Smilow Cancer Hospital Town Hall | May 22, 2024

Transcript

• 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&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.