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Recommended Citation
Turner N, Bellamy A, Watts M, et al . No Place Like Home: Collaborative Process for Code Chemo. Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Quality Improvement poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background
“Code Chemo” leverages nursing expertise to expedite care and ensures smooth interdepartmental collaboration. Project goals are to reduce hospital admissions for oncology patients with central lines presenting in ED with fever.
Local Problem
Previously, febrile pediatric oncology patients with central lines were directly admitted. To minimize unnecessary hospitalizations, this process maintained patient management in the emergency department (ED) and allowed patients to be discharged home for. “Code Chemo” increased bed capacity and minimized hospital cost while managing crucial bed and staff shortages.
Method
ED and IP nurses along with a multidisciplinary team executed this project using a multilayered communication strategy and an interdisciplinary flow map. Nursing education emphasized the importance of prompt evaluation, implanted port accessing, obtaining blood cultures and antibiotic administration to meet national benchmarks. Nurses developed “Code Chemo” carts stocked with essential supplies. Standing orders were modified to promote nurse autonomy in initiating care. Nurse navigators provided patient education on the new process in the ED. Nursing involvement was critical in ensuring improved patient care.
Results/Conclusions
We have had 80 patients discharged home from the ED, improving patient flow and patient satisfaction while reducing admissions/costs. We estimate that this process change has potentially facilitated $1,072,000 (80* $13,400 per average pediatric non-birth hospitalization) in cost savings, while opening beds for others. Our median time from arrival to antibiotic administration in the ED is less than the national benchmark of 60 min. Approximately 10% of our non-neutropenic febrile patients are admitted, which is down from 100% at the start of the project.
Implications for Practice
This work is a blueprint for translating a standardized pathway to a multi-tiered communication tool to protect patients from hospital-related risks. An engaged, inclusive team resulted in a shared patient-centered vision, with nursing at the heart of expedited care delivery.
References
Cohen C, King A, Lin CP, Friedman GK, Monroe K, Kutny M. Protocol for Reducing Time to Antibiotics in Pediatric Patients Presenting to an Emergency Department With Fever and Neutropenia: Efficacy and Barriers. Pediatric Emergency Care. 2016;32(11):739-745. doi:10.1097/PEC.0000000000000362
Geerlinks AV, Digout C, Bernstein M, et al. Improving Time to Antibiotics for Pediatric Oncology Patients With Fever and Suspected Neutropenia by Applying Lean Principles. Pediatric Emergency Care. 2020;36(11):509-514. doi:10.1097/PEC.0000000000001557
Keng MK, Thallner EA, Elson P, et al. Reducing Time to Antibiotic Administration for Febrile Neutropenia in the Emergency Department. J Oncol Pract. 2015;11(6):450-455. doi:10.1200/JOP.2014.002733
Monroe K, Cohen CT, Whelan K, et al. Quality Initiative to Improve time to Antibiotics for Febrile Pediatric Patients with Potential Neutropenia. Pediatr Qual Saf. 2018;3(4):e095. Published 2018 Aug 9. doi:10.1097/pq9.0000000000000095
Yoshida H, Leger KJ, Xu M, et al. Improving Time to Antibiotics for Pediatric Oncology Patients with Suspected Infections: An Emergency Department-Based Quality Improvement Intervention. Pediatr Emer Care. 2018;34(1):47-52. doi:10.1097/PEC.0000000000001367
Document Type
Poster
Publication Date
11-13-2024
No Place Like Home: Collaborative Process for Code Chemo
Background
“Code Chemo” leverages nursing expertise to expedite care and ensures smooth interdepartmental collaboration. Project goals are to reduce hospital admissions for oncology patients with central lines presenting in ED with fever.
Local Problem
Previously, febrile pediatric oncology patients with central lines were directly admitted. To minimize unnecessary hospitalizations, this process maintained patient management in the emergency department (ED) and allowed patients to be discharged home for. “Code Chemo” increased bed capacity and minimized hospital cost while managing crucial bed and staff shortages.
Method
ED and IP nurses along with a multidisciplinary team executed this project using a multilayered communication strategy and an interdisciplinary flow map. Nursing education emphasized the importance of prompt evaluation, implanted port accessing, obtaining blood cultures and antibiotic administration to meet national benchmarks. Nurses developed “Code Chemo” carts stocked with essential supplies. Standing orders were modified to promote nurse autonomy in initiating care. Nurse navigators provided patient education on the new process in the ED. Nursing involvement was critical in ensuring improved patient care.
Results/Conclusions
We have had 80 patients discharged home from the ED, improving patient flow and patient satisfaction while reducing admissions/costs. We estimate that this process change has potentially facilitated $1,072,000 (80* $13,400 per average pediatric non-birth hospitalization) in cost savings, while opening beds for others. Our median time from arrival to antibiotic administration in the ED is less than the national benchmark of 60 min. Approximately 10% of our non-neutropenic febrile patients are admitted, which is down from 100% at the start of the project.
Implications for Practice
This work is a blueprint for translating a standardized pathway to a multi-tiered communication tool to protect patients from hospital-related risks. An engaged, inclusive team resulted in a shared patient-centered vision, with nursing at the heart of expedited care delivery.
References
Cohen C, King A, Lin CP, Friedman GK, Monroe K, Kutny M. Protocol for Reducing Time to Antibiotics in Pediatric Patients Presenting to an Emergency Department With Fever and Neutropenia: Efficacy and Barriers. Pediatric Emergency Care. 2016;32(11):739-745. doi:10.1097/PEC.0000000000000362
Geerlinks AV, Digout C, Bernstein M, et al. Improving Time to Antibiotics for Pediatric Oncology Patients With Fever and Suspected Neutropenia by Applying Lean Principles. Pediatric Emergency Care. 2020;36(11):509-514. doi:10.1097/PEC.0000000000001557
Keng MK, Thallner EA, Elson P, et al. Reducing Time to Antibiotic Administration for Febrile Neutropenia in the Emergency Department. J Oncol Pract. 2015;11(6):450-455. doi:10.1200/JOP.2014.002733
Monroe K, Cohen CT, Whelan K, et al. Quality Initiative to Improve time to Antibiotics for Febrile Pediatric Patients with Potential Neutropenia. Pediatr Qual Saf. 2018;3(4):e095. Published 2018 Aug 9. doi:10.1097/pq9.0000000000000095
Yoshida H, Leger KJ, Xu M, et al. Improving Time to Antibiotics for Pediatric Oncology Patients with Suspected Infections: An Emergency Department-Based Quality Improvement Intervention. Pediatr Emer Care. 2018;34(1):47-52. doi:10.1097/PEC.0000000000001367
Affiliations
Atrium Health - Levine Children's