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Objectives. To assess the feasibility of chronic disease surveillance using distributed analysis of electronic health records and to compare results with Behavioral Risk Factor Surveillance System (BRFSS) state and small-area estimates. Methods. We queried the electronic health records of 3 independent Massachusetts-based practice groups using a distributed analysis tool called MDPHnet to measure the prevalence of diabetes, asthma, smoking, hypertension, and obesity in adults for the state and 13 cities. We adjusted observed rates for age, gender, and race/ethnicity relative to census data and compared them with BRFSS state and small-area estimates. Results. The MDPHnet population under surveillance included 1 073 545 adults (21.8% of the state adult population). MDPHnet and BRFSS state-level estimates were similar: 9.4% versus 9.7% for diabetes, 10.0% versus 12.0% for asthma, 13.5% versus 14.7% for smoking, 26.3% versus 29.6% for hypertension, and 22.8% versus 23.8% for obesity. Correlation coefficients for MDPHnet versus BRFSS small-area estimates ranged from 0.890 for diabetes to 0.646 for obesity. Conclusions. Chronic disease surveillance using electronic health record data is feasible and generates estimates comparable with BRFSS state and small-area estimates.

A lack of an evidence-based mobility program on an acute tertiary care adult oncology unit was identified at an 850 + bed academic medical center. To address the gap in practice, a quality improvement (QI) project was piloted on one 40 bed unit made up of patients with diverse oncology and hematology diagnoses. The project aimed to determine if, in an adult oncology population with high fall rates, would the nursing implementation of Johns Hopkins Activity and Mobility Promotion (JH-AMP), when compared to current practice, affect fall rates and the teams attitudes, beliefs, and behaviors related to promoting activity and mobility interventions. Intervention implementation utilized a 4 stage, Plan Do Study Act approach, and the entire JH-AMP toolkit (free access) was utilized throughout the stages. The entire project was designed to include measurement of the care teams attitudes, beliefs, and behaviors around mobility preand post-project implementation, educating the care team on using new JH-AMP activity and mobility capacity assessment goal-setting tools, implementation of the JH-AMP program tools, and monitoring of compliance surrounding AM-PAC assessment, JHHLM goal setting, completion of goals. Morning and evening shift change safety huddles were used to sure the bedside team was involved in the processes, had opportunities to communicate praises and concerns, and were included in decision making. The implementation of JH-AMP proved to be clinically significant. Findings included a reduction in fall rates when compared to falls rates for the same quarter one year prior, as well as identification of a learning gap related to the utilization of available mobility safety equipment, and statistically significant improvement in mobility behaviors. Opportunities for cost savings were recognized through a decrease in falls and falls with injury resulting in unreimbursed costs related to increased length of stays and care to treat injuries sustained due to falls. The results demonstrate the value of implementing the JH-AMP program into oncology nursing practice and leveraging an evidence-based program to augment current fall prevention practices improving patient care, patient outcomes, and preventing a functional decline in the oncology acute care population.

Coordination of Care Improving oncology patient admission efficacy is needed to optimize the patient experience, reduce costs, and stress on the interdisciplinary team. Delays in throughput negatively impact patient care and satisfaction, results in increased length of stay, and increase the likelihood of the need to transition care to an ED while waiting for a bed. Late admission times negatively impact the inpatient care team due to increased workloads during shift change and reductions in available providers and support personnel. One way to improve admission efficacy is to decrease wait times for admission to the inpatient unit. Modifying our approach to discharge was seen as an opportunity to impact throughput as timely discharge was impacting our ability to admit patients. This project aimed to determine if, in acute care oncology teams with high levels of late discharges, would the implementation of a nurseled discharge checklist, when compared to current oncology service discharge practices, affect discharge times and improve interdisciplinary communication regarding patient discharge needs during morning team rounds. Implementation utilized the four-stage, Plan-Do-Study-Act approach. During planning the discharge checklist was created by reviewing common themes delaying discharges after 1400 and input from the interdisciplinary team. Identified checklist items were then translated onto workroom dry-erase boards in a table format. At the beginning of rounds, the unit charge nurse and attending lead the team through the discharge checklist for each patient planned for sameday discharge and anticipated discharge for the next day. Identified discharge needs, issues, outcomes, and updates were noted on the board. The nurse-led discharge checklist has proven to identify discharge barriers, assign ownership, and increase the number of safe discharges before 1400. Opportunities to increase interdisciplinary participation were recognized by decreasing the time needed to attend rounds. Charge nurses are now able to quickly identify and communicate actions needed to expedite patient discharge. Potential cost savings are recognized through reduced length of stay and reduced transitions of care to multiple areas by improving same-day bed availability. Current results demonstrate the value of implementing a nurse-driven discharge checklist into interdisciplinary rounds. The project has expanded to include additional oncology services and work has begun to add a patient discharge checklist to our patient portal.

