Purpose: To improve oncology care for veterans seen at the Minneapolis VAHCS by implementing patient navigation with a navigation team and the use of specialty care coordination agreements.
Methods: Using the Vision Analysis Team Aim Map Measure Change Sustain (VA-TAMMCS) improvement model and Plan-Do-Study-Act (PDSA) principles, a multidisciplinary team was formed to map and measure current processes, identify barriers, and redefine work. Whereas other models of navigation use a specifically defined role, our model uses a team that allows all to “work at the top of their license.” Goals were to (1) decrease the number of face-to-face appointments; (2) implement nursing assessments for new patient consults; (3) decrease the time to completion for social work assessment; and (4) provide smooth transitions through the use of care coordination agreements. We also defined specific patient groups that could be managed with the assistance of the RN navigator. These include bone marrow transplant patients, benign hematology patients with stable chronic disease needing monitoring of blood counts, and more recently, prostate cancer patients requiring monitoring for radium treatments. We had hoped to add a second RN navigator for solid tumor management but were denied the second position. Medical support assistants (MSAs) were used for clerical/administrative elements, working closely with the RN Navigator. Finally, we are in the process of creating care coordination agreements between specialties to assure that all aspects of care are transparent and complete.
Results: We first revised the scheduling process for new oncology patients. The MSA uses an electronic calendar to alert both the RN and the social worker whenever a new patient is scheduled. Navigation order sets and documentation templates for standardization were implemented. Finally, in addition to the use of care coordination agreements between services, we created hand-off agreements to fully complete the circle of care. Metrics include (1) To increase the number of contacts/assessments by the RN navigator during the patients’ first visit; (2) decrease the number of patient visits between initial patient and provider decision for chemotherapy and the initiation of chemotherapy; (3) decrease the number of cancellations for initial oncology consultation; and (4) decrease the number of days between first oncology visit and social work assessment.
Conclusions: The use of the navigator team model allows efficient use of existing staff. Baseline data were collected to support the need for change. We are currently testing the model and plan to collect data to measure the degree of improvement in our processes. Leadership has been supportive, which is necessary to sustain the changes. By demonstrating effectiveness, efficiency and cost savings, it is hoped that the model can be expanded in Minneapolis and to other facilities.
