By Marissa Mullins, APN, DNP, FNP-C, Loyola Medicine
Each year, 1.5 million Americans visit an Emergency Department (ED) for complications related to cancer treatment. The Centers for Medicare and Medicaid Services (CMS) began monitoring hospitalizations and ED visits for patients undergoing chemoradiation (chemoRT) in 2022 with an aim to reduce the number of ED visits. With this, Yun Jeong Seo, DNP, FNP-C, AOCNP, of Mount Sinai West Hospital in New York, NY, saw an opportunity. As she said, "We chose to focus on patients undergoing chemoradiation because they are particularly vulnerable to a range of severe and complex complications. Addressing their needs proactively can significantly impact their quality of life and reduce the strain on emergency services. By targeting this patient population, we aim to improve their overall care experience and outcomes."
Along with Pinaki R. Dutta, MD, PhD, they conducted a quality improvement project implementing a High ED/Admission Risk Therapy (HEART) protocol. The protocol provided education to the multidisciplinary team and created enhanced nurse-driven symptom management protocols. Nurse participants were educated on detecting and managing the common complications of chemoRT including pain, fever, respiratory distress, fatigue, dehydration, altered mental status, and radiation dermatitis through two in-person training courses with a 30-minute PowerPoint presentation. Nurses were surveyed pre- and post-education to measure improvements in knowledge. Utilizing weekly huddles, point-of-care feedback, and the HEART checklist, nurses identified high-risk patients and referred them to the nurse practitioner (NP)-led clinic. The NPs then further evaluated high-risk patients, collaborated with the multidisciplinary HEART team (nurses, physicians and supportive oncology staff), and implemented early interventions to prevent ED visits. ED visits were measured pre- and post-intervention.
Nurses' knowledge and confidence improved after the training courses. Using a paired-samples t-test, average scores rose from pre-education 14.00 to 21.23 after training (t(4) = -19.24, p < .001), 95% confidence interval [CI: -8.24 to -6.16]). After the adaptation of the HEART team protocol, ED visits were reduced by 18% from 39% pre-HEART intervention to 21% post-HEART intervention.
Adaptation of the HEART team protocol enhanced nursing knowledge and reduced ED visits, providing guidance for the implementation of CMS recommendations for other organizations. Dr. Seo said of the program, "The reduction in ED visits by 18% not only signifies the success of the HEART team protocol in managing complications but also highlights its potential to transform patient care on a broader scale. Looking ahead, we envision this model as a framework that other institutions can adopt to enhance symptom management and prevent unnecessary ED visits/hospitalizations, ultimately leading to better patient outcomes and more efficient use of health care resources."
Abstract 1008, The HEART Team Protocol: A Strategic Approach to High-Risk Patient Management in Adult Oncology to Reduce Emergency Room Visits and Hospital Admissions, was presented during the QP 02 – Nursing 1: Nursing/Supportive Care Quick Pitch session of ASTRO’s 66th Annual Meeting.
