July 15, 2019

How Christiana Care cut ED visits for cancer patients (and saved $1,500 per patient)

Daily Briefing

    Christiana Care Health System in November 2016 introduced a nurse navigator initiative for cancer patients that has helped improve clinical outcomes while reducing costs, Christopher Cheney reports for HealthLeaders Media.

    Learn 3 successful models of emergency cancer care

    Previous research has shown positive results from high-quality nurse navigation and early introduction of supportive care for advanced cancer patients. With that in mind, Christiana Care officials hypothesized that the health system could achieve similar gains by launching the Supportive Care of Oncology Patients (SCOOP) program.

    The 4 key interventions to SCOOP

    SCOOP consists of four interventions: 

    1. Establish an electronic checklist for nurse navigators.

      As part of SCOOP, Christiana Care introduced a new nurse navigation electronic checklist integrated into the health system's EHR.

      The checklist displays automatically and updates daily as nurse navigators complete tasks, Cheney writes. Once a nurse navigator fills out the checklist's required fields, a set of patient-specific, time-driven tasks is created for the navigators to complete. These tasks will stay on the checklist until they're finished.

      Christopher Koprowski, associate cancer care service line leader at Christiana Care, explained, "Before, the nurse navigators had no daily electronic task list. They were writing things in steno pads; and there was no systematic, constant reminder to them to get these tasks done. So, a lot of the tasks were falling below the radar."

    2. Require patients to be screened for support services.

      SCOOP also added palliative care and supportive services staff to oncology clinics, Cheney writes. Before SCOOP, referrals for palliative care and supportive services occurred on an ad hoc basis, Koprowski said.

      "Now, supportive care staff review the records; and if the patient appears to have imminent problems, supportive care will see them immediately at a multidisciplinary clinic," he said. "Otherwise, supportive care provides patients with contact information to make a non-urgent referral to see them in the supportive and palliative care office."

      Christiana Care offers palliative and supportive services to patients that include:

      • Dentistry;
      • Hydration;
      • Nutrition; and
      • Psychosocial oncology.
    3. Implement electronic EHR alerts for emergency, inpatient visits.

      Another helpful feature of SCOOP, according to Koprowski, are EHR alerts that help nurse navigators and other providers communicate about a patient's condition and treatment plans .

      "When a patient has visited an [ED], a nurse navigator can immediately contact the medical or radiation oncology nurses to let them know that the patient may not be in for treatment. They may also let the medical or radiation oncology nurses know that it may be appropriate for the attending physicians to contact the inpatient physicians," Koprowski said. "Finally, the alerts enable the nurse navigators to communicate with the discharge planning staff in the hospital, so there is a seamless transfer from inpatient to outpatient care."

    4. Create an educational patient brochure.

      Christiana Care also revised its patient brochure to better address patients' questions and help patients navigate their care, Cheney writes. The new brochure includes:

      • A map of the health care campus;
      • Insights about how visits to the multidisciplinary clinic are conducted;
      • Information about services related to radiation, chemotherapy, surgery, palliative care, supportive services, and primary care;
      • Information on emotional and coping options;
      • Information on nutrition and well-being;
      • Symptoms and side effects the patients should expect; and
      • Ways to make and follow through on appointments.

    Results

    In a research article published in the Journal of Clinical Pathways, Koprowski and colleagues noted that the SCOOP program has helped the health system:

    • Decrease ED visits for targeted patients from 54% to 35%;
    • Decrease hospital admissions for targeted patients from 34% to 22%;
    • Decrease readmissions for targeted patients from 32% to 17%; and
    • Increase nurse navigator compliance from 94% to 98%.

    In addition, they noted the health system saved more than $1,500 per patient.

    According to Koprowski, Christiana Care is now looking at extending the SCOOP initiative to the health system's high-acuity cardiology patients.

    "The biggest message is that you can provide a better experience, probably lower costs, and decrease hospital admissions if you take this kind of intensive navigation and supportive care approach to patients who are being treated for cure if their acuity is high enough," Koprowski said (Cheney, HealthLeaders Media, 6/19).

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