A healthcare system is pioneering provision of palliative care and supportive services to oncology patients receiving curative treatment.
A new initiative called Supportive Care of Oncology Patients (SCOOP) pathway has helped a health system generate gains in clinical outcomes and cost reductions by improving nurse navigation as well as providing palliative care and supportive services for oncology patients in curative treatment.
Studies have shown positive results from high-quality nurse navigation and the early introduction of supportive care services for advanced cancer patients.
Wilmington, Delaware–based Christiana Care Health System hypothesized that similar gains could be generated at its healthcare organization and it launched SCOOP in November 2016.
The program generated several positive impacts in its first two years, according to a research article published recently in Journal of Clinical Pathways:
- Nurse navigator compliance with assigned tasks increased from 94% to 98%
- Emergency room visits for targeted patients dropped from 54% to 35%
- Hospital admissions for targeted patients dropped from 34% to 22%
- Hospital readmissions for targeted patients dropped from 32% to 17%
- Direct cost saving per patient was more than $1,500
"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," says Christopher Koprowski, MD, MBA, associate cancer service line leader at Christiana Care.
Initially, participants in SCOOP were limited to patients with esophagus and lung cancers, colorectal and anal malignancies, and head and neck cancers. The pathway was expanded to include patients with hepatobiliary and pancreatic malignancies as well as brain tumors.
The SCOOP pathway initiative features four interventions: a nurse navigation electronic checklist; mandatory screening of curative patients for suitability to receive supportive and palliative care services; flags in the inpatient EHR when participating patients visit an emergency room, are admitted to a hospital, and are discharged; and an improved educational brochure for patients.
1. Nurse navigation electronic checklist
According to the Journal of Clinical Pathways article, the nurse navigation electronic checklist includes several key features:
- The checklist is integrated into Christiana Care's EHR
- The checklist is displayed automatically and updated daily as nurse navigators complete checklist tasks
- After a nurse navigator fills out required fields, a patient-specific and time-driven set of tasks is generated for the navigators to complete
- Tasks stay on the checklist until they have been completed
"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," Koprowski says.
For example, the electronic checklists include tasks such as trying to ensure that patients attend medical appointments and receive nutrition support.
2. Mandatory screening of patients
A pivotal component of SCOOP was adding palliative care and supportive services staff to Christiana Care's multidisciplinary oncology clinics, which was made possible with newly allocated financial resources, Koprowski says. Before SCOOP was launched, referrals from the clinics for palliative care and supportive services were made on an ad hoc basis.
"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. Otherwise, supportive care provides patients with contact information to make a non-urgent referral to see them in the supportive and palliative care office," he says.
Palliative care and supportive services provided to patients include dentistry, nutrition, hydration, and psychosocial oncology.
3. Electronic alerts
EHR alerts for emergency room visits and inpatient stays have been helpful to the nurse navigators and their patients, Koprowski says.
"When a patient has visited an emergency room, 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. 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," he says.
4. Revised patient brochure
Elements of Christiana Care's new educational brochure for oncology patients include:
- A map and directions for how to navigate the healthcare campus
- Insights about how multidisciplinary clinic visits are conducted
- Care information about radiation, chemotherapy and medications, surgery, palliative care and supportive services, and primary care
- Emotional and coping options
- Nutrition and well-being
- Symptoms and side effects patients should expect
- How to make and follow through on appointments
- Post-treatment considerations
With SCOOP's success in the treatment of high-acuity oncology patients who are in curative care, the pathway may be extended to Christiana Care's high-acuity cardiology patients, Koprowski says.
"Cardiology already has similar clinical pathways for outpatients. It's quite possible that by enhancing navigation and providing more supportive care resources that they can get the same results we have generated. It could make it less likely that people will slip through the cracks," he says.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
An initiative called SCOOP provides palliative care and supportive services to cancer patients in curative treatment.
The SCOOP program has reduced hospital admissions, ER visits, and readmissions.
The initiative decreased direct costs per patient by more than $1,500.