Christiana Finds New Clinical Pathway Reduces Readmissions, ED Visits for Oncology Patients

May 15, 2019
Pathway-driven improvements include supportive and palliative care management, electronic nurse navigation checklist

Researchers at Christiana Care Health System in Delaware say that a new clinical pathway for cancer patients is improving their quality of life, providing better health outcomes and lowering healthcare costs.

A clinical pathway is a tool for achieving high-quality, high-value care through standardization, ensuring that all patients who meet a given criteria receive consistent evidence-based care without unnecessary variation. 

A study, published in the May 2019 issue of the Journal of Clinical Pathways, focuses on patients at Christiana Care’s Helen F. Graham Cancer Center & Research Institute. Called Supportive Care of Oncology Patients (SCOOP), the pathway launched in November 2016 and initially focused on patients with potentially curable thoracic, colorectal or head and neck cancers who were receiving combined chemotherapy and radiation through one of the Graham Cancer Center’s multidisciplinary clinics. 

Due to the nature of their treatment, these patients are at higher risk for debilitating side effects that can send them to the emergency department, such as dehydration from nausea and vomiting, pain or psychosocial distress.

Pathway-driven improvements included introducing supportive and palliative care management early in the patient experience and adding in an electronic nurse navigation checklist to keep everyone on track. Screening with the supportive and palliative care service is mandatory during the multidisciplinary clinic visit, and, if indicated, urgent or timely consultation. A comprehensive nurse navigation electronic checklist sets mandatory tasks and milestones during treatment and follow-up as standard care. 

For the first two years of the pathway, when compared to a control group of similar patients not on the pathway, SCOOP patients experienced fewer visits to the emergency department (34% vs. 54%), fewer hospital admissions (23% vs. 34%) and fewer readmissions (18% vs. 32%). Correspondingly, cost savings for pathway patients was estimated on average to be more than $1,500 per patient. The total cost savings for 207 SCOOP patients thru Oct. 31, 2018, was more than $319,000.

“The SCOOP protocol is a unique, early intervention tool shown to improve how we treat curative cancer patients effectively, safely and at lower cost,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute, in a prepared statement. “Our experience would indicate that any group of patients at high risk for emergency department visits and hospital admissions could potentially benefit from this kind of approach.”

 “What we have learned is that enhancing supportive and palliative care for patients being treated curatively seems to work as well as for patients with advanced disease,” added Chris Koprowski, M.D., M.B.A., associate service line leader for cancer and director of quality and safety at the Graham Cancer Center, in a prepared statement. “As far as we could determine from our review of the literature, the full scope of this approach was never before applied to patients with potentially curable cancers.”

Recently, the pool of eligible patients expanded to include those with brain and hepatobiliary and pancreatic cancers. The team is looking to broaden participation further to more patients who might be at risk from a multitude of factors that could lead to increased emergency department visits and readmissions including socioeconomic or financial concerns.

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