Smilow Cancer Hospital Town Hall | May 22, 2024

May 23, 2024

Information

New Clinical Announcements: Kevin Billingsley, MD, MBA and Tracy Carafeno, MS, RN, CNML

National Oncology Nurses Month: Celebrating Our Oncology Nurses: Tracy Carafeno, MS, RN, CNML

Smilow RN/APP Fellowship Program: Christina Matousek, MSN, RN, OCN

Extended Care Clinic: Opportunities and Challenges: Brianna Flanagan, BSN, RN, OCN and Vanna Dest, MSN, APRN-BC, AOCN

ID11712

To CiteDCA Citation Guide

00:05Good evening everyone, and
00:07welcome to the Smilo Town Hall.
00:11We will. We have a great agenda.
00:13It is fitting, I think,
00:15to be capping off a wonderful week
00:18of gratitude and nurses week and I
00:21think some of those things will be
00:25our our highlights this evening.
00:27Let's see and we have our slides up.
00:41Thank you.
00:46So I will quickly go through some
00:49announcements and then really
00:51turn the program over to Tracy
00:54and our nursing leaders for a
00:56number of kind of recognitions
00:59and some exciting updates next.
01:05So just to kick off,
01:08it's always exciting to welcome new
01:12faculty to Smilo in the Cancer Center.
01:16We're thrilled to have Doctor Sylvia
01:19Kurz joining our Neuro oncology team.
01:22Sylvia is a real superstar in neuro oncology.
01:26She's had a career that has spanned
01:29both North America and Europe,
01:32training here in North America,
01:33has spent time in Boston and returned to
01:37her native Germany where she's been on
01:39staff and faculty for a number of years.
01:42And we have been able to recruit her back
01:45to join Doctor Bering and company and
01:48she will be starting sometime next month.
01:51So very excited to have her returning.
01:54As many people know,
01:56the Neuro Oncology service has been
01:59extremely busy and short of both faculty
02:06physicians as well as other clinicians.
02:09So this will be a very much a
02:12needed boost for that program.
02:14And I'm excited to have Sylvia here.
02:17Please welcome her when you see her
02:23next. I could not be more thrilled
02:28to recognize Kelly Alino.
02:31Kelly is well known to our community.
02:34She leads our surgical efforts in
02:37Melanoma and sarcoma and she's the
02:40clinical leader of the Melanoma program.
02:43Kelly is a true truck triple threat.
02:46She was recognized along
02:48with Doctor Jim Cloon,
02:50for Clinical Excellence at the
02:52Cancer Center Conclave Award.
02:54She's a productive researcher and she has
02:58now been recognized for teaching excellence.
03:02Doctor Brown recognized her around
03:05the time of graduation with the Leah
03:08M Lowenstein Award for Excellence
03:10in the Promotion of Humane and
03:14Egalitarian Medical Education.
03:15I watched Kelly teach our
03:17rotating students on surgery,
03:19and she really creates such a
03:22special environment for them.
03:24It's delightful to see her work
03:27recognized in this way.
03:28Congratulations, Kelly.
03:30Thank you.
03:32Also exciting to recognize
03:34one of our fellows,
03:36Doctor Jennifer Efani Saki who's the
03:39ASH American Society of Hematology
03:43minority Fellow in Hematology award
03:46under Doctor Lee's Alfred Lee's direction,
03:50we are training on really an
03:54enormous cadre of a hematologist.
03:57As we all know,
03:59this is a desperately needed clinical
04:01specialty and and very excited to
04:05recognize and Jennifer's contributions
04:07her and her potential for a
04:11extraordinary career in this exciting space.
04:14Next Also congratulations to none other
04:19than our very own Barbara Burtness.
04:23Dr.
04:23Burtness has been awarded the
04:26Presidential Citation from the
04:29American Head and Neck Society in
04:32recognition of her contributions to
04:34the field of head and neck surgery.
04:37You know,
04:39obviously head and neck disease requires
04:42intensive multidisciplinary integration.
04:44And although Barbara is a medical oncologist,
04:48obviously seeing her recognized
04:51by the surgical colleagues in this
04:54arena is a true honor indeed.
04:56Congratulations,
04:57Barbara.
05:00Well, the list of achievements
05:04and recognitions continue.
05:06The American Academy of Hospice
05:08and Palliative Care Medicine
05:10have honored two of our faculty.
05:14Doctor Laura Morrison has been
05:16named a top leader in Hospice
05:19and palliative care medicine.
05:21Doctor Morrison leads many of our
05:24educational efforts in palliative
05:25care and is recognized both within
05:29our organization and nationally.
05:31Dr. Prasanna Ananth has been named
05:34an emerging leader in Hospice and
05:36palliative care medicine in 2024.
05:39Doctor Ananth has an active presence
05:44predominantly in the pediatric
05:46palliative care space and is a wonderful
05:49complement to our adult program.
05:51So kudos to you both.
05:55Thank you.
05:56So with that kind of recognition
06:00of the talent we have here,
06:02I think we'll keep the theme going
06:05in the nursing space and I'll kick
06:08the program over to my partner,
06:10Tracy Carafino.
06:13Welcome, everyone. And again,
06:14thank you for joining us this
06:17evening for the Smilo Town Hall.
06:21I think I can get this up here.
06:24I will share my screen we had.
06:32Are you guys seeing the
06:34presentation or yes. OK, great.
06:39We have had a great
06:41month of May so far.
06:42May includes National Nurses Week as
06:46as well as Oncology Nursing Month.
