Quality of telephone nursing services for adults with cancer and related non-emergent visits to the emergency department

Dawn Stacey; Lynne Jolicoeur; Katelyn Balchin; Kate Duke; Claire Ludwig; Meg Carley; Lindsay Jibb; Craig Kuziemsky; Suzanne Madore; Lisa Rambout; Jackie Romanick; Michael M Vickers; Lorraine Martelli

doi:10.5737/23688076303193199

Quality of telephone nursing services for adults with cancer and related non-emergent visits to the emergency department

Can Oncol Nurs J. 2020 Jul 1;30(3):193-199. doi: 10.5737/23688076303193199. eCollection 2020 Summer.

Authors

Dawn Stacey¹, Lynne Jolicoeur², Katelyn Balchin³, Kate Duke⁴, Claire Ludwig⁵, Meg Carley⁶, Lindsay Jibb⁷, Craig Kuziemsky⁸, Suzanne Madore⁹, Lisa Rambout¹⁰, Jackie Romanick¹¹, Michael M Vickers¹², Lorraine Martelli¹³

Affiliations

¹ Research Chair in Knowledge Translation to Patients Member, Royal Society of Canada's College Professor, School of Nursing, University of Ottawa Cross-Appointment, School of Epidemiology and Public Health, and Senior Scientist, Ottawa Hospital Research Institute, Centre for Practice Changing Research, Ottawa, ON.
² Clinical Manager Systemic Therapy, Regional Cancer Program, The Ottawa Hospital, Ottawa, ON K1H 8L6.
³ Business Leader, Program Manager, Blood and Marrow Transplant Program, Regional Cancer Program, The Ottawa Hospital, Ottawa, ON.
⁴ Clinical Manager, TOHCC Clinics & New Patient Registration, The Ottawa Hospital, Ottawa, ON.
⁵ School of Nursing, Faculty of Health Sciences, University of Ottawa, Roger Guindon Hall, Ottawa, ON.
⁶ Research Coordinator, Ottawa Hospital Research Institute, Centre for Practice Changing Research, Ottawa, ON.
⁷ Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Child Health Evaluative Sciences, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON.
⁸ Associate Vice-President, Research, MacEwan University, Edmonton, AB.
⁹ Clinical Director, Perioperative Services, Eye Care Program and Chronic Pain, The Ottawa Hospital, Ottawa, ON.
¹⁰ Oncology Professional Practice Coordinator, Pharmacy, The Ottawa Hospital, Ottawa, ON.
¹¹ Oncology Nurse, The Ottawa Hospital, Ottawa, ON.
¹² Physician, Medical Oncology, The Ottawa Hospital, Ottawa, ON.
¹³ Provincial Head-Cancer Nursing, Cancer Care Ontario, Toronto, ON.

Abstract

A quality improvement project was conducted to determine the quality of telephone nursing for patients with cancer symptoms. Eligible patients were ones who telephoned the nurse about cancer symptom(s) within four weeks prior to an emergency department (ED) visit not requiring hospital admission. Experienced oncology nurses extracting data indicated appropriateness of ED visits and opportunities for improvement. The Symptom Management Analysis Tool was used to analyze nurse documentation. For 77 patients, 87% ED visits occurred within four days of calls about symptoms (e.g., pain, breathlessness, constipation, diarrhea, nausea/vomiting) and 91% could have been managed by more complete telephone assessment and/or an urgent clinic visit. Quality of nurse documentation revealed few patients were assessed adequately (38%), received any symptom-specific medication review (49%), or were guided in self-care strategies (17%). There was low-quality telephone symptom management by nurses and a need for alternative options for patients requiring urgent face-to-face assessments. Our findings highlight a gap in use of guidelines for informing telephone symptom management.