This quality improvement project utilized a Plan-Do-Study-Act (PDSA) framework to implement a new process for unplanned inpatient hospital discharges in the ambulatory hematology oncology space aimed at supporting patient transitions.
Problem: When Hematology/Oncology clinic patients were admitted inpatient, there was not a standard discharge follow-up process in place. This caused delays in restarting chemotherapy, symptom management, and addressing cancer specific discharge needs. This project aimed to proactively evaluate patients’ needs post discharge related to their cancer care.
Measurement: Automation of clinical data extraction from EHR enabled assessment of the current state. Leveraging this information, a process map was created delineating the optimal workflow. A customized data collection tool measured touchpoint. Touchpoints were categorized into symptoms, medications, and care management needs, each rated on a 3-point Likert scale.
Analysis: Focus groups were conducted to gather input from key stakeholders to identify existing gaps. This feedback was integrated into an ideal state process map. Following creation, the new process underwent testing and refinement through a series of PDSA cycles.
Implementation: PDSA cycles identified an efficient method of hospital admission notification, established appropriate methodology of nursing action, simplified Likert Scale measurement, refined admission type receiving intervention, and team expansion. Time, staff engagement, and population size all presented obstacles. Frequent stakeholder review and incorporation of feedback was essential for project success.
Results/Discussion: Touchpoints were provided to 89 patients. Of those, 74% had cancer-related needs. Patients without follow-up decreased from 14% to 8%. The average days to appointment decreased by 3.7 days. Overall, 119 needs were identified. Due to these results, the process became the new standard of practice.
