The following article features coverage from the ONA 2019 Navigation Summit. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

Background The division of GI oncology at the Stanford Cancer Center receives a high volume of referrals for patients requiring complex care management. These referrals increasingly strained an outdated referral system causing significant treatment delays. Slow processing of referrals, lack of clinical triage, inaccurate or fragmented scheduling, and insufficient medical records consistently compromised efforts to provide efficient patient care, thereby prolonging the initiation of an appropriate treatment regimen. In a pilot program beginning in September 2017, a nurse navigator role was developed to oversee and improve the referral process to achieve timely and productive first visits.

Methods To establish a baseline from which to focus improvement efforts, a retrospective combined qualitative and quantitative analysis of five key metrics related to new patient referrals was reported from January 2017 to June 2017. Statistical measures for the length of time from referral to treatment, number of multidisciplinary clinic visits, volume of clinical trial accrual, and patient rated scores for likelihood to recommend and ease of scheduling were used to develop improvement strategies.

The pilot program was centered on patients referred to the Stanford Cancer Center for management of GI-related malignancies to include medical, surgical, and radiation oncology modalities. Experienced nurses from the GI oncology team were selected to function as nurse navigators with the primary responsibility of expeditious and comprehensive clinical triage of all new referrals. Where applicable, collaboration within the multidisciplinary team, to include clinical trial coordinators, was initiated by the nurse navigator. Ancillary support services were adapted to meet the goals of the program by modifying the data infrastructure for upgraded access to electronic medical records, patient education materials, and diagnostic imaging. The nurse navigators and revised scheduling structure were incorporated into the clinic workflow over several weeks, making ongoing adjustments to further define the role and standardize the process while accounting for operational variables confronted in real practice. Data collected from January 2018 to June 2018 was then compared to the previous year’s results for the same care metrics.

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Results Incorporating nurse navigators into the new patient referral process improved both procedural and patient experience outcomes. As a result of early clinical coordination, measurable improvements in each metric had a collective impact on the valuable time from referral to treatment, which was reduced from 72 days to 22 days. Thorough triage and oversight of medical record collection by the nurse navigators enhanced scheduling accuracy and provided opportunities for anticipatory allocation of multidisciplinary resources and clinical trial screening to move patients towards purposeful intervention. Of equal importance, patients were introduced to Stanford Healthcare through a clinician able to understand their medical story and provide insight and guidance through complex systems. Nurse navigators were also in a unique position to identify other nonmedical barriers to care for early access to patient support services.


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Conclusion The GI oncology nurse navigator pilot program presented compelling evidence for the benefits of early clinical coordination for new patients. The success of the nurse navigator program has been sustained, with plans to expand the methodology to other cancer care programs.