Anne F. Reilly, MD, MPH
Under the direction of Anne F. Reilly, MD, MPH, Medical Director of Oncology and an attending physician with the Cancer Center at Children’s Hospital of Philadelphia, a multidisciplinary team was assembled to tackle a particular goal: reducing the inpatient length of stay for children newly diagnosed with B-cell acute lymphoblastic leukemia (ALL). The team’s work successfully decreased the time these patients and families spend in the Hospital — and the initiative won an award at CHOP’s annual Quality and Patient Safety Day.
Previously, patients newly diagnosed with B-cell ALL typically remained inpatient for up to 4 weeks into induction therapy. Generally, however, these patients can be treated just as effectively as an outpatient.
“We knew that it was medically safe for most of these patients to go home earlier than we had historically kept them inpatient,” says team member Amanda DiNofia, MD, attending oncologist. “We have long encouraged patients with B-cell ALL to engage in their normal life activities as much as possible, knowing that patients involved in their communities do better emotionally. This initiative allowed for that process to happen much earlier.”
Shorter inpatient stays mean a lower risk of acquiring infections within the Hospital and less disruption to family life, as children can sleep in their own beds and parents don’t need to deal with childcare issues for siblings. However, team members were highly aware that a shorter inpatient stay meant less time for a family to get accustomed to the reality of a cancer diagnosis. “A big concern is to not make it seem overwhelming for the family,” says team member Patricia Flaherty, MPH, improvement adviser for Oncology with the Office of Clinical Quality Improvement.
Changes that were implemented included offering families more education early in their hospitalization. But anxious families can’t always retain all the information. Therefore, materials were developed to reinforce information, such as calendar templates that can be customized for each patient with medication lists and procedure days. The implementation of structured education in the outpatient setting further helped reinforce the important information.
Staff members throughout the Division of Oncology received education on the new guidelines so that all staff provided a consistent message to families.
After implementing these and other interventions, patients on average now go home 7 days after diagnosis. There has been no increase in subsequent inpatient admissions or sick visits in the oncology clinic following these earlier discharges. And there was no increase in the number of phone calls to the clinic with questions from families and no change in the types of questions asked during those calls.
At CHOP’s annual Quality and Patient Safety Day — a day dedicated to recognizing quality and safety work that happens across the institution and often isn’t known beyond individual units or teams — the ALL Length of Stay Team was awarded the Safe Keeping Achievement Award for the initiative.
The next step is to expand to include patients with newly diagnosed T-cell ALL and lymphoblastic lymphoma.