66 Background: Enhanced recovery programs (ERPs) apply multi-modal approaches to manage symptoms, decrease complications, and reduce length of stay (LOS). Widely adopted in surgical settings, there is limited evidence of their implementation in non-surgical patient cohorts. An ERP was implemented in a medical oncology population at a National Cancer Institute-designated comprehensive cancer center. The aim of this quality improvement initiative was to evaluate the implementation of an enhanced recovery framework and determine feasibility in medical oncology. Methods: Enhanced recovery in medical oncology (ERMO) was implemented using Plan, Do, Study, Act methodology. Implementation included introduction of integrative medicine, opioid sparing alternatives, fluid and nutrition management, and functional mobility. Outcome measures included symptom distress as measured by the Edmonton Symptom Assessment Scale (ESAS), return to intended oncologic therapy (RIOT), LOS, and opioid use, evaluated from January 2017 through April 2018. Results: A total of 50 patients were evaluated during the program implementation, and compared with 49 control patients retrospectively reviewed prior to ERMO implementation. Average LOS for ERMO patients was 7.3 days compared to 5.5 days for the control group. Time to RIOT averaged 18.9 days for control patients (n = 30) versus 20.8 days for ERMO patients (n = 17). Nineteen patients (38%) had a reduction in morphine equivalent daily dose (MEDD) from admission to discharge, with an average MEDD of 328.47 milligrams per patient. Conclusions: ERMO as a framework is feasible. The patient reported outcomes such as ESAS and RIOT, and barriers to implementation, including participant engagement and patient pain management perceptions, should be evaluated in the context of larger clinical trials.
149 Background: Integrated Ethics provides continuing education monthly for physicians, nurses, social workers, and others to enhance knowledge and understanding of ethical challenges associated with patient care and research. These are offered live at the main campus. There are four regional centers within a thirty-five mile radius of the main campus. Participants from those locations used to have to come to the main campus to participate. This project was initiated to help alleviate rising financial costs associated with the online recording/redistributing of continuing education credit presentations, travel expenses for regional center employees, removal of employees for 4+ hours from the regional centers daily clinical operations to attend presentations, and payment to outside institutions to obtain required ethics CME and CEU credits. Methods: Steps included internal and external discussions, establishing the need, tracking current process, determining which resources were needed, and then updating the process and evaluating it. Among the primary elements was the inclusion of nursing leaders, physicians and social workers from the centers. Ethics staff went to each center for discussions which had the added value of building relationships. Telehealth and information technology representatives assisted in developing the possible methods for delivery of the education and provided information about the process and costs of each for evaluation. Of note was the fact that the profession of the attendees was different among the main campus and regional centers. At main campus 58% of the attendees are physicians, at the regional center 66% are nurses. Varying requirements for continuing education in the professions had to be accounted for in the selection of method delivery and accreditation processes. Results: This project saves a minimum of $22,634 annually and participation at the Regional Care Centers increased by 20%. An average of 309 productivity hours are no longer lost at the centers. Conclusions: Understanding and utilizing new technology and consistent personalized communication efforts realized both cost savings and increased participation.
The popularity and increased use of online interaction and social media websites is certain to impact the healthcare profession. As 80% of Americans with Internet access search for health information, it is important for healthcare professionals (HCP) to adapt to the needs of their clients. Through the use of an online survey of HCP, this study offers insight into their current interest and use of online media. The findings indicate that many HCP have little interest in participating in online interaction with patients and are deterred by issues of privacy and liability. Applying a theoretical framework of uses and gratifications, our study addresses HCP motivations for interacting online, both professionally and personally. Analysis reveals that HCPs have three dominant motivations for using online social media: professional selfexpression, social entertainment, and convenience. Relationships are noted between motivations for use and frequency of social media activity. Findings inform best practices in communication via online platforms for HCP as they forge relationships with patients in a digital age.
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