Human resources allocation in oncologic day hospital: Validation of the Kohen-Gil Deza scale (KGD) for risk assesment.

Abstract

6596 Background: The oncological day hospital (ODH) at IOHM carries out 80 chemotherapies per day with 6 certified oncological nurses as staff. Human resources allocation in oncology has not been formally studied in relation to treatment risks. The objective of this paper is to present a risk assessment model for the rational allocation for human resources in the ODH using the KGD scale. Methods: The KGD scale was designed through a retrospective evaluation of more than 15,000 treatments (Tx). Between November 1st and December 1st, 2012, this instrument was validated with all new patients (Pt) beginning Tx at IOHM. The KGD scale evaluates risk according to: Five Pt characteristics (Elderly, Polymedicated, Without symptom control, Neuropsychiatric problems, Presence or absence of family members); Four Tx characteristics (New drugs, Complex protocol, High risk of acute toxicity, Infrequently used) and workplace context(New personnel, Holiday absences, With or without close medical support). The KGD scale was determined for each Tx and applied as follows: Low Risk (0-3 points): two nurses in the ODH, supervision is at the patient’s request and the chemotherapy can be administered at the beginning or end of the workday; Intermediate Risk (4-5 points): three nurses in the ODH, supervision is mandatory and the treatment can take place at any time in the workday; High Risk(6 or more points): four nurses in the ODH, supervision must be constant and the Tx must take place in the middle of the workday. The chemotherapy outcome was observed. Results: One hundred and thirty patients were admitted. Sex fem 74 (59%), male 56 (41%): age: 49y (range 22-87). Diagnosis: breast 40, colon: 21, lung: 16, ovaries:11, lymphoma: 11, testis:7, sarcoma: 5 ; others: 19 KGD risk assessment: Low Risk 25 pts (19 %); Intermediate Risk 77 pts (59%); High Risk 28 pts (21%). There were no complications in any of the 312 chemotherapy treatments administered to this cohort. Conclusions: 1) The KGD scale has shown to be a useful aid in the treatment risk assessment. 2) Use of the KGD scale allows for an efficient personnel allocation at the ODH according the Tx risk 3) The academic qualification of the nurses staff are mandatory to control the risk.