Reducing medical oncology infusion no-show rate by improving patient and intra-clinic communication.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 47-47
Author(s):  
Radhika Kainthla ◽  
Bryana Anderson ◽  
Sarah Culver ◽  
Amy Little Jones
Keyword(s):  
Medical Oncology ◽  
Safety Net ◽  
Missed Appointments ◽  
Hospital System ◽  
Dallas County ◽  
Resource Limited ◽  
Limited Health ◽  
Work Family ◽  
Telephone Screening

47 Background: Parkland Health and Hospital System (PHHS) is the safety-net health system for Dallas County. In a resource-limited health care system, no-shows create waste and delay care. We sought to decrease the no-show rate (NSR) for patients scheduled for infusions, transfusions, and injections in the PHHS medical oncology infusion center by 33% in a 4-month period. Methods: A multidisciplinary team reviewed the NSR from January 2020 to May 2020. The reasons for missed appointments were investigated via chart review to better develop an intervention for meaningful change. A telephone follow-up protocol by the infusion nurses with standardized documentation and communication with the clinic and scheduling teams (intra-clinic communication) was implemented for each missed infusion appointment starting in February 2020. Results: The infusion center had a 16.4% NSR in January 2020. Of the 306 missed appointments, there was no documented reason for 44% (159). 19% (70) were related to change in plan-of-care; 19% (67) were in patients who had been admitted. Patient-related issues (transportation, illness, work/family obligations, etc.) were 13% of no-shows. Only 40 (11%) of the no-shows had a follow-up call. After implementation of follow-up telephone calls, the NSR was 11.2% by May 2020, a 32% decrease. 57.8% (204/1822) of patients who no-showed received a follow-up call to document reason for the missed appointment. Conclusions: We decreased the NSR in the PHHS medical oncology infusion center by 32% over a 4-month period, nearly reaching our goal, by implementing standardized post-no-show follow-up calls. Through our process, we discovered that communication, with the patient and intra-clinic, accounted for the most missed appointments rather than patient-related or other factors. Perhaps confounding our results were changes brought about by the COVID-19 pandemic, including mandatory telephone screening of patients prior to infusion appointments. Next steps include integrating pre-appointment calls into the workflow, standardizing change-in-plan communication, and cost analysis of interventions in our resource-limited setting.

Use of palliative care among patients with metastatic breast cancer at a safety net hospital.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 117-117
Author(s):  
Sita Bushan ◽  
Hsiao Ching Li ◽  
Samira K. Syed ◽  
Nisha Unni ◽  
Navid Sadeghi
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Metastatic Breast Cancer ◽  
Hormone Receptor ◽  
Medical Oncology ◽  
Metastatic Breast ◽  
Safety Net ◽  
Hospital System ◽  
Advanced Directives ◽  
Safety Net Hospital

117 Background: Palliative Care (PC) has been shown to improve quality of life in lung cancer patients, and ASCO recommends it as an adjunct to standard oncologic care. Data regarding the use of PC in other cancers and in disadvantaged populations is scant. We studied the patterns of use of PC in patients with metastatic breast cancer (MBC) at a safety net hospital. Methods: Electronic health records (EHR) of 234 patients who were diagnosed with MBC from 2010 to 2016 at Parkland Health and Hospital System (PHHS) were reviewed, and data on demographics, diagnostics, treatments, and palliative care elements were collected. Results: 105 of 234 (44.8%) patients with MBC were referred to PC, either as outpatients, inpatients, or both. The average time from the first visit with medical oncology to placement of an outpatient referral to PC was 390 days. Of the 79 patients with outpatient referrals to palliative care, we have hormone receptor status on 50. 12 of these patients had triple negative breast cancer; 30 had hormone receptor positive breast cancer. 77 (32% of all patients) patients had formal documentation of advanced directives (AD) in the EHR. Of these, 69 (89.6%) had seen PC. 133 patients have died, and 37 (27.8% of expired patients) died at the Parkland Hospital. Among the 96 patients who did not die in the hospital, 73 (76%) patients had some discussion of hospice prior to death. Conclusions: Less than half of patients with MBC at PHHS were referred to PC, and among those who are, referrals are placed late in the disease course, on average, more than one year after the first medical oncology visit. Lack of a sustained relationship with PC results in truncated goals of care discussions. As a result, most patients do not have formal documentation of AD in the EHR. Furthermore, they do not benefit from discussions with PC that could guide the management of their malignancy while they still have therapeutic options. Instead, patients discuss hospice with their providers toward the end of life, only when they are no longer candidates for cancer directed therapies. Although the use of PC resources at PHHS does not meet clinical guidelines, it is consistent with data from other studies showing inadequate use of PC resources among patients with advanced cancer.

scholarly journals Long-term benefit of hepatitis C therapy in a safety net hospital system: a cross-sectional study with median 5-year follow-up