06:50And as Kevin mentioned,
06:51it was also gratitude,
06:52the 10 days of gratitude for
06:56YNHHS. So it's been
06:57a wonderful time of celebrations
06:59and we just wanted to share some
07:01of the recognitions that have
07:03gone on in the nursing realm.
07:08We Oncology Nursing Society Congress was in
07:14early May and we had a great presentation,
07:18a great showing of presentations for
07:22the event just gonna run through.
07:24We had Kylie Cuck who presented
07:27on the electronic car T handoff.
07:30Thea Malal and Brianna Flanagan presented
07:34the NEST assessment and that received best
07:38in clinical abstracts and best in class.
07:42So there it was really well attended.
07:44That's a picture of Thea
07:46down there presenting.
07:47Christina Matusik presented the
07:49ambulatory fellowship program.
07:51Vana Dest presented on APP productivity.
07:55Melanie Glenn presented to
07:58Clistamab outpatient management.
08:00Audrey Belew presented on classical
08:03hematology standing orders.
08:05Leanna Keys presented the using
08:07Ampex scores to drive mobility
08:09goals and then Carolyn McGuire
08:12and Heather Studwell presented on
08:15Breast Cancer Survivorship Series.
08:17Liz Ginio and Nancy Schofield
08:21presented provider education sessions.
08:24Courtney Willard and Sam Perlo.
08:25Improving data capture rates of
08:28nursing metrics in radiation oncology.
08:30Robin Esposito.
08:32Ambulatory response team Amy Pelgusi
08:36enhancing communication between providers
08:38and clinical secretaries Maureen
08:41Mcglennan long term follow up care
08:44for allogenetic transplant patients.
08:46Kathy sumpio mentoring the mentor
08:49Alex Dormal edition of plexifor
08:52and Melissa parotti presented
08:55patient focused referral process.
08:57So Yale had a really great
09:02representation. We also had a booth,
09:05and there was a lot of interest
09:06in the work going on at Yale.
09:07So I think we've come really far
09:10from the first Onsi attended maybe
09:1315 or 20 years in really Yale having
09:16quite a showing and really national
09:19recognition for the work happening here.
09:21So this was the group photo of everyone
09:23that attended Congress this year.
09:28Last week we celebrated on
09:30College Nursing Month with our
09:33annual celebration breakfast.
09:34We had a great speaker,
09:37Jenny Beeson, and then we did
09:40our annual Frederick A DeLuca
09:42Foundation's Milo Care Scholarships.
09:44And just for anyone
09:46who doesn't know this, these
09:47we give out 10 scholarships for
09:51nurses who are actively pursuing
09:56advanced education with these accolades.
10:00And there's it's not they
10:01not it's a self nomination.
10:03And then there's a committee
10:04that reviews the nominations.
10:05And the awards were presented last week.
10:09Sarah Ann Sarney was the first one.
10:11She's an infusion nurse at Smilo
10:14Greenwich attending Chamberlain
10:16University to get her BSN and there's
10:18a quote from each of them on here.
10:21Oncology has always been important to me.
10:24I have been in oncology for seven years
10:26and planning on continuing my nursing
10:28education and going for my master's.
10:29I want to be an oncology nurse practitioner
10:32and work for Illinois Haven Health.
10:34Ada Mecca is a registered nurse on the
10:37inpatient MP15 attending Quinnipiac
10:39getting her adult geriatology nurse
10:42practitioner and primary care.
10:45In my nursing career,
10:46I'm deeply committed to lifelong
10:47learning as an essential aspect of
10:49providing high quality patient care.
10:51One specific example is my proactive
10:54pursuit of continuing Ed and inquiring
10:57my masters and my goal is to become
11:00a geriatric nurse practitioner.
11:01Caitlin, I mean Galen Kateman,
11:04also on NP15,
11:05attend Sacred Heart Davis and Henley
11:08School of Nursing Family Nurse practitioner,
11:11Dr.
11:11of nursing practice and Galen decided
11:13to work in oncology because this
11:16patient population is special for
11:18their resilience and complexity in care
11:20and it remains in the field because
11:22she is committed to oncology nursing
11:25and the compassionate care that is
11:27provided by all the nurses and staff.
11:30Angelina Zacharillo is a nurse on
11:33NP11 attending Western Connecticut
11:34State University for her psychiatric
11:37mental health nurse practitioner.
11:39As a nurse,
11:39I do my best to make the patient
11:41feel the best way possible and
11:43at the center of all our care.
11:44I will be forever grateful to be part
11:47of the Smilo Cancer Hospital community.
11:50Gillian O Galligan is an outpatient
11:52nurse on MP7 attending UConn getting an
11:56Advanced Practice Registered Nurse degree.
11:58I believe in the healing power of
12:00laughter and strive to infuse humor and
12:03joy into their visits when possible.
12:05Patients have communicated that
12:06they love hearing staff laugh and
12:09joke with each other and patients
12:11as it lifts patients out of their
12:14illness and returns them to humanity.
12:16Marcella Nelson, MP12,
12:17registered nurse attending University of
12:20Saint Joseph for her doctorate of nursing.
12:23Oncology Nursing really touches me
12:24as I can provide direct assistance
12:26to someone going through a very
12:28difficult time in their lives.
12:30Taking care of people when they are
12:32at their most vulnerable is an honor.
12:36Devon Eckley, a registered nurse
12:39on MP12 attending Youngstown State
12:42University to achieve her BSN.
12:44I do my best to collaborate with other
12:46nurses and providers to strengthen my
12:48nursing practice so that I am providing
12:50the best possible care to my patients.
12:52Cancer is a very difficult
12:54diagnosis for everyone involved in,
12:55so treating the patient holistically
12:58is also very important to me.
