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Outcomes of Integrating Smart Phrase Interface Technology to Improve Cancer Symptom Management

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Outcomes of Integrating Smart Phrase Interface Technology to Improve Cancer Symptom Management Dufault M, et al., J Pract Prof Nurs 2021, 5: 024 DOI: 10.24966/PPN-5681/100024 HSOA Journal of Practical and Professional Nursing Research Article a 6-step collaborative translating-research-to-practice model as Outcomes of Integrating Smart process, Task-Technology-Fit Theory guided patient/nurse outcome evaluation. Analysis of repeated-measures using Generalized Phrase Interface Technology Linear Mixed Models, hierarchical regressions constructed the full variety of outcomes (p<.05). Analysis of patient outcomes of to Improve Cancer Symptom 375 telephone-triaged calls at each of five data-collection points found patient satisfaction on managing chemotherapy side effects, Management fatigue, and perceived safety/security improved significantly 6 months following smart phrase integration. Smart phrase usability and utilization increased, nursing documentation time decreased, Dufault M1*, Dalky A2, Ritz J3, Begnoche M4, Chauvin M5, and self-perceived effects on job performance increased for Cherenzia K6, Corrente J7, Laquale P8 and Machan J9 less-experienced oncology nurses from pre-to-6-month-post implementation. Evidence based approaches to standardize 1 Professor, College of Nursing, University of Rhode Island, USA telephone-triage symptom assessment, well-embedded into 2Assistant Professor, Health Management and Policy Department, Jordan practice, documented in the EHR, highly reliable, sustainable, and University of Science and Technology, Jordan widely disseminated show promise for enhancing patient/family engagement, and improving job performance in novice tele-triage 3Clinical Nurse Manager, Lifespan Cancer Center, Newport Hospital, USA oncology nurses. 4Nursing Safety and Quality Manager, Rhode Island Hospital, Lifespan Keywords: Nursing symptom management; Smart phrase; Cancer Center, USA Telephone triaging; Translational research 5Staff Nurse, Lifespan Cancer Center, Newport Hospital, USA 6Program Manager, Lifespan Cancer Center Address: Rhode Island Hospi- tal, USA Introduction 7Clinical Nurse Specialist, The Miriam Hospital, Lifespan, USA Communication errors are the most frequent cause of sentinel events in United States healthcare with oncology tele-health 8Clinical Manager, Radiation Oncology Clinic, Lifespan Cancer Center Address: Rhode Island Hospital, USA particularly at risk [1]. Assessing cancer treatment-related symptoms remotely is significantly error-prone for frontline telephone-triage 9 Adjunct Associate Professor Psychology, University of Rhode Island, USA nurses toggling multiple Electronic Health Record (EHR) screens for toxicity-risk predictors while simultaneously providing over-the- phone emotional support. Evidence-based approaches to improve and Abstract standardize telephone-triage symptom assessment, well-embedded into nursing practice, documented in the electronic health record Assessing cancer treatment-related symptoms is challenging for frontline telephone-triage nurses toggling multiple electronic health (EHR), highly reliable, sustainable, and widely disseminated are record (EHR) screens for information on toxicity-risk predictors needed to reduce cancer treatment toxicity risks and enhance patient/ while simultaneously providing over-the-phone emotional support. family engagement and comfort. Decision-support tools embedded into computer-telephone interface software, called smart phrases, are not widely used nor empirically Clinician-driven telephone-triaging and clinical pathways have evaluated for usability and remote symptom management impact. been used to safely, effectively and efficiently manage symptoms The process and outcomes of designing and empirically evaluating a using evidence-based algorithms as early as 1999 [2,3]. Limited recent telephone-triage smart phrase embedded into the EMR of a northeast attempts to interface these within the electronic health record (EHR) multi-site cancer center serving 14,000 patients is described. Using show promise to improve care transitions, handoff communications, *Corresponding author: Dufault M, Professor, College of Nursing, University of access, nurse-patient relationships and patient/ family education; Rhode Island, USA, Tel: +1 4017884116; Email: [email protected] decrease emergency room visits, delays in care, and readmission- Citation: Dufault M, Dalky A, Ritz J, Begnoche M, Chauvin M, et al. (2021) Out- related hospital-acquired infections [4-6]. Despite these advances, comes of Integrating Smart Phrase Interface Technology to Improve Cancer significant challenges to implementing high quality, cost effective Symptom Management. J Pract Prof Nurs 5: 024. remote triaging exist [7,8]. Major