JL512. Impact Analysis of an Advanced Practice Nurse on Outcomes for an Inpatient Hematological Malignancies Service in an Academic Medical Center
Sarah J. Jimenez, MSN, APN-C, AOCNP®, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, Tracy Krimmel, DNP, APN-BC, AOCN®, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, and Kimyatta Washington, MHSA, Department of Oncology Services, RWJBarnabas Health, West Orange, New Jersey
© 2018 Harborside™
JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017
The posters for the abstracts below can be found at:
Background: The complex care and management of hematological malignancy patients in the acute care setting requires a multidisciplinary team approach whose aim is to ensure favorable outcomes and safe discharge for the patients. Historically, the care team at our institution consisted of one attending physician, one oncology fellow, and one to two medical residents, all of which rotated frequently through the service. An analysis of the program showed that prolonged length of stay and overall quality of care were noted to be areas of improvement. Factors that contributed to prolonged length of stay and level of quality care included: no defined process of admission/discharge, lack of consistent team members, lack of consistency in care between providers, lack of communication between the inpatient/outpatient teams, lack of social work/case management support, disparities in documentation, and coding errors. As a quality assurance initiative, employment of an advanced practice nurse (APN) was suggested to help improve overall quality of care.
Intervention: An oncology APN was employed to oversee the management of patients admitted to the hematological malignancies service. The APN was the only consistent member of the service. The APN facilitated the admissions/discharges for all patients on the service, acted as liaison between inpatient and outpatient teams, developed standardized order sets, implemented multidisciplinary rounds to include both inpatient and outpatient social workers, case managers, nurse navigator, and oncology pharmacist. Thorough analysis of documentation led to the development of standardized progress note templates to ensure adequate documentation and billing capture. The coding team was re-educated to understand proper coding and a primary coder was provided to the team.
Outcomes: Retrospective data analysis over a 2-year period (2015–2016) revealed the implementation of an APN resulted in decreased length of stay, decreased cost of hospitalization per patient/per stay, better communication between inpatient/outpatient teams, and increased provider satisfaction. Specific data will be included in final poster.
Conclusion/Implications to Practice: The use of APNs for complex patients such as those with hematological malignancies have been shown to have improved outcomes, lower cost of hospitalization, and shorter lengths of stay when compared to historical data. In the setting of limited resources, APNs play a pivotal role in providing affordable quality complex patient care. More studies are needed to evaluate the role of advanced practice providers (APP) in the hematological malignancies inpatient service. Expansion of the APP specialized service and employment of additional APPs may continue to improve both patient and provider experience.
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