199 Background: The practice of conventional oncology has undoubtedly changed in the last 15 years, becoming more efficient, but also more complex and expensive. This complex care needs significant coordination. In the last 2 years in half of the continuing development of our care coordination working in the "Navigation Treatment" domain, the impact on reducing ER visits was, in media, 75%. Methods: In 2015 IOV developed a patient-centered Navigation System based on Kanban (board and visual signals-KNS) for managing the treatment plan of our patients that was successful. In 2016 with support of an educational grant from QTP-ASCO, we extended this system to manage pain to others cancers and treatment-related symptoms, education, resource referral or Coordination of multi-disciplinary care. This study addresses only decreased ER visits between Dec 15 and May 20 by all patients monitored by Nurses navigators. We measured the proportional reduction of ER visits related to pain to the total ER visits in three successive periods: development of the NKS (dec15-jul16), pilot phase (aug16-oct17), and as an adopted best practice (oct17-until today). The KNS comprises a set of standardized procedures and successive checks for patients in treatment based on three procedures: (a) standardized treatments prescriptions to pain and symptoms controls; (b) standardized follow up in 24 and 48 hours, 1, 2 and 4 weeks; and (c) manage side effects of opioids or other emerging problem (constipation, confusion, mucositis, diarrhea, fever, etc.). Any patient initiating opioid use is included in the KNS until opioid is discontinued. Once pain is adequately controlled, the frequency of checks become wider up to once a month if no toxicity is identified. Any new condition (will restart the 24-48 hours loop. The KNS is managed by oncology nurses using phone or video calls, messaging, and appointments; Mon-Sun from 6 AM to 8 PM. Results: The KNS managed a median of 204 (table*) patients per month during the last 32 months (Oct 17 to May 20). Patients with pain, symptoms, or side effects that were effectively managed by the team avoided an unwanted visit to the ER, in media by 75%. Pain represents 20% of ER visits generally; in pilot phase 15% of ER visits, and actually 4% of ER visits, an 80% reduction in pain-related ER visits. ER visits represent patients with uncontrolled pain and not effectively managed by the KNS. Conclusions: The development of a system to deliver more effective care patients resulted in a 75% reduction of ER visits and adequate pain control in our practice.
e18265 Background: Pain is the most frequent and one of the most important cancer related symptom with significant impact in quality of life. It is also the most frequent reason (27% of visits) for a patient to go to an ER and 53% can be prevented with adequate care (Panattoni, JCO 35, 2017 suppl; abstr 6505). Methods: In 2015 IOV developed a patient centered Navigation System based on Kanban (board and visual signals - KNS) for managing treatment plan of our patients that was very successful. In 2016 with support of an educational grant from QTP-ASCO we extended this system to manage pain and other cancer or treatment related symptoms. This study addresses only pain management and ER visits between dec16 and dec18 for a total of 187 patients using opioids. We measured the proportional reduction of ER visits related to pain to the total ER visits in three successive periods: development of the NKS (dec15-jul16), pilot phase (aug16-oct17) and as an adopted best practice (oct17-dec18). The pain KNS comprises a set of standardized procedures and successive checks for patients using opioids based on three procedures: (a) standardized prescription and use of analgesics using WHO’s Pain Ladder; (b) standardized follow up in 24 and 48 hours, 1, 2 and 4 weeks; and (c) manage side effects of opioids or other emerging problem (constipation, confusion, etc). Any patient initiating opioid use is included in the KNS until opioid is discontinued. Once pain is adequately controlled, the frequency of checks become wider up to once a month if no toxicity is identified. Any new condition will restart the 24-48 hours loop. The KNS is managed by oncology nurses using phone or video calls, messaging, and appointments; Mon-Sat from 6AM to 10PM. Results: The KNS managed a median of 132 patients per month during 29 months (aug16 to dec18). Pain represented 20% of ER visits (33.65 UCL and 6.7 LCL); in pilot phase 15% of ER visits (27.34 UCL and 3.70 LCL); and now 4% of ER visits ( 8.46 UCL and 0 LCL), an 80% reduction in pain related ER visits. ER visits represents patients with uncontrolled pain and not effectively managed by the KNS. Conclusions: The development of a simple visual system to manage cancer patients with pain resulted in 80% reduction of ER visits and adequate pain control in our practice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.