Page 17 - Christiana Care Focus

Pathway-driven improvements included introducing supportive and palliative care management early in the patient experience and
adding in an electronic nurse navigation checklist to keep everyone on track.
“What we have learned is that enhancing supportive and palliative care for patients being treated curatively seems to work as well as for patients with advanced disease,” said Chris Koprowski, M.D., MBA, associate service line leader for Cancer and director of Quality and Safety at the Graham Cancer Center. “As far as we could determine from our review of the literature, the full scope of this approach was never before applied to patients with potentially curable cancers.”
Recently, the pool of eligible patients expanded to include those with brain and hepatobiliary and pancreatic cancers. The team is looking to broaden participation further to more patients who might be at risk from a multitude of factors that could lead to increased emergency department visits and readmissions including socioeconomic or financial concerns.
Supportive care management starts on day one
On the SCOOP pathway, screening with the supportive and palliative care service is mandatory during the multidisciplinary clinic visit, and, if indicated, urgent or timely consultation.
A comprehensive nurse navigation electronic checklist sets mandatory tasks and milestones during treatment and follow-up as standard care.
“In a somewhat novel approach we lev- eraged technology by using the Aerial Popu- lation Health platform to support nurse navigation,” said Pathway Project Manager E.J. Johnson, Ph.D., MBA, MS, managing consultant for Organizational Excellence
at Christiana Care. “The customized Aerial tool allows the nurse navigator to access a combined modality checklist rather than input each task manually. The system auto- matically generates an individualized task list for each patient.”
Items included are dates for prescribed communication with patients, scheduled consults and reminders to assess additional or unmet needs throughout the course of treatment. As a quality control mechanism, the system requires navigators to opt out of, rather than put in, service consults such as nutrition, behavioral health or social work.
Flags in the inpatient information system alert the supportive care team, the navigators and the oncologists when a patient is seen, admitted or discharged from the emergency room.
Nurse navigator compliance with the new navigation system increased from 94% to 99% during the first year.
“Having that automated process streamlines our workload and helps ensure we don’t miss critical time points for the patient,” said supervising Nurse Navigator Karen Sites, BSN, RN, OCN, who worked with cancer care management to develop the checklist. 
For more information, visit christianacare.org/cancer.
| Cancer Care SUCCESS OF THE
SCOOP PATHWAY SCOOP
34%
EMERGENCY DEPARTMENT VISITS
23%
HOSPITAL ADMISSIONS
18%
READMISSIONS
CONTROL GROUP
54%
EMERGENCY DEPARTMENT VISITS
34%
HOSPITAL ADMISSIONS
32%
READMISSIONS
“ Since day one when I came here, [with] the whole Helen Graham team, I had nothing to worry about. . . . Even on my days when I could barely walk, they helped me back.”
Joseph Bates
FOCUS • SUMMER 2019 15