BMJ Open ◽  
2013 ◽  
Vol 3 (9) ◽  
pp. e003231 ◽  
Author(s):  
Amit G Singal ◽  
Tushar D Dharia ◽  
Peter F Malet ◽  
Saleh Alqahtani ◽  
Song Zhang ◽  
...  
Keyword(s):  
Safety Net ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hospital System ◽  
System A ◽  
Safety Net Hospital ◽  
Term Benefit

Opioid prescribing upon discharge for patients with solid malignancies.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 50-50
Author(s):  
Ashima Lal ◽  
Jennifer Ann LaFollette ◽  
Constance Terrell
Keyword(s):  
Solid Tumor ◽  
Medical Oncology ◽  
Safety Net ◽  
Common Symptom ◽  
Potential Health ◽  
Adequate Supply ◽  
Opioid Prescribing ◽  
Safety Net Hospital ◽  
Ed Visits

50 Background: Pain is a common symptom associated with cancer resulting in increased health care utilization. We aim to study patients admitted with uncontrolled pain and review their discharge medications after development of an effective pain regimen while hospitalized. Anecdotally, we observe patients are being discharged with suboptimal regimens resulting in increased Emergency Department (ED) visits or readmissions. By identifying suboptimal opioid prescriptions we hope to improve care and patient satisfaction and minimize ED visits or readmission rates. The primary objective is to identify opportunities for improvement of opioid prescribing upon discharge for medical oncology patients. Methods: Retrospective study exempt from IRB review. We reviewed admitted patients with a solid tumor cancer diagnosis and consult to inpatient medical oncology at a safety-net hospital in an urban Southeastern population from June to November 2017 with data collected on 29 patients. Data was analyzed using descriptive statistics. Potential health-system cost avoidance was calculated. Results: 51% of patients were discharged with a lower daily oral morphine equivalent (DOME) than received while inpatient, with a median of 12 days until scheduled follow-up appointment. While 75% of patients were prescribed an adequate supply for long acting opioids, only 39% received an adequate supply of short acting opioids. 12 patients (41%) returned to the ED or urgent clinic within 30 days. 4 events were associated with a lower DOME and/or inadequate supply compared to their inpatient regimen. The total amount billed for missed opportunities showed the hospital was reimbursed only 25%. Conclusions: Opportunities to prevent discrepancies in discharge regimens exist. Pain regimens should be assessed for accuracy and supply at discharge and appointments. Patients should be discharged with a sufficient amount of opioids until their follow up, including ensuring insurance coverage of medication prescribed, with emphasis on patients maintaining their outpatient appointments. We plan to continue analysis post continuous QI initiative to improve clinical practice in pain management for patients with solid tumor malignancy.

Implementation of a Quality Improvement Project to Increase Access to Dietitian Services for Patients With Gastrointestinal Cancer in a Safety-Net Hospital System

2021 ◽  
pp. OP.20.01031
Author(s):  
Nicholas S. Levonyak ◽  
Mary P. Hodges ◽  
Nicole Haaf ◽  
Verca Mhoon ◽  
Ricardo Lopez ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Serum Albumin ◽  
Safety Net ◽  
Quality Improvement Project ◽  
Initial Visit ◽  
Registered Dietitian ◽  
Hospital System ◽  
Improvement Project ◽  
Gi Cancer

PURPOSE: Rates of malnutrition are high in patients with GI cancer, leading to poor outcomes. The aim of our project was to increase the rate of documented dietitian assessment in patients with GI cancer at Parkland Health and Hospital System from 5% to 25%. METHODS: Three PDSA cycles were conducted after identifying barriers to dietitian services. A registered dietitian was assigned to the GI oncology clinic during the first cycle, an adapted Malnutrition Screening Tool was implemented through the electronic medical record during the second cycle, and clinical staff training was performed during the third cycle. New patients with GI cancer seen by the registered dietitian had weight, Eastern Cooperative Oncology Group performance status, and serum albumin recorded at initial visit and 3-month follow-up. Paired t tests were performed. Emergency department visits and hospital admissions were also recorded during this time. RESULTS: Through these interventions, the percentage of patients with GI cancer with documented assessment by the registered dietitian increased from 5.1% in October 2018 prior to our interventions to 21.8% in July 2019 and has sustained in the 15%-20% range thereafter. From May to July 2019, there were 63 new patients with GI cancer seen by a registered dietitian. No significant difference was observed in average difference in weight and serum albumin level at initial visit and 3-month follow-up. CONCLUSION: A nutrition-focused quality improvement project led to a more than three-fold increase in the rate of documented dietitian assessment in patients with GI cancer.

