It takes more than committed physicians and nurses to deliver the best care to patients. Providing quality care involves all our staff, even if they don’t work in a clinic, lab or operating room.

Working through the Accelerating City of Hope Excellence (ACE) program, five teams of employees recently improved five out-of-the spotlight areas that are critical to care:

• Securing Medi-Cal treatment authorization
• Developing research orders for clinical trials
• Preparing patients for bone marrow transplants in an outpatient setting
• Coordinating care for bone marrow transplant patients
• Centralizing patient blood draws into one location for patient convenience

The ACE teams reported their work Aug. 24.

From left, Ashley Thompson, Miranda Hoh and Preston White perform a skit. (Photo by Thomas Brown)

Medi-Cal authorizations

Medi-Cal, California’s public medical plan, requires authorization in advance for imaging scans, surgeries and other important medical procedures. Any delays in getting authorizations can delay treatment, said Brenda Thomson, director of case management at City of Hope. “Issues with outstanding authorizations also create possible problems with City of Hope getting reimbursed for the treatments or hospital days.”

An ACE team developed a uniform process for the Case Management Department to timely and effectively track and obtain authorizations. Before the ACE event, the team identified 110 MediCal authorization cases that were outstanding. A month after completion of the ACE event, only five authorization requests were incomplete.

Standard research orders

Our City of Hope clinical trial activation process requires standard research orders (SROs) to be developed, reviewed by our pharmacy, and posted online before each new clinical trial can be activated. A trial may require as many as 100 orders specifying the drugs the patient is to receive, the laboratory testing, required and a variety of other details. Defects in the SRO development and review process delays the availability of new treatment options for our patients.

In an effort to increase quality and efficiency of the process, “an ACE team improved the process for development, prioritization, review and approval of these orders by creating a template for all orders and enabling electronic submission and tracking”, said team leader Bernie Tegtmeier, Ph.D., senior clinical analytics specialist in the Department of Quality, Risk and Regulatory Management.

They’ll pilot the new process with hematology clinical trials next month.

Preparing for a bone marrow transplant in an outpatient setting

City of Hope patients preparing for a bone marrow transplant traditionally check into the hospital to get the radiation or chemotherapy they need prior to the transplant. But is a hospital stay always necessary?

“Several cancer centers are providing conditioning treatments to appropriate patients as an outpatient service,” said Carl Kildoo, Pharm.D., director of pharmacy and ACE team leader. “We looked at the feasibility of outpatient conditioning services, which could help make more beds available for additional transplant patients, as well as possibly lowering the cost of treatment for patients.”

An ACE team created a model to provide conditioning treatments as an outpatient service. They created guidelines for identifying patients appropriate for this kind of care.

The recommendations included patient and caregiver education, a transportation plan and rigorous patient safety measures. The next step is getting an organizational review of the recommendations.

Coordinating care

Earlier this year, an ACE team examined how to coordinate care of bone marrow transplant patients across a large multidisciplinary team. The team recently continued its efforts.

As team members learned about the importance of easily tracking and sharing patients’ progress towards transplant with one another, they realized they need a process, such as electronic dashboard, to monitor patients’ progress and communicate important clinical milestones and barriers, said Gerry Gorospe, R.N., a clinical nurse manager in the Department of Hematology and Hematopoietic Cell Transplantation and team leader for the event.

Patient, family and caregiver education, supportive care, financial counseling and clinical trials are some critical topics that need discussion during this time period, Gorospe added. The team will continue working to improve care coordination.

Centralized blood draw area

Because City of Hope has five blood draw locations throughout the medical center, many patients — about 22 each week — end up going to the wrong place for their tests, causing delays in care and patient dissatisfaction.

What was intended to be convenient for patients often turns out to  be confusing, said Dan Ross, Pharm.D., vice president Ancillary Services and chief pharmacy officer, who was executive sponsor of this ACE event. “With this event, our goal was to design a new space that would allow us to consolidate all blood draw areas into one location.”

The team developed a plan to help educate staff on directing patients to the new centralized blood draw area as well as how specimens will be transported to lab for analysis. In addition, the team gave recommendations for setting up the new location to ensure a smooth work flow.

The next ACE events are scheduled for Sept. 24 through 28. For more information, employees may visit www.coh.org/ACE. Questions about ACE also may be addressed to Tricia Kassab, R.N., B.S.N., M.S., vice president of quality and patient safety, at tkassab@coh.org.