Disseminating team training across an academic cancer center and community-based satellites.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 188-188
Author(s):  
Anne Gross ◽  
Susan Mann ◽  
Saul Weingart ◽  
Michael Kalfin ◽  
Andrew David Norden ◽  
...  
Keyword(s):  
Situational Awareness ◽  
Team Training ◽  
Patient Perception ◽  
Near Miss ◽  
Cancer Center ◽  
Quality Improvement Initiative ◽  
Community Based ◽  
Main Campus ◽  
Communication Task ◽  
Academic Center

188 Background: Dana-Farber Cancer Institute is the first cancer center to implement Team Training (TT). This program illustrates critical lessons about disseminating a quality improvement initiative across an academic center and its regional community-based satellites. Methods: We adapted TT principles to the needs of our satellite centers. This required recognizing different work flows and communication patterns, identifying hazards in routine communications, integrating satellite-main campus communication, and facilitating situational awareness when practicing at multiple sites. Key components included: support from executive leadership and Board of Trustees; previous success at the main campus; use of data and actual near-miss scenarios; development of workflows for critical communications; and workflows for shared care of patients at different sites. Results: Staff surveys demonstrated safer, more efficient, and more respectful practice environments. Higher scores were seen across most categories in comparison to main campus. We observed an increase in the number of chemotherapy orders without issues (81.7% to 91.9%) and a decrease in the number of missing (7.0% to 3.4%) or noncommunicated order changes (3.1% to 1.0%) when the patient arrived for treatment pre TT vs. post TT. Patient perception of teamwork, measured by Press-Ganey, showed a statistically significant increase at both the main and satellite campuses. Conclusions: TT improved communication, task coordination, perceptions of efficiency, quality, safety, and patient perception of care coordination, at both the academic main campus and our community-based satellite practices. [Table: see text]

PD-L1 expression profile and immunotherapy (IO) experience in African American (AA) and Hispanic (H) lung cancer (LC) patients: Addressing disparities at a minority-based academic cancer center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18073-e18073 ◽  
Author(s):  
Elaine Shum ◽  
Christopher Su ◽  
Changcheng Zhu ◽  
Rasim A. Gucalp ◽  
Missak Haigentz ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Checkpoint Inhibitors ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Cancer Center ◽  
Community Based ◽  
Academic Center ◽  
Significant Difference ◽  
Treatment Paradigm ◽  
Looking Glass

e18073 Background: Immune checkpoint inhibitors have changed the treatment paradigm for metastatic LC. Minority populations are under-represented in large IO clinical trials. Among 989 pts with newly diagnosed LC at Montefiore Medical Center - a community-based academic center from 2014-2015, 330 (33%) were AA and 195 (20%) were H. In line with practice-changing clinical studies, PD-L1 expression testing and IO have been incorporated into LC treatment. Methods: Pts receiving IO and/or had PD-L1 testing between 1/1/14-12/31/16 were identified from records obtained from pathology, pharmacy, oncology clinics and Clinical Looking Glass. Retrospective chart review was conducted. PD-L1 testing was performed using 22C3pharmDx IHC. Results: We identified 111 pts with LC who received IO and/or had PD-L1 testing, with a median age of 66. 55% were female. Based on race, 52 (47%) were AA, 24 (22%) were White, 26 (24%) were Other, and 9 (8%) were race unknown. Based on ethnicity, 30 (27%) were H, 73 (66%) were non-H and 8 (7%) were ethnicity unknown. 82% were former/current smokers. Adenocarcinoma was the dominant histology (60%). The majority were EGFR WT (91%) and ALK neg (98%). PD-L1 testing was performed in 67 (60%), including 32 (29%) AAs and 20 (18%) Hs. Archival tissue was used in 63%. PD-L1 TPS > 50% was found in 30%, 1-49% in 24%, < 1% in 37%. 62 pts received IO, including 26 (42%) AAs and 18 (29%) Hs. Nivolumab was the most commonly used agent (77%). In AAs, 8 (31%) received IO as 1st line, 13 (50%) as 2nd line, 5 (19%) as 3rd line and above. In Hs, 1 (5%) received IO as 1st line, 10 (56%) as 2nd line, 7 (39%) as 3rd line and above. Immune-related adverse events (IRAEs) were reported in 31% of AAs and 39% of Hs. Data analysis on survival is ongoing. Conclusions: Unlike the low numbers of minority pts in large clinical trials, we found no significant difference in PD-L1 testing and IO across racial and ethnic groups treated at our center. Compared to large clinical trials, we observed lower rates of IRAEs in our cohort. Our current and ongoing observations in these populations may have future implications in narrowing health disparities based on race/ethnicity.

