A Quality Improvement Approach to Increase Exercise Assessment in Survivors of Childhood Leukemia

Survivors of childhood cancer are at increased risk of treatment-related cardiovascular disease, the severity of which is impacted by the level of regular exercise. Exercise assessments (EAs) are not a routine component of follow-up care.

We incorporated a quantitative EA tool into the clinic triage during follow-up visits for survivors of acute lymphoblastic leukemia. The nursing staff was surveyed on the use of the EA tool to gauge understanding and level of comfort with addressing patient questions.

Over 27 months, the percentage of off-therapy acute lymphoblastic leukemia patients with documented EA increased from 0% to 80%. We noted degradation in EA completions in the last 6 months of the project, which we attributed to project nursing staff transition and failure to maintain education. Interventions that improved the percentage of completed EA included the incorporation the assessment tool into the electronic medical record and weekly reminders of scheduled eligible patients. A nurse incentive plan did not impact project success. Survey results revealed that the nursing staff were comfortable with the EA and did not view the new process as hurting patient flow.

Implementation of an EA tool into routine clinic follow-up was successful. We met the project goal of assessing greater than 50% of the follow-up patients. This work will serve as the foundation for the next phase of the project, which will be to provide education on the importance of exercise and earlier intervention when a sedentary lifestyle is identified.