Proactive telephone support reduces unplanned hospitalizations in blood cancers

Implementing proactive telephone support reduced unplanned hospitalizations among patients with blood cancers by 70%.
Implementing proactive telephone support reduced unplanned hospitalizations among patients with blood cancers by 70%.

ORLANDO, FL—Implementing proactive telephone support reduced unplanned hospitalizations among patients with blood cancers by 70%, saving an estimated $495,000 per year in health care costs, according to study results presented at the ONS 40th Annual Congress has found.

“The physical, emotional, and economic consequences of hospitalization among cancer patients are well documented and underscore the need for nursing interventions to reduce unplanned hospitalizations,” said Lori Dagostino, BSN, RN, OCN®, of Penrose Cancer Center, in Colorado Springs, Colorado, in explaining the rationale for instituting the evidence-based practice.

Approximately 300 cases of lymphoma, leukemia, and multiple myeloma are diagnosed and treated at the hospital-based, community cancer center each year.

In 2011, a retrospective chart audit revealed that 27% of patients being navigated by an oncology certified nurse who specialized in the care of patients with blood cancers had unplanned hospitalizations.

This led to an evidence review and a multidisciplinary discussion that resulted in the navigator initiating a proactive telephone intervention for ambulatory patients who were receiving chemotherapy.

“The navigator utilizes evidence and experience to anticipate symptoms commonly occurring between scheduled appointments,” Dagostino said. “Weekly telephone support, consisting of proactive symptom assessment, is administered to patients at high risk for hospitalization.”

Criteria for high risk are live alone, uninsured or limited financial resources, poorly managed depression or anxiety, or a diagnosis of dementia or cognitive deficit. Presence of just one criterium qualifies a patient as high-risk.

The phone call starts with a question about the patient's general well-being. Then the nurse navigator continues with questions about hematologic indicators, common sites and signs of infections, and psychosocial status, and symptom-focused  questions (eg, fatigue, pain, oral  or GI complaints).

“When symptoms cannot be adequately managed through telephone support, the navigator collaborates with primary nurses to ensure the patient is examined in office by an oncology provider or instructs the patient to seek emergency care when appropriate,” she said.

Over 2 years, data demonstrated that the proactive telephone support helped decrease unplanned hospitalizations from 27% to 8%, a 70% overall decrease.

Future studies will compare unplanned hospitalization rates for navigated patients vs nonnavigated patients, determine the best way to report the cost implications of the program, and examine the relationship between unplanned hospitalizations and timing and dose of chemotherapy.

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