barriers include clinician lack of Received: January 26, 2021; Accepted: February 12, 2021; Published: Feb- knowledge, computer skills, and confidence to remotely assess, ruary 19, 2021 triage, and guide patients in self-care for symptom treatment, time Copyright: © 2021 Dufault M, et al. This is an open-access article distributed management, discomfort in not recommending use of the emergency under the terms of the Creative Commons Attribution License, which permits un- room, documentation issues, and lack of user-friendly access to restricted use, distribution, and reproduction in any medium, provided the original author and source are credited. software [9-12,4,6]. Citation: Dufault M, Dalky A, Ritz J, Begnoche M, Chauvin M, et al. (2021) Outcomes of Integrating Smart Phrase Interface Technology to Improve Cancer Symptom Management. J Pract Prof Nurs 5: 024. • Page 2 of 11 • Purpose Approach The purpose of this translational research project was to: (1) The project site, a multi-site cancer center included three hospitals develop and integrate an evidence-based tele-triage nursing assessment and one full-service satellite outpatient clinic with the goal of decision-support interface tool into a multi-site cancer center’s EHR providing state-of-the-art cancer care and support for over 14,000 and (2) to evaluate its usability and impact on nurse /patient satisfaction patients/families in the northeastern United States. Hospital members and nurse-sensitive quality outcomes. It was believed that an interface included a large urban academic tertiary medical center, a medium- tool, called a smart phrase held much promise for improving patient sized Magnet-designated urban teaching hospital, and a small urban community hospital, also Magnet-designated. Care teams include satisfaction with symptom management. By their involvement in all board-certified hematologists/oncologists, nutritionists, pharmacists, aspects of the project, tele-triage nursing job performance, usability, social workers, and 61 nurses, the majority oncology certified. As and utilization for documentation and quality outcome measurement members of a large system with highly integrated computerized might also be enhanced. patient information and nursing documentation system in place Conceptual Framework for three years, the center maintains a 24-hour hotline call center for oncology patients. Currently an average of 1,875 symptom The overall project’s framework centered on research translation management calls per month is answered with 25% of patients theory using Default’s 6-step Collaborative Research Utilization surveyed for satisfaction outcomes and a 30% response-rate. Nurse- (CRU) model. This process uses sequentially designed activities in sensitive quality outcomes are analyzed using the system’s Outpatient which practice-based clinicians are paired with academic researchers Oncology Patient Satisfaction Survey [17] and the system’s quality and students to promote evidence-based practice by addressing the database [18]. long lag time from when research discoveries are made to when they Step One. Problem Identification and Assessment of Clinical, become integrated into clinician’s day-to-day care. Used to change Theoretical, and Empirical Evidence for Potential Translation: practice in over 200 targeted areas, the process was successfully In the first CRU step, clinical, theoretical, and validated empirical tested in eight previous studies to improve pain management, handoff evidence on telephone triaging and symptom assessment and communications, and other clinical issues [13-16]. management was accessed (Table 1). Strength of Evidence (Polit & Beck, 2012 Reference Study Objective Sample and Type Design / Method Findings criteria)/Recommen- dations After a three-month trial of Seven questions using the on- educational presentations, a line tool, SurveyMonkey®on- 25% increase in knowledge line tool was used to assess to about diseases, a 20% Gleason, K., O'neill, To standardize triage practice 13 Phone Triage RN’s at North evaluate the nurse’s comfort increase in management E. B., Goldschmitt, J., and ultimately improve the Shore LIJ Health Systems Monter with telephone triage and its of side effects, and a 20% Level VI/ Horigan, J., & Moriarty, effectiveness of telephone Cancer Center, Center for Ad- management, identification increase in the comfort level L. (2013). triage management. vanced Medicine of obstacles to telephone tri- of the nurses not referring aging, knowledge of dis- ease patients to the emergency process, and recognition of room for evaluation were oncologic emergencies. noted 1. Ty Type of com- munication tool for documenting useful 2. Nurse satisfac- tion questions too broad-need to be more specific related to outcome measures. Kuntz, G, Tozer, J. M., Innovative multipartite Four oncology practices (29 phy- Snegosky, J, Fox, J. MD, The total
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