Implementation of a team training program in the treatment of breast cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16515-e16515
Author(s):  
Craig A. Bunnell ◽  
Anne Gross ◽  
Michael Kalfin ◽  
Ann H. Partridge ◽  
Sharon Lane ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Care Coordination ◽  
Team Training ◽  
Patient Perception ◽  
Change Orders ◽  
Team Members ◽  
Task Coordination ◽  
Communication Task ◽  
Significant Difference ◽  
Perception Of Care

e16515 Background: Team Training (TT) principles, used in high-risk industries to reduce errors and improve communication and task coordination, have been applied in other areas of medicine, but never in an outpatient subspecialty setting. We piloted a TT program in a large, academic breast cancer program. Methods: Observations, interviews and anonymous adverse event reporting systems were used to identify areas of vulnerability warranting intervention: 1) communication of changes in chemotherapy orders on the day of treatment ("change orders") 2) missing orders on treatment days that patients were not also scheduled to see their physician (“unlinked” visits) 3) follow-up and communication to other team members on important patient issues (e.g. pending test results or changes in patient status) 4) conflict resolution between providers and staff. For each area, agreements about roles, responsibilities and behaviors were made. Using a train-the-trainer model, clinical leaders trained all providers and staff in TT principles, the agreements, and the tools to support them. Results: The program was evaluated six months after implementation. There was insufficient power to detect a significant difference in communication of change orders because of the infrequency of events (< 2% pre and post-training). However, 100% of providers reported it was easier to communicate change orders and 87% of infusion nurses reported a decrease in non-communicated changes. The incidence of missing orders for unlinked visits decreased from 30% to 2%. Press-Ganey patient satisfaction scores suggested improvement in patient perception of care coordination. Providers, infusion nurses and support staff reported strongly positive perceptions of improvement in efficiency (75%, 86%, 90%), quality (82%, 93%, 93%) and safety (92%, 92%, 90%) of patient care. Similarly, all groups reported improved relationships and more respectful behavior among team members (91%, 85%, 93%). Conclusions: Team Training improved communication, task coordination and perceptions of efficiency, quality, safety and interactions among team members as well as patient perception of care coordination. Widespread implementation of this strategy is ongoing at our institution.

Performance teamwork training in ambulatory oncology.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16559-e16559
Author(s):  
Anne Gross ◽  
Susan Mann ◽  
Michael Kalfin ◽  
Sharon Lane ◽  
Saul Weingart ◽  
...  
Keyword(s):  
Data Collection ◽  
Multimodality Treatment ◽  
Team Training ◽  
Training Data ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Team Members ◽  
Communication Task ◽  
Ambulatory Oncology ◽  
Patient Reported

