WASHINGTON, DC — A new model of care that has shortened the time new patients spend with nurses by 45 minutes is increasing the satisfaction of physicians and patients at Miami Cancer Institute, according to a new study.
“The results have been phenomenal,” said lead investigator Stella Fernandez, RN, who is a nurse manager at the institute.
Nurses had been frustrated by the inefficiency of the intake process, she explained. Patients would be asked to arrive more than an hour before their appointments, when it would be frequently discovered that information or forms were missing. That, combined with a last-minute scramble to round up all imaging, delayed care and put more stress on patients already reeling from a recent cancer diagnosis.
“Many of these patients are paralyzed with fear because they don’t know what to do with the disease or diagnosis,” Fernandez said here at the Oncology Nursing Society 2018 Annual Congress.
Many of these patients are paralyzed with fear because they don’t know what to do with the disease or diagnosis.
The nurse manager helped design a system that teams oncology nurses with medical records coordinators who work through a checklist. The team completes records, collects imaging, assesses patients, and verifies family histories over the phone about a week before the first appointment. Nurses can also address patients’ questions in advance about what will happen at the first visit, whether a wheelchair or oxygen tank will be available, when treatment will start, and what they should know about fertility preservation.
Before this model was implemented, new patients were spending 2 hours and 25 minutes from check-in to the time the oncologist left the room, Fernandez reported.
Someone would come in to take vitals, then a nurse screened the patient, then the advanced practice provider came in to do the previsit screening and then left the room to prepare the oncologist, and then the oncologist came in for the visit.
After implementation, the time was cut to 1 hour and 58 minutes.
On the day of the visit, “it went from 60 minutes of nursing time with patients to 15 minutes,” she said.
Patients, nurses, and doctors have shared their enthusiasm for the changes anecdotally and in informal surveys.
Patients get providers who walk into the room knowing much more than they did before, and they can spend more time answering patients’ questions instead of gathering information.
In fact, the program has been so successful that it is being expanded to the 13 other oncology services of Baptist Health South Florida, said Marguerite Rowell, MSN, assistant vice president of nursing at the Miami Cancer Institute.
Currently, more than 50 physicians at the institute are using all or part of the intake services. It is expected that by the end of the summer, all doctors will be on board, she reported.
The time saved has been substantial, because there are about 1200 to 1300 new consults a month at the Miami Cancer Institute, Rowell told Medscape Medical News.
When the work has been done in advance, providers come into the room with a more complete picture and can focus on the key questions they want to ask. “Before we started this process, it was a discovery for all,” she said.
Although more staff has been hired for intake, the nonprofit institute saves money when follow-up appointments to go over missing information are eliminated and when the process becomes more efficient.
Next up will be a review of the financial impact of the program, followed by a patient satisfaction survey, Rowell said.
“I definitely think this can be replicated,” she said. “Patients get providers who walk into the room knowing much more than they did before, and they can spend more time answering patients’ questions instead of gathering information.”
Fernandez and Rowell have disclosed no relevant financial relationships.
Oncology Nursing Society (ONS) 2018 Annual Congress. Presented May 18, 2018.
Follow Medscape Nurses on Twitter @MedscapeNurses and Marcia Frellick @mfrellick
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