13:00Kimberly Babson is a care manager
13:03on the NP11 Hematology unit,
13:05attending Western Governor's for her
13:07Master in Healthcare Administration.
13:09As a care manager,
13:10I am continuously working with
13:12patients and their families.
13:13I see discharge planning as
13:15a whole family and patient.
13:16Together we can make the best decisions
13:19for what is needed for the patient.
13:22Shannon Cardoza, NP15, nurse,
13:23attending Fairfield University to
13:25get her family nurse practitioner
13:27and doctorate of nursing practice.
13:30I embrace this Milo Cancer Hospital
13:32vision mission by being a team player.
13:34I learned early on that working
13:36together makes each shift a lot better.
13:39Amanda Ingham is a registered
13:41nurse at Smilo Saint Francis,
13:43also attending Western governors
13:45getting her adult gerontology
13:47primary care nurse practitioner.
13:49The words who have cancer are something
13:51no one should ever have to hear,
13:52but providing patients and their
13:54families with compassionate,
13:55competent oncology nursing care
13:56can make their cancer journey
13:58just a little bit easier.
14:00I provide compassionate patient centered
14:02care by allowing patients time to process
14:06their diagnosis and ask questions.
14:08So a big shout out to all of the 10
14:11nurses who received scholarships and
14:13are advancing their careers and their
14:19some in oncology, some not,
14:20but all moving forward.
14:22And then we also gave out the 3rd
14:25annual Kathy Lyons Excellent in
14:27Nursing Leadership on award for those.
14:30I think most people know Kathy was the
14:35Vice President for patient services first
14:38Milo for several years before leaving
14:41about four years ago. Unfortunately,
14:44Kathy was also a cancer in cancer
14:49treatment and lost her battle
14:50about a year and a half ago.
14:52And so the this scholarship was
14:54started by Kathy's family to recognize
14:57excellence in nursing leadership
15:00and the qualities and tenants
15:02that Kathy really spoke
15:04to and mentored. And it was an honor
15:07to present this award to Alex Dormal,
15:09who's our program Manager for Cellular
15:12Therapy and the Smilo Carty program.
15:15Alex's dedication to advocating for
15:17patients is most evident in her
15:19role as cellular therapy manager.
15:21When advocating for staff,
15:22she takes all of our concerns
15:24and addresses them.
15:25She is great at circling back
15:27with any info and closing the loop
15:28when she has produced a solution.
15:30Alex has the unique ability to treat
15:32all those that report to her as equals.
15:34She values each team members skills
15:36and is inherently respectful in
15:38her request and interactions.
15:40She is also honest and forthright
15:42and provides constructive,
15:43targeted feedback to help us
15:45continually improve our performance.
15:47Alex tries to accommodate the often
15:49rapidly shifting goals of care and
15:51timelines throughout the departments
15:53that she manages as these cases evolves.
15:56Alex is is truly an exceptional
15:58leader and so well deserving of this award.
16:03And just a little shout out to the committee,
16:05the rewards and recognition committee.
16:07This is a smile committee that really
16:10works to recognize and reward members of
16:13the care team throughout the entire year.
16:15But their big celebration it was
16:18putting on these events last week.
16:20And so listed here is the the members
16:23of that committee with the leaders,
16:26Liana Braga Keys and Christina Matusik,
16:30who really have worked hard and and have
16:34really helped promote and reward many Smilo
16:38staff leaders and do events that really
16:43recognize the work that all
16:46of these employees are doing.
16:50So I am going to give one,
16:52you know, thanks to all the nurses
16:56in Smilo who work tirelessly
16:59every day and really are the
17:02backbone of the care provided at
17:03the bedside in the clinic chair.
17:05And you know, some of these quotes just
17:08are the tip of the iceberg of what,
17:10what how the nurses feel and what
17:12what really drives their passion to
17:14make this difficult work meaningful.
17:17So thanks to all of you.
17:21I'm going to now turn it over
17:23to Christina Matusek,
17:24who is our manager of our RN and
17:28APP Fellowship program to give you
17:31sort of an overview of the program
17:33and where it stands currently today.
17:38Thank you so much for the introduction,
17:39Tracy. And this will be hard to follow
17:41all those great nurses that were
17:43recognized and happy to be a part of
17:45the committee that helped to do that.
17:47So I'm going to share my screen.
17:53You guys can all see my screen,
17:54right? I got a slideshow.
17:59OK. So as Tracy mentioned,
18:02I'm the manager of the fellowship
18:05program for RNS and APPS and I had
18:08the great honor of presenting this
18:10project at ONS this past Congress
18:11as well as a podium presentation.
18:14So this is an overview of that as well
18:16as where we stand today 'cause I have
18:18presented this topic previously when
18:20we were first developing the program,
18:22but kind of wanted to refresh
18:25everybody's memory and give an
18:26give an overview of where we stand.
18:30So special thank you, of course,
18:32to Tracy Carafino and Kim Kim Slessor,
18:35who were great advocates for this program,
18:38as well as the Frederick A De Luca
18:41Foundation who helped support this
18:44work with their philanthropic dollars.
18:47So as a background,
18:48I'm not gonna spend too much time on this
18:50because we've reviewed it in the past.
18:51But really the the reason why we
18:54started this program was because of the
18:57overall issues with retention rates,
19:00turnover rates as well as
19:02cost the organization.
19:03So this data is from last year,
19:06but our vacancy rate for Smilo is about 15%
19:09and our turnover rate is about 12% or so.
