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Significance & Background: As oncology care becomes increasingly complex, timely access to nurse triage for symptom management is crucial. Traditional models of assigning triage as an additional responsibility for the ambulatory care nurse often leads to delays and inefficiencies in addressing patient needs, which can impact patient outcomes and satisfaction. To address these challenges an oncology nurse triage service was proposed to increase patient access to care and enhance care delivery. Purpose: The purpose of this quality improvement (QI) initiative was to develop an innovative care delivery model, embed a digital workflow in the electronic medical record (EMR) and implement an oncology nurse triage service designed to improve patient access to care, across a large service area, while maximizing scope of practice for oncology nurses. Interventions: The QI project employed a multi-phased approach. Phase 1 included a comprehensive needs assessment, stakeholder engagement, and design of evidenced based triage protocols. In phase 2 the triage service model was developed and structured around a call center model, staffed with experienced oncology nurses trained in triage protocols. Key components of this project included building evidenced based triage protocols into the EHR for real-time patient information access and the development of standardized triage pathways based on clinical urgency and patient needs. The third phase involved training for all involved staff, establishment of performance metrics, and a phased rollout of the service across the service area. Metrics included volumes for incoming and outgoing calls, number of in-basket messages handled, response times and call abandon rate. Data was collected and analyzed over a six-month period to assess the impact of the new service. Results: The triage service has expanded to include five practices with plans to bring on three additional clinics by year end. Call volumes increased by 111% while maintaining service level targets for answering 80% of all calls within 60 seconds (m=82.59%) and call abandon rates decreased by 37% (m=3.45%). The integration with EHRs facilitated better continuity of care and more informed decision-making by triage nurses. Discussion: This project illustrates how implementing a dedicated triage service with standardized workflows and evidence-based algorithms can enhance timely patient access to care and ensure safe delivery of services. Future steps include ongoing program evaluation, symptom and disposition tracker, and exploration of expanded service capabilities to further optimize oncology care delivery.

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.

[...]of the new Breast Cancer Multidisciplinary Clinic workflows, APP visit volumes also steadily rose over time. With the deployment of the new Breast Cancer Multidisciplinary Clinic, market share in the primary service area jumped to an all-time high of 46.7% during this 5-year period. [...]the role of an oncology nurse navigator is vital for making a clinical judgement about appropriate specialties and establishing a patient relationship with the institution to drive patient retention.

Previously, we reported successful cellular expansion of a murine colorectal carcinoma cell line (CT-26) using a three-dimensional (3D) engineered extracellular matrix (EECM) fibrillar scaffold structure. CCL-247 were grown over a limited time period of 8 days on 3D EECM or tissue culture polystyrene (TCPS). Cells were then assayed for growth, electroporation efficiency and Vigil manufacturing release criteria. Using EECM scaffolds, we report an expansion of CCL-247 (HCT116), a colorectal carcinoma cell line, from a starting concentration of 2.45 × 10 5 cells to 1.9 × 10 6 cells per scaffold. Following expansion, 3D EECM-derived cells were assessed based on clinical release criteria of the Vigil manufacturing process utilized for Phase IIb trial operation with the FDA. 3D EECM-derived cells passed all Vigil manufacturing release criteria including cytokine expression. Here, we demonstrate successful Vigil product manufacture achieving the specifications necessary for the clinical trial product release of Vigil treatment. Our results confirm that 3D EECM can be utilized for the expansion of human cancer cell CCL-247, justifying further clinical development involving human tissue sample manufacturing including core needle biopsy and minimal ascites samples.

The demand for high‐throughput and scalable cell expansion platforms that can accommodate diverse cell types remains a critical requirement across various biomedical fields. Fibronectin (Fn), an essential component of the extracellular matrix (ECM), has been used as a conformal surface coating for two‐dimensional (2D) cell culture systems. However, the soluble, globular Fn used for 2D coatings differs structurally from the native Fn, which possesses a three‐dimensional (3D) fibrillar structure. Herein, a large‐scale engineered ECM (EECM) cell expansion platform based on a 3D fibrillar Fn network spanning over centimeters is presented. Extended fibrillar networks are formed by shearing dilute Fn solutions over tessellated polymeric scaffolds, which are conveniently prepared by 3D printing. The structure and size of the Fn‐based 3D EECM scaffold are optimized by evaluating the proliferation of a colorectal tumor cell line, CT26, commonly used in the in vivo tumor immunotherapy models. The 3D EECM scaffolds support a fourfold more efficient tumor cell expansion than a conventional 2D culture system, demonstrating the potential efficacy in supporting the robust expansion of cancer cells ex vivo with an eye on cancer immunotherapy. A scalable three‐dimensional engineered extracellular matrix (3D EECM) holds promise as a novel cell expansion platform for personalized cancer immunotherapies. By integrating shear‐induced fibronectin fibers into 3D polycaprolactone scaffolds, efficient expansion of cancer cells can be achieved, making it a potential solution for obtaining a clinically relevant number of cells necessary for personalized cancer treatment.

Cell Therapies In article number 2300012, Joerg Lahann and co‐workers present a scalable three‐dimensional engineered extracellular matrix (3D EECM) as a novel cell expansion platform for personalized cancer immunotherapies. By integrating shear‐induced fibronectin fibers into 3D polycaprolactone scaffolds, efficient expansion of cancer cells can be achieved, making it a potential solution for obtaining a clinically relevant number of cells necessary for personalized cancer treatment. The cover image shows the scaffolds (brown) featuring engineered extracellular matrix with a fibrillar architecture (green) to promote three‐dimensional expansion of human cancer cells (blue).