients with a first cancer diagnosis, the ONN organized an average of 4 tests. A questionnaire about patients’ satisfaction reached a response rate of 100%, with a mean score of 85.2/90.
Conclusion: These preliminary results showed the ONN to be effective and to enhance quality and outcomes of the management pathway of surgical oncology patients. Further studies with more patients over longer periods of inclusion are required to enhance the results and identify possible room for improvements within the ONN oncology pathways. The ONN’s professional role, with predefined technical and nontechnical skills, should also be officially recognized by the healthcare system and the hospital administration.
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