19:14Nationally,
19:1625% of nurses leave their jobs within
19:18the first year and that really can cause
19:21a lot of costs to the institution,
19:24upwards of over $600,000 if there
19:27are multiple turnovers in place.
19:30So as mentioned,
19:32Smilo has moved a lot of their
19:35care from inpatient to ambulatory,
19:38which really called for strategic
19:42and creative,
19:43creative ways to help with the turnover
19:45and vacancy rates that we're currently
19:48happening in the ambulatory setting.
19:50In addition,
19:51we also looked at the fact that a
19:53lot of our inpatient nurses were
19:56going to the ambulatory settings
19:58pretty much as soon as they could
20:00after about two years of service,
20:02which has historically been our
20:04standard to allow nurses to come to
20:06ambulatory after they've been inpatient
20:08for about two years and received
20:11their chemotherapy certification.
20:15So our goals were to provide adequate
20:17education and support to new grads
20:19in the ambulatory setting while
20:21reducing turnover in both inpatient
20:23and outpatient and improving their
20:25attention rates of of staff overall.
20:29So we went through a whole
20:31program development which
20:33consisted of literature reviews,
20:34connecting with other cancer centers,
20:37collaborating with system leaders as
20:41well as developing the program structure,
20:43marketing the program into
20:46providing an interview process,
20:49development of preceptors,
20:52developing the orientation
20:54plan as well as implementation.
20:56So as we all know,
20:59there has been a huge rate of turnover,
21:01especially in oncology nursing,
21:03which has linked to burnout,
21:06high turnover rates or job dissatisfactions.
21:09And so a lot of our cancer centers
21:11across the country had already
21:13developed this type of program,
21:14especially our competitive
21:16centers in New England.
21:17So with really finding that if
21:19onboarding a strategic and methodical
21:21new grads can be successful in providing
21:24safe outpatient oncology care.
21:26So we really wanted to try to market
21:28this to bring new grads who are
21:31introduced interested in this type
21:33of work to our Cancer Center versus
21:35others in our surrounding areas that
21:37currently offer this type of program.
21:40So these are all the cancer centers
21:42that I was fortunate to to work
21:45with over the several months that
21:47I was developing this program,
21:49especially Duke was a huge one and
21:53individuals from Dana Farber as well
21:55or kind of like the top two that
21:58really helped to develop this program.
22:00I went through and looked at
22:03everything with them as far as
22:05what their recommendations were,
22:07how they got by in for their program,
22:09preceptor development,
22:10the length of their program,
22:13the majority of them were about
22:15a year in length.
22:16And so we opted and were funded
22:18for nine months in length,
22:19which is what,
22:20which is why we went the nine month route.
22:23So our program structure,
22:25it's a nine month fellowship program.
22:27We had our first cohort start in
22:29July of last year and they actually
22:32graduated in April of this year,
22:34all six of them.
22:36And then we had a second cohort
22:38for this year.
22:38We're actually opting to split
22:41it up into two separate cohorts
22:44of three people per cohort.
22:46So we had our second cohort start
22:49in February of this year and we
22:51just hired our 3rd technically
22:53our third cohort which will start
22:55in July of 2024 to total out the
22:58six new grads for this year.
23:03We opted to do that the the division
23:06of it because it really was,
23:08it was challenging at the end
23:10of it to have six open positions
23:12for everybody at the same time.
23:15So we opted to split it up in this,
23:17in this route for this time.
23:21The basically what happens too is
23:23that they spend about six months
23:25rotating through different infusion
23:27areas and then also care centers,
23:29infusion areas as well.
23:32So I really wanted to make sure
23:34that there was a structure to their
23:38orientation to ensure success.
23:40So again, it's nine months
23:42of the program itself.
23:43They spend 6 months rotating
23:45and then they actually do their
23:47chemo certification at month 3.
23:49And then once they're hired
23:51to a specific unit,
23:52which is typically around the five
23:54to six month mark is when they
23:56will have three months additional
23:58onboarding to the hiring unit to
24:00ensure that they are successful
24:02in onboarding to that unit.
24:04So in the beginning,
24:06we focused all on their skill
24:08mastery such as IV insertion,
24:09port accessing, head to toe assessments,
24:12drawing blood.
24:12They have all access to all the same
24:15classes that we have that we give
24:17all of our new hires into oncology,
24:19including our oncology fundamentals classes.
24:23They also are partaking in
24:25nurse residency programs.
24:26So there has been some collaboration
24:28with that program as well
24:30since they typically do not see
24:32ambulatory new graduate nurses.
24:35So this is just an example of their
24:38monthly goals and objectives which I
24:40developed to ensure that the preceptor
24:42and to the orientee knew what was
24:45expected of that month to month.
24:49We also wanted to make sure that we
24:51marketed this program effectively,
24:52which was I worked great.
24:55I worked very hard with Eliza
24:58Folsom and Renee Gaudette to
25:01actually create Instagram posts,
25:03LinkedIn posts, Facebook posts,
25:05things of that nature so that we can
25:07actually reach some of those new grads.
25:10Also with Judy Hahn and her
25:11team to promote the program to
25:13local nursing schools as well.
25:15And we really had a great success
25:17at recruiting some really great
25:19applicants throughout this process.
25:23Something I also wanted to do was ensure
25:25that all the preceptors had enough
25:27support as well as many of them have not
25:30precepted a new grad in many in many years.
25:33So we spent, we did 2-4 hour preceptor
25:36support sessions with our preceptors
25:37that were identified at different areas,
25:40which really went over the expectations,
25:43the orientation plan,
25:44what was what they should be focusing
25:47on with new graduate nurses,
25:49things of that nature.
