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Taking Huddle to the Next Level: Implementing a Risk Assessment Patient Acuity Tool to Improve Continuity and Outcomes

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Taking Huddle to the Next Level Using a Patient Acuity Tool to Improve Outcomes

Esther Vazquez, RN, BSN; Karley Kinsey, RN, BSN; Debra Burgess, RN, BSN ,MHA
University of California Davis Medical Center – UC Davis Comprehensive Cancer Center

Purpose:  Establish a huddle process aimed at improving patient outcomes and interdepartmental communication for Combined Modality Therapy (CMT) patients and other high risk oncology patients

Coordination of cancer care is complex, involving multiple sites for entry.  Oncology patients require multidisciplinary management frequently involving surgeons, medical & radiation oncologists, radiation therapy, psychiatrists/social workers, nursing and nutritional support.   Patients treated with CMT are especially at high risk for developing complications leading to the need for urgent IV hydration and unplanned treatment breaks.  Complex oncology treatment plans necessitate optimal communication between Cancer Center clinics, Infusion Rooms and Radiation Oncology to facilitate treatment as care transitions from inpatient to outpatient therapy and along the care continuum.  The Huddle process is an established model well documented in literature (Institute for Healthcare Improvement, TeamStepps) proven effective to streamline care, improve communication and team dynamics.

Method & Measurement

  • A nurse-led interdepartmental huddle process was developed to improve patient outcomes and communication between departments with input from Radiation Oncology, Cancer Center Clinics, and Adult Infusion Rooms.
  • Interdisciplinary huddle sessions are held weekly.  Attended by infusion nurses, nurse navigator, clinic case managers, social worker, dietitian, and are open to other clinical staff as needed.  Timeframe for huddle meeting is 15-20 minutes
  • Priority patients include CMT (receiving radiation & chemotherapy) and other patients at high risk for developing complications. (weight loss, dehydration, pain, anxiety).  Assistance is given with coordinating appointments to improve continuity and avoid time delays. 
  • Once referred for huddle patients were re-assessed weekly to ensure the huddle/navigation process was beneficial.  This process led to the development of
    a “risk-based” acuity tool to objectively evaluate and score high-risk patients. 

Quality metrics to measure improvement:

  • Pre & post staff survey at 6-12-18 months to evaluate sustainability of results and look at whether the new huddle process improved
    interdepartmental communication, staff satisfaction and workflow using 5 point Likert scale (1=strongly disagree/5=strongly agree)
  • Monitored gaps of unplanned treatment breaks in radiation therapy related to side effects or treatment complications
  • Tracked administration of urgent IV hydration in Radiation Oncology Department

Findings & Benefits

  • 56% reduction in need for urgent hydration post huddle, 67% reduction  in patients requiring  >1L of IV fluid post huddle
  • Average RT Treatment breaks dropped to 1.7/patient, a 43% reduction
  • Identified problem areas where more attention and coordination of care was needed to assist patients preparing for treatment and lessen the complications of therapy
  • Increased referral to LCSW for psychosocial support and referral to dietitian for nutritional counseling
  • Proactively schedule planned IV hydration in the Infusion Room to prevent dehydration
  • Issues with communication dropped to 10% leading to higher staff satisfaction.
  • Improved ability to address issues and act as a team
  • Staff felt more satisfied with the work process after huddle was implemented. Increased their able to  address care issues with other departments

Discussion & Recommendations

Implementation of the outpatient huddle process for CMT and other high risk cancer patients improved interdepartmental staff communication and helped to improve care coordination leading to improved clinical outcomes for our patients.   Cancer Center staff was also more satisfied with how things worked after huddle.   Moving forward we plan to evaluate the most common side effects leading to preventable complications and treatment breaks.  We will also work with nurse navigators to improve the timeliness to start radiation & chemotherapy when moving to the outpatient setting.  Future studies planned include using the risk scale model to assess reduction of high frequency complications and evaluation of risk acuity model to effectively concentrate nursing staff resources.

Conclusion

The interdepartmental huddle process led to improved communication and care coordination for high risk oncology patients.  It was also effective to reduce urgent IV hydration and lower the average number of RT treatment breaks/patient.  More studies are needed to evaluate the use of the acuity assessment tool to minimize or prevent complications. 

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