Communication among oncology teams at an academic center.

Abstract

166 Background: Effective communication is essential to ensure optimal care for oncology patients admitted to the hospital and safe transitions between care settings. Methods: A questionnaire adapted from the Collaboration and Satisfaction about Care Decisions survey instrument addressing inpatient/outpatient communication was sent to nurses and physicians who cared for patients admitted to the housestaff oncology services at the University of Pennsylvania from 10/2016-2/2017. Questions addressed care plan formulation, communication, and satisfaction with medical decision making on a seven-point Likert scale. Contextual interviews with stakeholders were also conducted. Iterative adjusted rounding pilots were implemented in PDSA cycles including rounding checklist, multi-disciplinary rounds and a two-step paging process to inform nurses of teams’ rounding times. Results: For 66 respondents, the ranges of mean score for each question by provider type were: oncology nurses (4.07-4.29, n = 28), medicine interns (4.33-5.11, n = 9) and residents (4.00-4.83, n = 12), oncology fellows (5.00-7.00, n = 1), and oncology attendings inpatient (5.56-5.89, n = 9) and outpatient (4.71-5.57, n = 7). Given the lowest scores among nurses, rounding interventions targeting nursing attendance on rounds were trialed. Baseline data demonstrated nursing presence on rounds for 47.0% (95% CI: 37.2-56.8%) of patients. During a pilot of the two-step paging process, the rate increased to 63.1% (55.6-70.6%; p = 0.01 for two-sided Z test). A balancing metric of time per patient did not vary significantly before and during the pilot process. Contextual interviews surrounding interventions suggested several barriers to systematically restructuring provider rounds: time limitations for team rounds, frequent rotation of providers and variations in rounding styles as dictated by attending physicians. Conclusions: Satisfaction regarding the care of acutely ill oncology patients appears to negatively correlate with face-to-face time spent with patients in the inpatient setting. These findings provided the basis for a series of pilots of modified rounding models with a focus on integrating nursing staff into provider rounds, which have been difficult to sustain