Admit in Confidence: Implementing a Pre-Admission Phone Screening for Hematopoietic Stem Cell Transplant

Abstract

Topic Significance & Study Purpose/Background/Rationale According to UpToDate, active infections in the hematopoietic stem cell transplant (HSCT) candidate should be eliminated prior to transplantation. HSCT causes immune deficiency meaning even asymptomatic infections can turn into sepsis following transplant. Our nursing team recognized a trend of delaying transplants or discharging a patient admission due to infection. There was a clear need for a standardized, pre-admission screening for HSCT. The purpose of this study was to see how a standardized, pre-admission phone screening effected HSCT delays or cancellations a 16-bed in-patient HSCT unit in an academic medical center. Methods, Intervention, & Analysis From December 2018- August 2019, a standardized pre-admission phone screening was implemented. The checklist was created by nursing and coordinators. In-services were conducted 2 weeks prior to implementation. The pre-admission screening addressed targeted HSCT concerns including respiratory, skin, gastrointestinal, and hemodynamic issues. HSCT coordinators performed the pre-admission screening two days before admission. If the patient responded no to all questions, admission would be as planned. If the patient responded yes to any questions, they would see their provider the following day. The provider, would approve or delay admission. Pre-admission screening information was reported out to the team via admission emails. Findings & Interpretation A total of 126 pre-admission phone screenings were conducted. Of those 126 calls, 5% of patients were flagged for infection and 2% were delayed prior to admission. Of those 126 pre-screenings, 72 were conducted during the official mask on flu season as deemed by infection control. Of those 72 calls, 8% of patients were flagged for infection and 3% were delayed prior to admission. As opposed to 2% being flagged for infection and 0% delays the off flu season. Nurses expressed this study decreased unnecessary admissions. Limitations of this study included the data collection process. Discussion & Implications A standardized, pre-admission phone screening helps to decrease delayed or cancelled HSCTs during the declared mask on flu season. In the future, we plan to conduct pre-admission phone screening during the flu season only. Oncology nurses play a pivotal role in patient assessment. To safely transplant patients, all nurses and members of the interdisciplinary team should be proactive and work together.