Patient Care Delivery
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HEALTHCARE BUSINESS INSIGHTS PATIENT CARE DELIVERY Cost & Quality Academy Journal January 2017 Expediting Oncology Care Through Nurse Navigation to Alleviate Patient Challenges Many oncology and cancer programs can be fragmented due to the length of time Greenville Health System South Carolina between patients’ appointments and the number of healthcare professionals they • Number of Licensed Beds: 1,662 need to see before a consensus can be • Hospital Discharges: 51,895 reached about treatment plans. This may cause patients to become anxious and • Number of Cancer Institute Offces: 8 frustrated with their overall experience with oncology care. To help alleviate these navigators’ role in bridging gaps in oncology calm those fears. The nurse navigator is negative care experiences, some health care, The Academy spoke with Julia Yates, critical for a successful visit for the patient systems have expedited the cancer treat- MSN, RN, OCN, Clinical Nurse Manager for and families because they’re procuring ment process with nurse navigators. the multidisciplinary clinic and oncology records, including pathology and imaging Greenville Health System (GHS) Cancer support services, which include nurse navi- studies, and being available to the patient Institute—which has the largest cancer gation services. for education and support.” program in South Carolina and provides Identifying Patient Needs The initial workup for a suspected malig- services to five counties in the state— nancy can involve numerous exams and implemented the use of nurse navigators to “The patient may become very anxious, tests. Waiting for a final diagnosis plan of act as liaisons between patients and treat- especially when they are newly diagnosed care can be a very high-anxiety time for ment providers. Moreover, GHS employs and awaiting a treatment plan,” Yates says. patients, especially with the process some- a multidisciplinary clinic to address the “So seeing patients at a multidisciplinary times extending over weeks. The oncology individual needs of patients with differ- clinic, with two to three physician special- ent diagnoses. To learn more about nurse ists at once, is extremely efficient and can SEE ONCOLOGY ON PAGE 2 Improving Departmental Efciency Through Value Stream Analysis and Other Lean Methodologies Safe and efficient delivery of care in the such as redundancies in physical actions, “Our Senior Vice President at the time Lean surgical department is an ongoing ambi- disorganized unit navigation, and a lack was initiated said our numbers were down, tion for many hospitals and healthcare sys- of comprehension of staff responsibilities we were losing patients, and we needed to tems. However, operational inefficiencies undermine the timeliness and quality of look at our processes,” Dr. McNelis says. surgical care. As a result, it is important for “So we took that message and identified surgery as one of the areas that needed a Turnaround Time in the Orthopedic Unit organizations to identify operational inef- at Jacobi Medical Center (in Minutes) ficiencies and develop targeted and sus- value stream analysis.” tainable changes to achieve high-quality 32.3 surgical care. Identifying Improvement Needs Jacobi Medical Center of NYC Health + Value stream analysis is a Lean method- Hospitals—a 457-bed trauma and tertiary ology that identifies and assesses steps 18.4 care center in the Bronx, New York—has needed to bring a project from its current utilized Lean methods to improve effi- state to the ideal state. Jacobi hired exter- ciency in its surgical department. In par- nal Lean assistance personnel who were ticular, Jacobi’s value stream analyses heavily involved in the initial assessment identified key areas for improvement and and development of its perioperative value Pre- Post- initiated focused changes. To learn more streams before implementing the neces- Implementation Implementation sary efficiency changes on its own. The sur- about the efforts of the facility and its tar- By utilizing Lean methods to improve inef- gery department framed this value stream fciencies in surgical care processes, Jacobi geted surgical department improvements, initiative around the current state of its Medical Center reduced patient turnaround The Academy spoke with Dr. John McNelis, time in its orthopedic unit by nearly 50%. Chair of the Department of Surgery. SEE VALUE STREAM ON PAGE 4 PATIENT CARE DELIVERY preoperative and postoperative education FROM ONCOLOGY ON PAGE 1 % of Patients Noncompliant with and instructions specific to the program team at GHS Cancer Institute aims to alle- Radiation Therapy Treatment to provide them with additional support viate some of the stress that patients and Source: Ohri N et al. (2016) when