e16559 Background: Increasingly complex diagnostic and multimodality treatment algorithms have yielded superior outcomes, but also magnified the risk for adverse events precipitated by failures of communication and coordination. We implemented team training principles in 14 outpatient oncology practices across 3 campuses (community and academic) to reduce the risk of errors and increase operational efficiency and quality. Methods: Over 950 physicians, nurses, pharmacists, and staff were trained in evidence-based concepts of teamwork. Intervention included 1) baseline data collection regarding key clinical processes, (e.g. non-communication of same-day chemotherapy order changes); 2) observations/interviews with care team members; 3) process meetings to identify vulnerabilities and develop agreements and tools to support them; 4) Train the Trainer methodology; 5) staff training; 6) post-training data collection. Results: Despite the infrequency of non-communicated same-day changes in chemotherapy orders at baseline (~2%), a trend toward improvement was seen (chi-square p=0.068). The incidence of missing chemotherapy orders for infusion visits not associated with an MD visit decreased significantly. Staff reported improved practice efficiencies and a more respectful, safer environment. Press Ganey patient-reported perceptions of teamwork improved significantly. Conclusions: Team training improved communication, task coordination, perceptions of efficiency, quality, safety and interactions among team members, as well as patient perception of teamwork in both community and academic environments of a comprehensive cancer center. [Table: see text]

Team training in adult oncology.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 27-27
Author(s):  
Anne Gross ◽  
Susan Mann ◽  
Michael Kalfin ◽  
Sharon Lane ◽  
Saul Weingart ◽  
...  
Keyword(s):  
Qualitative Interviews ◽  
Team Training ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Staff Perceptions ◽  
Chi Square ◽  
Team Members ◽  
Train The Trainer ◽  
Manage Care ◽  
Communication Task

27 Background: In outpatient oncology, clinicians working in various locations and at different times, rely on each other for information to coordinate and manage care. Increasingly complex treatment algorithms magnify risk for adverse events precipitated by failures of communication/coordination. We implemented team training in 16 adult practices across five campuses (community and academic) to reduce errors and increase efficiency/quality. Methods: 1,000+ MDs, NPs, PAs, RNs, pharmacists, and support staff were trained in teamwork concepts. Interventions and methods included baseline data collection on key clinical processes, (e.g. same-day chemotherapy changes not communicated to treating RN); observations and interviews with teams; “train-the-trainer” sessions; identification of “pain points”; interdisciplinary "process meetings" to develop agreements, tools and systems changes to support better communication/efficiency; trained all staff; collected data six months post-training. Results: Despite infrequency of noncommunicated same-day changes in chemotherapy at baseline (~2%), an improvement trend was seen (chi-square p=0.068). Incidence of missing infusion orders, not associated with an MD visit, decreased significantly. Providers reported fewer unnecessary pages. Nurses reported quicker, more reliable responses to pages sent. Staff reported improved practice efficiencies and safer, respectful work environments. Qualitative interviews elicited patient perceptions of communication, teamwork, and care coordination. Patients’ quantitative perceptions of teamwork improved significantly. Conclusions: Team training improved communication, task coordination, interactions with team members, staff perceptions of efficiency, quality, and safety and patient perception of teamwork in the outpatient practices of a comprehensive cancer center. [Table: see text]

The Trach Safe Initiative: A Quality Improvement Initiative to Reduce Mortality among Pediatric Tracheostomy Patients

2020 ◽  
Vol 163 (2) ◽  
pp. 221-231
Author(s):  
Thida Ong ◽  
C. Carrie Liu ◽  
Leslie Elder ◽  
Leslee Hill ◽  
Matthew Abts ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hospital Discharge ◽  
Near Miss ◽  
Quality Improvement Initiative ◽  
Community Based ◽  
Emergency Airway ◽  
Before And After ◽  
Routine Assessment ◽  
Related Mortality ◽  
Safe Practices