1195-P: Improving Diabetes Self-Management with a Mobile App: Results of a Pilot Program at a Safety Net Hospital System

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1195-P
Author(s):  
ROOPA KALYANARAMAN MARCELLO ◽  
JOHANNA DOLLE ◽  
SHARANJIT KAUR ◽  
SAWKIA R. PATTERSON ◽  
NICHOLA DAVIS
Keyword(s):  
Safety Net ◽  
Mobile App ◽  
Self Management ◽  
Pilot Program ◽  
Hospital System ◽  
Safety Net Hospital

Critical Care in Critical Access Hospitals

2015 ◽  
Vol 35 (5) ◽  
pp. 62-67 ◽  
Author(s):  
Teresa J. Seright ◽  
Charlene A. Winters
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Rural Areas ◽  
Tertiary Care ◽  
Safety Net ◽  
The United States ◽  
Infusion Therapy ◽  
Critical Access Hospitals ◽  
Hospital System ◽  
Critical Access Hospital

What began as a grant-funded demonstration project, as a means of bridging the gap in rural health care, has developed into a critical access hospital system comprising 1328 facilities across 45 states. A critical access hospital is not just a safety net for health care in a rural community. Such hospitals may also provide specialized services such as same-day surgery, infusion therapy, and intensive care. For hospitals located near the required minimum of 35 miles from a tertiary care center, management of critically ill patients may be a matter of stabilization and transfer. Critical access hospitals in more rural areas are often much farther from tertiary care; some of these hospitals are situated within frontier areas of the United States. This article describes the development of critical access hospitals, provision of care and services, challenges to critical care in critical access hospitals, and suggestions to address gaps in research and collaborative care.

Implementation of “Epic Healthy Planet” registry for survivorship care coordination.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 337-337
Author(s):  
Karen Kinahan ◽  
Bijal Desai ◽  
Michele Volpentesta ◽  
Margo Klein ◽  
Melissa Duffy ◽  
...  
Keyword(s):  
Medical Oncology ◽  
Discrete Data ◽  
Mandatory Reporting ◽  
Survivorship Care ◽  
Management Tools ◽  
Noticeable Increase ◽  
Episode Of Care ◽  
Data Points ◽  
User Friendly

337 Background: The evolving Commission on Cancer (CoC) reporting mandate and institution’s growing survivorship program led to identifying the need for systematic tracking of survivorship patients, surveillance tests, return appointments and referrals placed. Our aim was to develop an electronic medical record (EMR) integrated registry utilizing discrete data fields to assist our team in tracking key elements of high-quality survivorship care. Methods: Stakeholders from our survivorship team (APP/RN), medical oncology, psychology, research, operations and IT analytics reached consensus on essential discrete EMR fields to be included in the registry. For implementation we utilized the EPIC module, “Healthy Planet”, where patients enter the registry by initiating an “Episode of Care” at their initial survivorship visit. SmartForm fields create unique discrete patient data points identified by the stakeholders. Results: The following domains were identified as important elements of care that require tracking in a dedicated survivorship program. The registry domains populate from two sources: 1) currently existing EMR data fields, 2) domains with no currently discrete data (e.g. lymphedema, peripheral neuropathy) were captured in the developed SmartForm (see Table). From January 1, 2019 to June 1, 2021, 778 patients were entered into the registry. Since September 4, 2020, 112 patient follow-up appointment reminders were sent via EMR which has led to a noticeable increase in return appointments. SmartForm data fields are being amended as additional malignancy types are added to our survivorship program. Conclusions: The utilization of Healthy Planet is an effective and user-friendly way to track survivorship return appointments, remind providers of diagnostic tests that are due, and track referrals for CoC reporting. As the numbers of cancer survivors continues to increase, systematic population management tools are essential to ensure adherence to survivorship guideline recommendations, follow-up care and mandatory reporting.[Table: see text]

scholarly journals An Examination of End-of-Life Care in a Safety Net Hospital System: A Decade in Review

2013 ◽  
Vol 24 (4) ◽  
pp. 1666-1675 ◽  
Author(s):  
Ramona L. Rhodes ◽  
Lei Xuan ◽  
M. Elizabeth Paulk ◽  
Heather Stieglitz ◽  
Ethan A. Halm
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Safety Net ◽  
Life Care ◽  
Hospital System ◽  
System A ◽  
Safety Net Hospital

scholarly journals Surgical Resection with Boyd Technique for Metastatic Ewing Sarcoma of the Bone Plus Docetaxel/Gemcitabine, Associated with Improved Outcomes in Tumor Activity

2020 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Ewing Sarcoma ◽  
Distal Femur ◽  
Medical Oncology ◽  
Femur Fracture ◽  
Improved Outcomes ◽  
History Of ◽  
Metastatic Activity ◽  
History Of Epilepsy ◽  
Histopathological Result

Ewing sarcoma is a malignant bone tumor that mainly affects children, adolescents and young adults with more than 1.5 cases per million worldwide. Approximately 20-25% of patients present metastatic disease at the diagnosis, that is often resistant to intensive therapy.We present the case of a 19-year-old male with history of epilepsy who started his condition with weight loss, increased volume, pain, swelling after receiving surgical treatment due to a left distal femur fracture, showing tomographic evidence of a 50-cm tumor with multiple lung lesions, so disarticulation was performed with the Boyd technique, obtaining histopathological result of Ewing’s Sarcoma, and was subsequently sent to the medical oncology service for follow-up and adjuvant treatment with significant clinical and radiological improvement in pulmonary metastatic activity.

Sign in / Sign up

Export Citation Format

Share Document