{"id":4937,"date":"2016-01-20T00:00:00","date_gmt":"2016-01-20T07:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/01\/20\/gyn-onc-providers-trim-patient-stays-at-uch-with-standardized-care\/"},"modified":"2022-07-29T12:53:34","modified_gmt":"2022-07-29T18:53:34","slug":"gyn-onc-providers-trim-patient-stays-at-uch-with-standardized-care","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/gyn-onc-providers-trim-patient-stays-at-uch-with-standardized-care\/","title":{"rendered":"Gyn Onc providers trim patient stays at UCH with standardized care"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><p>The Gynecologic Oncology group at University of Colorado Hospital is changing the way patients receive care, both before they enter the hospital and during their stays \u2013 and showing that doing so can get them home sooner.<\/p>\n<p>A team of inpatient and outpatient staff and providers from Gynecologic Oncology (aka Gyn Onc) joined forces last year to develop a process improvement project with the <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28145139\/ihqse20update20july202015.pdf\">Institute for Healthcare Quality, Safety and Efficiency<\/a> (IHQSE). Their broad goal was to streamline the care patients receive, from pre-admission, through their hospital stay, to their post-discharge care.<\/p>\n<p>It wasn\u2019t an easy assignment, said Jamie Nordhagen, RN, nurse manager of the hospital\u2019s Oncology\/Gynecologic Oncology\/Medicine Unit.<\/p>\n<p>\u201cWe wanted to unite inpatient and outpatient care into one service line,\u201d she said. \u201cBut we realized we were pretty siloed.\u201d<\/p>\n<p>The work is still underway, but the IHQSE project has helped to break down some of those walls. For example, the team is meeting a goal of implementing and integrating inpatient education into teaching before patients are admitted to the hospital, Nordhagen said.<\/p>\n<figure id=\"attachment_2137\" aria-describedby=\"caption-attachment-2137\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-2137\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145140\/EXT_012016_Jamie20Nordhagen-scaled.webp\" alt=\"\" width=\"300\" height=\"206\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145140\/EXT_012016_Jamie20Nordhagen-scaled.webp 1600w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145140\/EXT_012016_Jamie20Nordhagen-300x206.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145140\/EXT_012016_Jamie20Nordhagen-1024x704.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145140\/EXT_012016_Jamie20Nordhagen-768x528.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145140\/EXT_012016_Jamie20Nordhagen-1536x1057.webp 1536w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145140\/EXT_012016_Jamie20Nordhagen-2048x1409.webp 2048w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145140\/EXT_012016_Jamie20Nordhagen-150x103.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145140\/EXT_012016_Jamie20Nordhagen-200x138.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2137\" class=\"wp-caption-text\">Jamie Nordhagen, RN, nurse manager of the Oncology\/Gynecologic Oncology\/Medicine Unit at UCH, says process improvement efforts have helped providers and staff build closer relationships and improve patient care.<\/figcaption><\/figure>\n<p>Post-surgery, providers follow a clinical pathway \u2013 embodied in an evidence-based order set \u2013 that includes advancing patients\u2019 diets, getting them up and moving earlier, titrating their supplemental oxygen, following steps to prevent deep-vein thromboses, and removing indwelling catheters as soon as it is safe to do so.<\/p>\n<p>Consults for social work and case management are also embedded in the order set to address post-discharge needs, such as home health, depression treatment, substance abuse, palliative care and the like, and improve patients\u2019 transitions of care, Nordhagen said.<\/p>\n<p>It\u2019s working: Recent data from the IHQSE show that the clinical pathway, which rolled out last October, has helped to reduce the average length of stay for Gyn Onc inpatients by a day and a half.<\/p>\n<p><strong>Eyes on the unit<\/strong><\/p>\n<figure style=\"width: 300px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145139\/EXT_012016_Georgina20Cheng-scaled.webp\" alt=\"Georgina Cheng, MD\" width=\"300\" height=\"200\" \/><figcaption class=\"wp-caption-text\">Clinical pathways and order sets have standardized care for Gynecologic Oncology patients, says Georgina Cheng, MD, a fellow with the service line.<\/figcaption><\/figure>\n<p>The project sprung from daily observations of life on the unit, said Georgina Cheng, MD, PhD, a fellow with the Gyn Onc service. Cheng said she, Nordhagen, and Barbara Wenger, RN, MS, a clinical nurse specialist with Nursing Professional Development, noticed inconsistencies in implementing orders for patients on the unit.