Significance & Background: Hospitalized patients are at risk for falls, particularly patients with cancer. Myelosuppression can prove catastrophic for a patient with cancer who falls, potential hemorrhage, prolonged hospitalization and death. Fall prevention continues to be multifactorial and effective solutions elusive. Deconditioning and fatigue are risk factors for falls in cancer patients. A medical/oncology unit in a Comprehensive Cancer Center experienced a statistically significant increase in falls during the baseline period of December 2022-August 2023, with an average of 6.67. While mobility nursing assistants (M-NA) have been utilized previously on this unit, an opportunity for specialized onboarding was noted. Purpose: This quality improvement project was to decrease falls on an inpatient oncology unit by increasing mobility via a specialized M-NA. Interventions: The onboarding M-NA completed orientation specifically targeted at mobilization. The M-NA completed training time with a physical therapist, the oncology nurse practice specialist, and surgical oncology M-NAs. The M-NA's tasks were focused on the Johns Hopkins Mobility and Activity Promotion (JH-AMP). Based on this model, the M-NA utilized the Johns Hopkins Highest Level of Mobility (JH-HLM) score to determine the patient activity goal for the day. The mobility NA attends safety huddles and maintains communication with nursing, physical and occupational therapists to be sure that patients are mobilized effectively. Results: Since the implementation in August 2023, the unit has been eight months below the baseline mean of 6.67, causing a shift in the data, with a mean of 3.25 falls a month during the intervention period. With an estimated cost of a fall with injury to be $6,694 per event, this data represents a significant decrease not only in cost of falls, but also in patient harm. Discussion: Early and continued mobilization of patients while in the hospital is proven to decrease falls. A dedicated M-NA assists patients in reaching activity goals, thereby decreasing falls on an inpatient oncology unit where most of the patients are at high risk for falling. Continued interdisciplinary feedback on the mobility NA role will be vital and input from the mobility NA role themselves.

Throughput delays have a negative impact on patient care and satisfaction. Decreasing wait times for admission to the inpatient unit requires a process that identifies and removes discharge barriers. On average, discharge ready patients on acute care oncology units, were waiting approximately 45 minutes for transport to arrive. In addition to hospital transport delays, approximately 20% of oncology patients were waiting up to 3 hours for their family to arrive before they could be discharged from the room. The project's purpose was to reduce the time from discharge ready to complete discharge from room by implementing an oncology-specific discharge lounge waiting area and discharge transportation service. Through the zation of principles, oncology nursing leaders identified the necessary people, processes, documentation, equipment, and space that would reduce waste and improve workflow efficiencies. Peak periods of discharge activity helped define the hours of operation (M-F, ioam-6pm). A Plan, Do, Study, Act methodology was implemented over a twelve-week period. The concept of an oncology specific discharge lounge was developed. Over the course of too days of operations, 620 patients passed through the oncology discharge lounge. Approximately 80% of those patients had less than a 15-minute stay in the lounge prior to departing, improving patient satisfaction. An average of 4.65 bed hours were gained each day, improving the throughput of patients being admitted from the emergency department, PAGU, clinics and outside hospitals. An oncology specific discharge lounge with a dedicated transporter facilitated improved wait times for discharge transport and room turnover. Early in the development it was determined that the term discharge lounge was perceived by patients that they would have to wait for discharge, so it was renamed the transportation station which improved patients' willingness to utilize. Concerns from patients related to prolonged discharge times were notably decreased on patient satisfaction surveys. Additionally, we improved PACU and ED wait times for inpatient admission. Strategies aimed at improving efficiencies and decreasing waste, such as the implementation of a discharge lounge, have implications for improving the throughput of cancer patients.

A healthcare system merger resulted in the need to begin integrating oncology nursing practices across approximately 40 acute and ambulatory oncology patient care areas. Nursing grand rounds (NGR) are well supported by literature to promote peer learning, acknowledge best practices, improve rapport across nursing staff, and promote professional development. The purpose was to remove geographical barriers, establish nursing relationships, and promote practice inquiry and learning across a merging health care system by implementing a quarterly virtual, live, and enduring oncology NGR program. A NGR team consisting of nursing leadership, nursing educators, and frontline nursing staff across the system began meeting to establish NGR topics, standardized content delivery, apply for continuing education hours, and develop evaluation methods. Special attention was given to ensure content applied to all nursing practice areas, involved actual patient case studies, included time for discussion to learn practice difference across the system, and involved frontline oncology nurses from content planning to delivery. A total of 3 NGR programs have been offered in 2023. To earn contact hours, nurses were required to evaluate overall learning, answer questions to assess learning, provide feedback, and ideas for future sessions. Over 206 total contact hours were earned for first and second quarter events. Enduring hours remain open for 3rd quarter and the 4th quarter event will be held in November. Over 80% of learners strongly agreed or agreed learning outcomes were met by NGR programs. Comments by attendees were positive and included representation from over 30 different sites. The first topic, led to a review of infusion reaction reporting and harmonization with emergency procedures and order sets. Other topics have included health literacy and system patient education and trauma informed care with a review of resources. While NGR is not a new concept, implementing an oncology NGR with the goal of integrating nursing practice across a merging health system, has proven to be effective. Delivery via numerous formats offered opportunities for nurses to network, learn from one another, advocate needs or concerns to integration leadership and is leading to efficiency and improved patient care through practice and resource alignment. Networking leading to policy, procedure, evidenced based practice standardization has accelerated as a result of NGR. NGR programs can be used by leaders to integrate oncology nursing practices during healthcare system mergers.