25:50Also spending once a month sessions with
25:53all the preceptors in the beginning to
25:55really just talk about where the issues are,
25:58what are the concerns,
25:59things of that nature.
26:00So that was super helpful for them as well.
26:04I also wanted to focus on
26:06innovative strategies.
26:06So I've developed a website
26:09for our fellowship program,
26:11also electronic feedback form for
26:13interviews as well as weekly feedback
26:16forms for our weekly check insurance.
26:18And then we also have been collecting
26:21data before and every three months
26:23during the fellowship program to
26:25ensure that their knowledge and
26:28skills are improving over time.
26:30This is an example of the website
26:32that I developed as well as
26:33the program evaluation form
26:37and then our data.
26:38So for pre fellowship knowledge,
26:41we looked at using the same type of survey
26:43that they do for nurse residency program.
26:46So that looked at their competency
26:47and this is a self-assessment for
26:49all of them for blood transfusions,
26:52central lines, pleuric strains,
26:54Emergency Management,
26:56ANC Emergency Management and IV skills.
26:58So I utilize some elements of the
27:00survey they get during nursing
27:02residency and then incorporated
27:04stuff that was specific to oncology.
27:06And so this was their pre fellowship
27:09knowledge and then this is where
27:10they felt like they were at,
27:12at the three month mark.
27:13So definitely a great improvement in
27:15elements such as blood transfusions,
27:17central lines and Emergency Management.
27:24And then this is our six month data.
27:26So this again is a self-assessment.
27:30Some of them feel like they're
27:31experts at a lot of these things,
27:32which they probably are honestly because
27:34they've been doing it for a while.
27:35And especially for infusion nurses who
27:38give blood say every single day you get,
27:41you get good really quick.
27:42So,
27:42but they really showed great improvement
27:45at the six month mark as well.
27:48This is actually the total amount
27:50of hours of education that they
27:51spent as well as the total number of
27:53hours that they spent on the unit.
27:55So they spent almost 800 hours on
27:58the units itself at themselves
28:00learning from their preceptors,
28:0232 hours of in person education.
28:06The they also had online modules that they
28:08did such as the chemo immunotherapy course,
28:11the Orient ONS orientation bundle,
28:14things of that nature.
28:15And then they also did online
28:17non ANC related elements such
28:19as the nurse residency program.
28:21So they actually received a total number
28:24of 72 hours of CES over the course of
28:27their nine month fellowship program.
28:30So current state like I mentioned,
28:32we had our first cohort graduate in April.
28:36We have our second cohort spring
28:392024 that just began and our July,
28:42the July cohort will be starting
28:45as well in with four new hires
28:48starting at the end of July.
28:50This is a current some pictures of when
28:53they were in their rotational periods,
28:55they got to go to the operating
28:58room interventional radiology.
28:59So these are some pictures of them.
29:02So our current cohort,
29:04our first cohort all were offered
29:06jobs at various locations.
29:08So Smilo Tremble has Catherine
29:11Aceves and Emily Kempa,
29:13Smilo Guilford has Amanda John.
29:15Phase one clinical trials is Priya
29:18Desai and then NPA infusion is Monica
29:21Bevilacqua and Allison Candela.
29:23During this process,
29:23we actually didn't really even think
29:25that phase one would be something
29:26that we would be offering them,
29:28but they really did a great
29:30job during this whole process.
29:32And we were fortunate that we
29:33were able to offer one of them
29:35a position in phase one.
29:36And she's been really thriving there.
29:40And these are some pictures from
29:42the fellowship itself.
29:44We actually two of the on the upper left,
29:46they actually went to nursing school
29:48together and they both took a job
29:49in the fellowship, which was fun,
29:51but just all different like
29:53pictures from their preceptors
29:54and in the operating room and
29:56different parties and stuff,
29:58which was really nice.
30:01So lessons learned.
30:02We really found that having a large cohort
30:05was, was challenging with the hires,
30:07which is why we opted to do
30:09spring and summer cohorts,
30:103 of each to eliminate some of that stress.
30:14Communication to all team members is key.
30:17I also implemented an orientation day
30:19to the fellowship program for this
30:22cohort that just started in February
30:24to just review things that they before
30:26they actually even set foot on the unit.
30:29So they have a little bit of a background.
30:32We also went through resiliency
30:33training with them for this next cohort,
30:36and we opted to find dedicated space
30:39for them to do online trainings to
30:42just ensure compliance with that.
30:44We also got a lot of feedback from people.
30:47There were some shadow experiences
30:49they felt were not relevant,
30:50some they felt were great.
30:52So I really updated that
30:54based on all their feedback.
30:55They also really wanted to
30:56spend more time on each unit.
30:58So I increased each rotation to
31:00two months versus the one month,
31:02which I think will be a lot more
31:05beneficial for the new new grads
31:07as well as strategic orientation
31:08planning based on their interests
31:10when they start the fellowship program
31:12to kind of set them up for success
31:14for something like say going to
31:15hematology or things of that nature.
31:19Key takeaways.
31:20New graduate nurses can enter ambulatory.
31:23The ambulatory setting with
31:24strategic onboarding and obtaining
31:26approval from key stakeholders
31:28is essential to creating,
31:30implementing and sustaining a new
31:32graduate RN ambulatory fellowship program.
31:37So thank you so much for the opportunity
31:39to share the update with everybody.
31:42And I really appreciate everybody's hard
31:44work and dedication to this program
31:46because really I helped build it,
31:49but everybody else has been make
31:50helping it make it be successful.
31:52So I just really appreciate everybody,
31:54everybody with this process.
31:58Thank you, Christina.
