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Oncology Fellow-Led Quality Improvement Project to Improve Rates of Palliative Care Utilization in Patients With
Ramy Sedhom1, Arjun Gupta1, Mirat Shah1
1Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD.
JCO Oncology Practice
|April 28, 2020
Summary
Palliative care (PC) referrals for advanced cancer patients increased significantly after a quality improvement initiative. This multidisciplinary approach streamlined electronic medical record (EMR) processes and improved patient access to essential supportive services.
Area of Science:
- Oncology
- Palliative Care
- Healthcare Quality Improvement
Background:
- ASCO guidelines advocate for palliative care (PC) referral in advanced cancer.
- Significant implementation hurdles limit PC utilization in oncology settings.
- Oncology fellows identified low PC utilization in their clinics as a key area for improvement.
Purpose of the Study:
- To increase palliative care (PC) utilization for advanced cancer patients in a fellows' clinic.
- To improve PC referral rates from a baseline of 11.5% to a target of 30% over six months.
- To address identified barriers hindering PC referrals.
Main Methods:
- A fellow-led multidisciplinary team implemented Plan-Do-Study-Act (PDSA) cycles.
- Barriers identified included EMR order complexity, multiple referral pathways, and lack of centralized scheduling.
- Interventions focused on standardizing the referral process via a single order set and improving communication.
Main Results:
- PC utilization increased from 11.5% to 48.4% post-intervention.
- 48 out of 99 patients were referred to PC after the quality improvement initiative.
- The study demonstrated a substantial improvement in PC referral rates.
Conclusions:
- A multidisciplinary approach using quality improvement methodology effectively enhanced PC use in advanced cancer patients.
- Streamlined EMR interventions and ancillary staff engagement are key to overcoming underreferrals.
- Successful implementation was supported by stakeholder buy-in and institutional leadership.
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