Diane Baldwin, RN, OCN, CBCN
A caseload management tool developed at the Mitchell Cancer Institute (MCI) at the University of South Alabama offers a comprehensive portrait of a patient’s condition that helps oncology nurse navigators to allocate their time and resources efficiently and enables managers to optimize patient care by assigning appropriate caseloads. The Association of Community Cancer Centers (ACCC) recognized the value of the analytical instrument at its recent conference by issuing MCI a 2017 Innovator Award for the accomplishment.
Acuity tools generally use a more limited set of measures to determine staffing needs, improve patient care, and control costs. Healthcare workers at MCI wanted to do a better job of distinguishing between patients who needed very few resources and those who needed more attention, according to the Rev Diane Baldwin, RN, OCN, CBCN, manager of quality assurance at MCI.
MCI’s new Oncology Navigation Acuity Tool incorporates 12 measures of the level of care required by each patient, Baldwin said (Table 1). This enables the MCI tool to provide a broad assessment of a patient’s health and needs status. “Some of the factors include staging and diagnosis, depression score, performance score, comorbidities, family support, number of treatment modalities the patient is undergoing, and recent hospitalizations,” said Baldwin.
Table 1. The Mitchell Cancer Center Institute Activity Tool Evaluates Patient Status From Multiple Angles
Baldwin, a United Methodist minister, presented her experience using the tool during the ACCC’s 34th National Oncology Conference, held October 18-20 in Nashville, Tennessee. She emphasized the importance of a key measure included in the tool that takes into account the nurse navigator’s own assessment of the patient. “Patients are more than a score,” she said. “There are times when the patient’s scores add up to an acuity number, but there are issues that the nurse navigator knows about the patient that will affect that score.”
She described the case of a patient who was suffering from depression because of the recent death of a spouse on whom she had depended during her cancer treatment. The oncologist advised the patient to return in 6 months for followup care, but the nurse navigator determined from the patient’s acuity assessment that she needed immediate referrals for grief counseling, a support group for widows, and increased phone contact. That was the course of action taken, and this represented a valuable intervention that might not have happened without the expanded assessment possible through the MCI tool. Based on 247 patients treated over 6 months at MCI, the services provided per month broke down as follows: the number of patients handled was 144, the number of in-person visits, 97; phone calls, 56; referrals, 13; clinical interventions, 30; and “stat” interventions, 4. Stat interventions are those that prevent unnecessary ED visits or hospital admissions (Table 2).
Table 2. Acuity Scores Predict Patient Needs (n = 247)
When evaluating patient visits on the basis of individual acuity tool scores for need, Baldwin found that 29% of patients were high acuity and accounted for 41% of visits. “These high-acuity patients are using the most resources,” she said. When she looked at stat interventions, she found that 29% of patients had high acuity scores, and 58% of those required stat interventions.
Baldwin said training for staff and use of the acuity tool are minimal and easy. The tool can be customized for individual institutions and has accurately identified which patients need more services and resources.
“Using the tool, I know exactly how much my nurse navigators can take on, based on acuity and not so much on sheer numbers,” she said. “It has given us a clear picture of where we expect our utilization, referrals, time, and interventions to come from. This helps us to plan our navigation team much better than before implementing the tool.” It makes sense to have a broader set of measures embodied in an acuity tool because giving patients the care they need to successfully battle cancer often entails looking beyond their mere oncologic needs. The acuity tool developed at MCI can help to accomplish this while also improving the allocation of limited resources, Baldwin said.