<\/p>\n<p>For example, in rounding on patients, Wenger noticed variations in care, such as catheters retained longer than necessary, Cheng said. Wenger would relay the information back to nurses, but the need for standardizing practice was clear. With input and consensus from attending physicians, the team created the clinical pathway and order set. It is now being integrated into the Epic electronic health record to ensure the standardized care is delivered to patients consistently.<\/p>\n<p>The work has created predictable milestones for patients treated for conditions such as endometrial cancer, Cheng said. \u201cThere will always be exceptions,\u201d she said, \u201cbut we are able also to identify barriers to moving patients to the next step in their care.\u201d<\/p>\n<p>The direction is important for Gyn Onc\u2019s staff of more than 100 nurses, as well as for the certified nursing assistants (CNAs) and advanced care partners who work the floor,\u00a0Nordhagen noted.<\/p>\n<p>\u201cThey need structure and consistency in providing care,\u201d she said. \u201cWe\u2019ve empowered nurses and allowed them to function at a higher scope in their jobs.\u201d<\/p>\n<p><strong>Getting in and getting out<\/strong><\/p>\n<p>Cheng said the team has also concentrated on consistently \u201csetting patients\u2019 expectations\u201d with pre-operative education about preparations for procedures, such as cleansing to prevent infections; expected length of stay; pain levels; medications; contacts for providers and more.<\/p>\n<p>The effort also helps to prepare patients for discharge, where they frequently get large amounts of information in a short period of time.<\/p>\n<p>\u201cThe pre-op education decreases the load of discharge preparation,\u201d Cheng said. \u201cRepetition is important.\u201d<\/p>\n<p>The work to build a continuum of care continues. Inpatient and outpatient representatives now meet to strengthen communication with patients after they leave the hospital. The goals: increase patient satisfaction and\u00a0head off complications that could lead to readmissions. Nordhagen said the plan could also include post-discharge phone calls, possibly by the end of the first quarter of this year.<\/p>\n<p>\u201cWe\u2019re trying to bridge transitions of care to the outpatient setting,\u201d Nordhagen said.<\/p>\n<p>\u201cThe challenge is developing a unifying message and defining the information that patients receive,\u201d Cheng added. \u201cWe improve satisfaction when patients know what to expect.\u201d<\/p>\n<p>Reducing average length of stay and improving the patient experience are important payoffs from the IHQSE project, said Nordhagen, but she highlighted an additional benefit.<\/p>\n<p>\u201cPerhaps the most beneficial outcome has been improved collegiality and collaboration between our unit\u2019s leadership and Gyn Onc providers,\u201d she said. \u201cWe\u2019ve laid a strong foundation to move ahead.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Gynecologic Oncology group at University of Colorado Hospital is changing the way patients receive care, both before they enter the hospital and during their stays \u2013 and showing that doing so can get them home sooner. A team of inpatient and outpatient staff and providers from Gynecologic Oncology (aka Gyn Onc) joined forces last [&hellip;]<\/p>\n","protected":false},"author":2143,"featured_media":2137,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[28,212,23],"class_list":["post-4937","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-cancer-care-oncology","tag-womens-care","tag-womens-health"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Gyn Onc providers trim patient stays at UCH with standardized care - UCHealth Today<\/title>\n<meta name=\"description\" content=\"The Gynecologic Oncology group at University of Colorado Hospital is changing the way patients receive care, both before they enter the hospital and during their stays \u2013 and showing that doing so can get them home sooner. 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A team of inpatient and outpatient staff and providers f...","robots":{"index":"noindex","follow":"follow"},"og_locale":"en_US","og_type":"article","og_title":"Gyn Onc providers trim patient stays at UCH with standardized care","og_description":"The Gynecologic Oncology group at University of Colorado Hospital is changing the way patients receive care, both before they enter the hospital and during their stays \u2013 and showing that doing so can get them home sooner. 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