Implementing an Additional Weekly Treatment Visit with an Advance Practice Provider to Reduce Hospitalizations and Improve Quality of Care in Patients Undergoing Radiation Therapy

Abstract

Patients undergoing chemotherapy and radiation therapy (RT) simultaneously are at an increased risk of developing complications and requiring hospitalization. To reduce acute hospital admissions, patients were seen in an additional weekly on treatment visit, named high risk on-treatment visits (HR OTVS) with a radiation oncology advanced practice provider to identify and manage treatment induced symptoms. With early identification and management of these symptoms, our goal was to improve patient's wellbeing and reduce the rate of hospitalizations while undergoing radiation therapy, limiting treatment breaks, and improving patient outcomes. Oneyear of radiation therapy patients and their hospitalization rate during active radiation treatment was studied 2017. In 2018, the new quality implementation of HR OTVs was added at the end of the week (in addition to on-treatment visit day with the physician) for patients deemed high-risk of complications during radiation therapy. In 2019, one full year after implementation of HR OTVs, hospitalization rates were examined in patients undergoing radiation therapy and directly compared to hospitalization rates of 2017 before the new visit implementation. In 2017,40 out of 417 patients undergoing RT in our department were admitted to the hospital versus 44 out of 668 patients in 2019. As a result of implementing APP lead HR OTVs, the inpatient hospitalization rate went from 9.6% down to 6.5%. Chi-square test confirmed this to be significant with p value 0.03 (p <0.5). Of the 40 patients hospitalized in 2017, 9 of those 40 were undergoing concurrent chemotherapy and radiation and 0% had additional high-risk visits. In 2019, 12 of the 44 admissions included patients receiving concurrent chemoradiation. Of these specific 12 patients, 4 saw APP weekly and 8 did not. If a patient was undergoing chemotherapy and radiation therapy and they saw the nurse practitioner weekly, they were less likely to be admitted to the hospital (33% versus 67%). Utilizing advanced practice practitioners with weekly high-risk visits in addition to the routine on treatment visit can help identify, monitor, and manage treatment induced side effects, and in turn reduce hospitalization rates of patients undergoing radiation therapy.