32:01Any now we're going to turn it
32:04over to Ivana desk and Brianna
32:05Flanagan who are gonna give
32:07us an update on the ECC.
32:09All things ECC. Thank
32:12you, Tracy. Let me share my screen.
32:24Can you guys see that?
32:27Yes, you just gotta Yep, just swap
32:31into presenter. OK, well, thank
32:34you for having us. Bri and I
32:35are gonna give an update on the
32:37oncology extended care clinic.
32:41So if you don't know,
32:42it's located on MP12.
32:44It's across from the inpatient unit.
32:46And I have to say it is truly
32:47the best view of the house.
32:48Just looking out onto the sound
32:51patients truly just love it.
32:52We opened up on April 3rd of 2017,
32:55so it's already been seven years.
32:57We have occupancy for six patients.
32:59There's two beds that are private
33:01rooms and then there's four chairs.
33:03Our hours of operation
33:04are 7:00 AM to 11:30 PM.
33:07Our patients are prioritized for
33:09tests and procedures with the same
33:11priority that is given to patients
33:13in the emergency room department.
33:14We also have prioritization when it
33:16comes to bed management and we do have
33:18the support of rapid response team when
33:20one of our patients is decompensating.
33:22Clinically, it is an APP driven clinic with
33:25oversight by the oncology hospitalists.
33:27Our APPS really have a mix of both Ed,
33:30urgent care,
33:31and also oncology experience,
33:33and they truly make such
33:35a difference in the ECC.
33:37Our medical director is Sarah Shellhorn,
33:40so we thank her for all of her support.
33:43Just to talk a little bit about the mission,
33:46you know,
33:46back when we started looking at the
33:48extended care clinic and how we were
33:50gonna really try to implement this,
33:52we really wanted to look at
33:55reduction of patients going to the
33:57emergency room to get evaluated.
33:59And at the time when we first
34:00started to look at the data,
34:0190% of our patients that were coming
34:03to the Ed were actually admitted.
34:05So as a result of that their average
34:07length of stay was five to six days.
34:09It was incurring a lot of hospital
34:10costs and it certainly negatively
34:12impacted their patients quality of life.
34:15So I'm very proud to say that we have
34:17been able to reduce the number of
34:19patients being admitted from the ECC.
34:20And over the past seven years
34:22that really has been maintained
34:24at 65% of patients are admitted
34:26are are discharged to home and
34:2935% are admitted to the hospital.
34:31We continue to have wonderful
34:33patient satisfaction,
34:34which is evidenced by Prescady
34:36and it's about 97% satisfaction,
34:38which is really the 99th percentile.
34:42This is just some data that
34:44I'm gonna go through.
34:45So you can see this is really the
34:47roll up data which started from
34:49the day that we opened April 3rd
34:52of 2017 to the end of April 30th
34:55of 2024 / 20,000 patients have
34:57been evaluated in the ECC.
35:00And we do have a lot of patients that,
35:01you know,
35:01come time and time again because again,
35:03you know,
35:03they know about the ECC and they
35:05request to come here rather
35:06than go to the emergency room.
35:08Again,
35:08the amount of patients being discharged
35:10after being seen in the ECC is 65%.
35:14And the percentage of patients
35:15that is seen by the disease team
35:17first is only about 22%.
35:18And that really has dropped
35:20down certainly during COVID.
35:22And I think now that we're
35:24also in other satellite
35:25areas that it's really hard for clinicians
35:26to be seeing patients initially in clinic
35:28and then have to send them to the ECC.
35:32Anyways, in terms of distribution
35:33by the day of the week,
35:35you can see it's really pretty consistent.
35:37The weekend it drops off a little bit,
35:39but for the most part Monday through
35:42Friday are are relatively busy
35:44distribution by the arrival time,
35:46our busiest time truly is
35:48between 11:00 AM and 7:00 PM.
35:50Things drop down after 7:00 PM and
35:52usually first thing in the morning.
35:54Those are generally patients that
35:55may be elective admissions or for
35:57the calls that are coming in from
35:59the fellows that are doing the phone
36:01calls from from 7:30 PM until 8:00 AM.
36:04And this is just another example
36:06of the visits by the hour.
36:08Again, our busiest times are
36:10truly 11:00 AM to 7:00 PM.
36:12Referrals by clinic and disease
36:15team are three top referrals are
36:18from the GI medical oncology team,
36:20thoracic medical oncology team
36:22and breast medical oncology team.
36:23However,
36:24the ECC will take patients from
36:26from any Smilo area care centers.
36:29Also includes classical hematology,
36:30GYN oncology and surgical oncology.
36:35In terms of distribution
36:36by reason for the visit,
36:38the majority of our patients are truly
36:40coming in for symptom management.
36:42A lot of shortness of breath, fevers,
36:44neutropenic fever, failure to thrive,
36:47electrolyte imbalances, shortness of breath.
36:51And then about 36% is really from a
36:55kind of continuation of treatment.
36:57Maybe they had a hypersensitivity
36:58reaction on one of the infusion units.
37:00They have to come and be observed
37:01for a couple hours.
37:02There may be continuation of
37:04their chemotherapy or possibly
37:05their blood transfusions.
37:09And now I'm gonna turn it over to
37:11brief to talk a little bit about the
37:14ECC overview and also future state.
37:17Thank you very much, Bana.
37:20This is all has been standard
37:22since the ECC opened. But again,
37:24feel like it's a good time to refresh.
37:26A lot changed during COVID
37:28and and took some time to get
37:30back to quote UN quote normal.
37:32So referrals at this time should
37:34still be made directly to the ACCAPPS
37:38or providers that are there. We do.
