ANAHEIM, CALIFORNIA—A weekly huddle between inpatient and outpatient units not only led to appropriate follow-up care but also increased nurse knowledge about a patient’s course of disease, improved nurse education, and empowered nurse coordinators. One staff shared their experience during a presentation at the Oncology Nursing Society (ONS) 39th Annual Congress.

“The concept of the huddle came unexpectedly,” Karen Schaedlich, RN, BSN, OC, of the Hillcrest Hospital—Cleveland Clinic in Mayfield Heights, Ohio, said during a podium session. She explained that, at one point, inpatient and outpatient staffs experienced frustration due to a lack of communication.

For example, copresenter Lynn Szoka, RN, MSN, OCN, also from the Hillcrest Hospital—Cleveland Clinic, said that, prior to implementation of the huddle, the inpatient unit was unaware of the services offered by the outpatient oncology unit, including emotional support, genetic counselors, and more.

The huddle, she said, appeared to be a viable solution.

The huddle was started in October 2012 with little guidance, thanks to a lack of research in the area, and evolved over time. A quality nursing representative joined the group once a week and two goals were soon developed: logistics, such as how often the group would meet, and the development of a form so that nurses would have a database on each patient, which included information on their diagnosis and treatment course.

The huddle included social workers, nurse managers, the inpatient case management team, and outpatient nurse coordinators. The logistics were worked out over the course of 5 months, and when the time came for implementation, the core group in turn educated the staff.

The carefully crafted form, however, was eventually phased out due to its cumbersome nature. What the nurses really wanted to know about was the patient’s well-being, how the family was coping with the diagnosis, and potential insurance issues, according to Schaedlich.  

“This was the most exciting part of the huddle because it became something that nurses needed to hear and talk about, and it formed naturally,” Schaedlich said. “From the inpatient side, they could discuss the patients’ barriers and experience while from the outpatient side, we could tell them what their last weeks, months, or years were like, and our social workers were able to hone in on insurance and financial issues.”

Szoka said the huddle continues on a weekly basis, and 1 year after implementation, it’s exciting to see how much change has come as a result.

“The group is very close, regimented, and everyone knows their role,” she said. “We’re working on fine-tuning, so we have a discussion of each patient, the diagnosis staging treatment plan, and more, and all basic information is logged into a patient database. We’ve even used this information to track quality metrics, such as appropriate discharge plans and follow-up.”

In a description of the huddle’s success, Szoka said that the nurses in the inpatient unit are now able to track patients through outpatient treatment and subsequent inpatient admission until they are ready to sign up for symptom management and hospice.

“Overall, we have a reduced fear of having those difficult conversations with patients and their families,” she said.

On the outpatient side, the huddle has enabled nurses to keep a better continuity of care, according to Schaedlich. They can ensure that patients are undergoing appropriate follow-up care upon discharge and therefore prevent hospital readmissions.

“We are able to welcome patients. We know they’ve been in-house, and we know what’s been happening, which gives a greater sense that we’re working as one big team,” she said.

The team continues to evaluate the huddle to make sure that it’s worth the time and effort and has value for both patients and coworkers.

What they have found is that the huddle may harbor benefits beyond oncology.

“As we continue as a nation and health care environment, looking at readmissions and care, the inpatient and outpatient huddle can be used in other units,” Szoka said.

She noted that tailoring the huddle to the needs of the individual institution is paramount and that a sustainable meeting requires a lot of planning and revisions. Also, meetings should be kept short and to the point so as to accommodate the staff’s busy schedule.

“You also need to be open for it to evolve and help bring engagement to the staff. It’s important to remember that it’s a patient-focused huddle,” Szoka said. “It is all unique. The situations are all complex, and huddles give knowledge and direction. With dedication to this process, we made a better place to receive oncology care.”

REFERENCE

Schaedlich K, Szoka L. Maintaining patient safety: Creation of a nursling-led inpatient/outpatient oncology huddle. Poster presented at: Oncology Nursing Society (ONS) 39th Annual Congress. May 1-4, 2014; Anaheim, CA.

Prepared by Kathy Boltz, PhD, and Melissa Foster