they return home. The GHS Cancer family members experience by providing Institute has also developed a caregiver advanced support, education, and focus- toolkit to assist family members after a ing on their individual needs. patient’s cancer diagnosis. During monthly leadership rounds, 22% To further guide patients through their navigators meet with their manager for care, navigators assist them and their one-on-one visits to discuss their obser- families in overcoming external barriers. vations regarding patient needs and avail- Two main areas of nonclinical case man- able resources. These visits present an With poor patient outcomes associated with agement assistance that navigators pro- opportunity for staff members to discuss treatment noncompliance, one in fve patients vide are for inability to pay for services or challenges, barriers, and ideas to address displaying noncompliance for radiation therapy may indicate the need for case management to lack of support at home. Navigators pro- these issues, which may lead to new pro- ensure that patients receive appropriate care. vide patients with additional community gram developments. These continual dis- resources and service contacts to assist cussions can help transform and adapt the entire course of treatment, recovery, them with billing, treatment payment navigation to meet patients’ specific and survivorship. plans, in-home care services, and trans- healthcare needs. portation for appointments. GHS Cancer Institute has also expe- Guiding Patient Care dited the care process for its patients Oncology nurse navigators at the GHS Providing Reliable Care by offering a unique approach to cancer Cancer Institute serve as clinicians, care The MDC at the GHS Cancer Institute treatment through its Multidisciplinary coordinators, educators, and counsel- has reduced and consolidated the num- Center (MDC). The MDC allows a patient ors for patients and families. They remain ber of appointments each cancer patient to accomplish in a single visit what pre- available and in contact with the patient requires. Patients are able to see multiple viously may have taken several weeks of and caregivers throughout the treatment medical disciplines in one visit, leading to visiting different sites. Under the collab- process. Patients may call nurse navigators an increase in patient satisfaction. orative format of the MDC, a group of at any time, day or night, with questions “It is important to know whether or not the specialists including a surgeon, medical about medication, lifestyle changes, and patient felt heard, understood, prepared, oncologist, radiation oncologist, nurse other concerns. Caseloads for these navi- and valued,” Yates says. “Patient comments navigator, radiologist, and pathologist gators are not limited and are based on the and suggestions guide our next steps.” meet to review records, discuss treatment number of patients seen in the multidisci- options, and develop a treatment plan plinary clinic, which is set by physicians. Due to the success of its program, patients proposal. The patient then meets with These numbers are tracked by the GHS from other hospitals and healthcare cen- each practitioner of the proposed plan Cancer Institute and assessed for trends to ters are referred to and seek second opin- following this collaborative conference. provide insight into utilization needs, such ions regarding their cancer diagnosis and The nurse navigator is available through- as using the same staff at multiple clinic treatment. GHS Cancer Institute collabo- out this visit and remains available to the sites or opening an additional day for areas rates with facilities outside of its system patient and the patient’s family through trending upward. via its electronic health record to procure outside records for these second opinion As part of their dual nursing and case % of Visits in Outpatient Department patients and ease their overall oncology in Which Health Education Was management responsibilities, the nurse care experience. Provided to Patient (By Provider Type) navigators track and prepare patient Source: Ritsema TS et al. (2014) records with the cancer type, test results, For other organizations looking to imple- genetics, reports, and eligibility for clini- ment a nurse navigation program for oncol- cal trials. All of the information collected ogy, the practices of Greenville Health Physician 20.2% for a patient’s records are documented System Cancer Institute can provide valu- and ready prior to the patient’s first visit able insight. By providing nurse navigators with their oncologist. Additionally, the in multiple disciplines, facilitating better Physician 31.0% nurse navigators contact patients to make diagnostic education, and sustaining sup- Assistant sure they know how to get to appoint- port