37:41If patients are able to be seen in
37:43clinic prior to coming up to the ECC,
37:46we would love clinic RNS to be able
37:50to give a hand off to the ECCRNS.
37:53And likewise when ECCRNS are
37:56admitting patients to wanting
37:57any of the inpatient units,
37:59the expectation is again an RN,
38:02RN hand off.
38:03But that initial referral for the
38:05purposes of appropriate triage
38:07does need to be made from a
38:10provider to a provider in the ECC.
38:13Referrals should always still be
38:15based upon urgent clinical needs.
38:17And in that light,
38:20we are really not booking pre
38:23booking patients in the ECC in
38:25the way that they are in standard
38:28outpatient clinics or or care centers.
38:30So requests for for special approval
38:35for pre booking patients will
38:37require approval by PSM or APSM
38:40for the unit just to ensure that
38:42we are maintaining the mission of
38:45the ECC and allowing for urgent
38:48evaluations of sick patients.
38:51Patients in clinic waiting for admission
38:54to an inpatient unit really shouldn't,
38:57shouldn't be coming to
38:59the ECC before 6:00 PM.
39:01Again,
39:02if the ECC has availability,
39:04we're happy to take those patients
39:06knowing that the the outpatient clinics
39:08and do close earlier than the ECC does.
39:12But we will make these appointments
39:13in a in the standard way that
39:15we would any patient.
39:16So they'll be triaged and prioritized
39:19based on availability in the ECC.
39:21And of course,
39:22sick patients requiring evaluation
39:24will take precedent unless there are
39:27multiple open chairs at that time.
39:30And again,
39:30the report from the from the
39:32clinic RNS is to the inpatient
39:34team is really ideal to just take
39:36out the middleman of the ECC.
39:37It's of course always a safety risk.
39:40The more and more handoffs that
39:42we that we do and patients really
39:45we're trying to limit them coming
39:48to the ECC to complete infusions
39:50or transfusions with less than
39:5260 minutes remaining.
39:54This is really patient centered
39:57and in an effort to not have the
40:01patients be coming up only for for
40:0310/15/20 minutes it we're trying to
40:06to minimize that and and there's
40:08never because we're not pre booking
40:10patients will we are never able to
40:13guarantee when and if a chair will
40:15become available for patients later
40:16in the day to finish transfusions.
40:21The next slide.
40:26And some exciting future state for the ECC,
40:32We are our hope very still hopeful
40:35for 24 hour operations just like
40:39Vanna said in the in the beginning,
40:42because there's a higher admission
40:44from the Ed, we would love to still be
40:48able to decrease the impact of that
40:51on the off shift hours of the ECC.
40:54But in the meantime,
40:55since we don't have that in the immediacy,
40:59we recently did a huge safety
41:03optimization for the extended care
41:06clinic when we noted that there is
41:09currently no answering service for
41:11the ECC after the clinic closes.
41:13So from 11:00 PM to 7:00 AM the phones
41:17are unmanned without a voicemail setup or
41:20any anything redirecting the patients.
41:23So we were able to set up an the ECC
41:27with the same answering service that the
41:30outpatient clinics and care centers have.
41:32Typically the the calls that we're
41:35expecting are gonna be critical results
41:38most likely from the microbiology team.
41:41And we've agreed that all of these
41:43calls will be routed to the on call
41:46hematology oncology fellow who will
41:48make an appropriate determination
41:49if the patient is safe to remain at
41:52home until the clinic opens in the
41:54morning or if they need to urgently
41:56be evaluated in the emergency room.
41:59So we're very excited about that.
42:02We did find luckily that this wasn't
42:04a huge volume of patients,
42:06but of course every single one of them
42:09is important and we want to make sure
42:11that we have the ability to triage
42:14these patients in when they were
42:16seen in discharged home in the ECC.
42:19And lastly,
42:20we are working with some really
42:23wonderful Epic IT analysts to
42:26develop an electronic referral to
42:29the extended care clinic.
42:31So this would be able to be done from the
42:33current outpatient referring providers.
42:36It would come directly to the ECC
42:38with all the pertinent information.
42:41Our ECCAPPS would still be able
42:44to triage and prioritize the same
42:46way that they do now just over the
42:49phone and they would also be able
42:51to create an automatic wait list.
42:53I know that's one of the most
42:55challenging things in the ACC now for,
42:57for all parties,
42:58for the APPS managing the wait list
43:01in the ACC and for everybody in the
43:04outpatient setting trying to triage the
43:06importance triage the how long they
43:09can allow their patients to wait for a,
43:12a space that may or may not even open up.
43:14So this would be an electronic wait list.
43:16We would be able to have maybe even
43:19some support from our RNS and AC
43:21as in the ECC to help manage that
43:24and decrease the APP burden and
43:27really allow them to to focus on on
43:30clinical triage instead of the the
43:34administration of maintaining right now
43:36really is a paper trail of a wait list.
43:39So we're very hopeful for for many
43:43of those things and I believe that
43:46is all that we have.
43:48But we are happy to take some questions
43:51now or I'm not sure at the end.
43:55Thanks, Free and Vana there.
43:58This is the end the last presentation.
44:00We do have one question in the chat.
44:03Please if anyone has questions
44:05about any of the presentations,
44:06please feel free to put
44:07them in the Q&amp;A or chat.
44:09And the question is,
44:10are there plans to expand capacity
44:12And at this point there is not except
44:15expanding in the number of hours.
44:18If there is no plans at this
44:20point to expand into more chairs.
44:23We don't have any space in the current ECC.