Objective To describe the Trach Safe Initiative and assess its impact on unanticipated tracheostomy-related mortality in outpatient tracheostomy-dependent children (TDC). Methods An interdisciplinary team including parents and providers designed the initiative with quality improvement methods. Three practice changes were prioritized: (1) surveillance airway endoscopy prior to hospital discharge from tracheostomy placement, (2) education for community-based nurses on TDC-focused emergency airway management, and (3) routine assessment of airway events for TDC in clinic. The primary outcome was annual unanticipated mortality after hospital discharge from tracheostomy placement before and after the initiative. Results In the 5 years before and after the initiative, 131 children and 155 children underwent tracheostomy placement, respectively. At the end of the study period, the institution sustained Trach Safe practices: (1) surveillance bronchoscopies increased from 104 to 429 bronchoscopies, (2) the course trained 209 community-based nurses, and (3) the survey was used in 488 home ventilator clinic visits to identify near-miss airway events. Prior to the initiative, 9 deaths were unanticipated. After Trach Safe implementation, 1 death was unanticipated. Control chart analysis demonstrates significant special-cause variation in reduced unanticipated mortality. Discussion We describe a system shift in reduced unanticipated mortality for TDC through 3 major practice changes of the Trach Safe Initiative. Implication for Practice Death in a child with a tracheostomy tube at home may represent modifiable tracheostomy-related airway events. Using Trach Safe practices, we address multiple facets to improve safety of TDC out of the hospital.

scholarly journals 139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S81
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
Cara Acklin ◽  
Christian Cheatham
Keyword(s):  
Antimicrobial Stewardship ◽  
Healthcare Providers ◽  
Hospital Setting ◽  
Secondary Outcome ◽  
Quality Improvement Initiative ◽  
Oral Antibiotic ◽  
Ambulatory Care Setting ◽  
Community Based ◽  
Before And After ◽  
Physician Network

Abstract Background Antimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative. Methods This was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions. Results There was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year. Conclusion These findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

Advance Directives Among Health Care Professionals at a Community-Based Cancer Center

2007 ◽  
Vol 82 (12) ◽  
pp. 1487-1490 ◽  
Author(s):  
R. S. Go ◽  
B. A. Hammes ◽  
J. A. Lee ◽  
M. A. Mathiason
Keyword(s):  
Health Care ◽  
Advance Directives ◽  
Health Care Professionals ◽  
Cancer Center ◽  
Community Based

Patient Perception and Duration of Pain after Microdirect Laryngoscopy

2020 ◽  
Vol 162 (5) ◽  
pp. 702-708
Author(s):  
Trylon Matthew Tsang ◽  
Oliver Brett ◽  
Amanda Hu
Keyword(s):  
Short Form ◽  
Tertiary Care ◽  
Case Series ◽  
Patient Perception ◽  
Mcgill Pain Questionnaire ◽  
Academic Center ◽  
Mallampati Score ◽  
Sensory Score ◽  
Present Pain Intensity ◽  
Pain History

Objective Postoperative pain is an important part of the patient’s surgical experience. The objective was to evaluate patient perception and duration of pain after microdirect laryngoscopy (MDL). Study Design Case series with planned data collection. Setting Tertiary care, academic center. Subjects and Methods Adult patients undergoing MDL were administered the short-form McGill Pain Questionnaire (SF-MPQ) before surgery and on postoperative days (PODs) 1, 3, and 7. Demographic and clinical data were collected. Results In total, 130 patients (mean age 52.6 years, 84 male) participated in the study. About 46.2% required analgesia on POD 1, but only 23.1% required opioids. Overall, mild levels of pain were reported on the SF-MPQ: sensory score, affective score, total score, present pain intensity (PPI), and visual analog scale (VAS). Patients reported a significant increase in pain on POD 1, with decreases in pain on PODs 3 and 7. Pain score returned to preoperative values for total score and affective score on POD 7 but remained significantly elevated for PPI, VAS, and sensory score. None of the following factors were associated with increased pain: age, sex, body mass index, Mallampati score, Cormack score, laryngoscope used, type of MDL, time under anesthesia, employment status, intubation, Voice Handicap Index 10, and chronic pain history. Conclusion Although mild levels of pain were reported after MDL, the pain persisted for up to 7 days. No demographic or clinical factors were found to be associated with increased pain. This study was one of the few prospective studies evaluating pain after MDL.

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