44:26And our goal right now is to work on
44:29expanding the hours and then continue
44:32to monitor the volumes to see where
44:34where we might need to expand capacity,
44:37Which is why this referral form will
44:39be really critical 'cause we'll be
44:41able to better track the number of
44:44patients that we are not able to see.
44:46And that will really help with this,
44:48you know,
44:49in the future looking at the
44:51ability to expand,
44:56you know, I, I'll just jump in and see.
44:57I think Marianne asks a great question
44:59and her points are well taken.
45:01As we grow our cell therapy program and
45:04by specifics and other complex therapies
45:07that we are aiming to transition
45:10increasingly into the outpatient arena,
45:13the role of the ECC will
45:16be ever more critical.
45:19So I don't think it is unfair to say
45:23that Tracy and I spend some waking
45:27hours and probably some other hours
45:30when we should be sleeping thinking
45:32about how to move this forward.
45:34And it is, it's clearly a need and we
45:40will be working with our senior leaders
45:43to kind of make the business case
45:45as well as the clinical case that is
45:48clearly there to to extend the services.
45:53Yeah, I would just say that,
45:55you know, Doctor Weiner and Lori
45:57Pickens are both very engaged in
46:00this business plan of 24 hours and,
46:03and even leaders from the from
46:05the emergency department and the
46:07hospitalist program are all working
46:09together to try and make this happen.
46:11So it is active, it is very active.
46:19Any other questions, comments?
46:22I, I'm actually going to jump
46:25in with another question.
46:27Christina, I just a,
46:28having spoken to some of your
46:31recent graduates as I've rounded,
46:33just want to kind of take my hat off
46:35to you and your partners in the team
46:38who've developed this amazing program.
46:41You know, I think developing our
46:45oncology workforce is such an important
46:47part of the work we need to be doing.
46:50And I what I heard you say is that
46:52that you feel like there's some
46:55limitations into in how many nurses
47:00you can actually move through the
47:02program in a nine month period
47:05and provide a great experience.
47:08Are there opportunities to expand
47:10the capacity of the program
47:13by making it enterprise wide?
47:16Could we engage our kind of experienced
47:22oncology nurses at other sites throughout
47:25our cancer care enterprise to to?
47:29Yeah,
47:29So it's a, it's a great question.
47:31Tracy and I, you know,
47:32have talked about this a lot as far as
47:35like the future of the program goes.
47:37So it's a grant funded program
47:39for three years and so we were
47:41funded to have 6 new graduate
47:43nurses per year to go through this.
47:46The exciting thing is that we're
47:47also going to be doing this for
47:49the APP side of things as well.
47:51So that will hopefully be
47:52starting in the fall of this year.
47:54We're just finalizing some background things,
47:58but I think that I would love to be able to,
48:03I think that it's nice to have it,
48:05to have it smaller in the sense
48:07that you're able to really like
48:09tailor their orientation and
48:10provide them with this excellent,
48:11this great amount of support
48:14from their preceptors.
48:15But I would be happy and open to
48:19discussing ideas that people have for
48:22expansion or across like other areas.
48:25We've really tried to do.
48:27We've,
48:27we've focused a lot on main campus and,
48:29and the surrounding care centers,
48:32for example, Trumbull, Guildford,
48:34North Haven.
48:35But I know that there are people out there,
48:38say from Greenwich or individuals
48:40that are further away that would want
48:43this type of program in their area.
48:46And I am,
48:46I would love to be able to do that for sure,
48:49'cause I do think that this is
48:51kind of the wave of the future.
48:53And you know,
48:55whether their orientation remains
48:56being a nine month period,
48:58we would have to discuss that
49:00because it is a big chunk of
49:02time for people to dedicated to.
49:03But it's proven to just be very effective.
49:06And like just something small
49:08like that I noticed was, you know,
49:11we had all of them go through
49:13our chemo research this past,
49:14this past month.
49:16And the individuals who went through
49:18from the fellowship program did phenomenally.
49:21And which was which was great to
49:23see as a first,
49:24first observer of that,
49:26because I really wanted to make
49:28sure that they were comfortable
49:30and confident and competent to
49:32provide oncology care to patients.
49:34And I really feel like we've
49:36been achieving that.
49:37So I really appreciate your,
49:38your feedback and your,
49:39you know, and your accolades.
49:41It's
49:44great to see. Thank you.
49:47Thank you.
49:53I grew up out there tonight.
49:59Tracy, did I answer that appropriately?
50:01Were there any other things you
50:02thought I should have added? But
50:03that was great. OK,
50:13all right. Well, it is a beautiful, beautiful
50:16Wednesday and I'm sure everyone would
50:18love to have some 9 minutes left to go
50:21try and catch some of the sunshine.
50:24Thank you all so much for joining.
50:25We appreciate you and thank you to Ivana,
50:30Christina and Bree for
50:32your great presentations.
50:34Any closing comments, Kevin?
50:38No, I also echo your gratitude
50:42and I'm just it makes me proud
50:44to see the work that our nurses,
50:46staff and physicians are doing
50:49and see people recognized and
50:52particularly to kind of wrap up
50:55this week of nursing recognition.
50:57I will just from a personal standpoint
51:01echo some of Tracy's sentiments.
51:05You know, our, our nurses are really
51:10the heartbeat of our Cancer Center.
51:14And I often stand in awe of
51:18what you all do every day in the
51:22clinics and the infusion rooms,
51:24in the operating rooms, on the wards.
51:29And it does strike me how much you
51:34impact patients every day and how
51:37grateful patients and families are
51:39for everything you do to pull the
51:44strands of their care together and
51:46help them on their healing journeys.
51:48So thank you. Have a great evening.