1008 - The HEART Team Protocol: A Strategic Approach to High-Risk Patient Management in Adult Oncology to Reduce Emergency Room Visits and Hospital Admissions

Y. J. Seo¹, T. Bressler¹, and P. R. Dutta²; ¹Mount Sinai West Hospital, New York, NY, ²Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY

Purpose/Objective(s): Annually, over 1.5 million Americans visit an emergency department (ED) for complications related to cancer treatment. Patients receiving multimodal chemoradiation (chemoRT) experience complications, including pain, fever, respiratory distress, fatigue, dehydration, altered mental status, and radiation dermatitis. In 2022, the Centers for Medicare and Medicaid Services (CMS) began to monitor hospitalizations and ED visits (EDV) for patients receiving outpatient chemoRT, aiming to reduce the number of EDV. We conducted a quality improvement project to determine if educating providers using a High ED/Admission Risk Therapy (HEART) team protocol could reduce EDV rates among patients receiving chemoRT with enhanced nurse-driven symptom management protocols. This project aimed to train nursing staff in early detection of cancer treatment-related symptoms and initiate early interventions to reduce unnecessary EDV. Materials/

Methods: We developed an evidence-based assessment tool and HEART team algorithm, emphasizing multidisciplinary collaboration and a patient-centered approach. Radiation Oncology nurses underwent 2 in-person training courses with a 30-minute PowerPoint presentation. The education included a multidisciplinary approach to understanding risk factors for cancer patients receiving chemoRT. Participants were given point-of-care feedback and weekly huddles to enhance their knowledge in detecting and managing cancer treatment-related signs and symptoms. Nursing staff were surveyed pre and post education to measure improvements in knowledge and identifying high risk signs and symptoms. Using the HEARTS checklist twice weekly and following the HEART team algorithms, nurses were trained to identify high-risk patients and to manage their conditions with subsequent referral to the HEART team for early intervention. An NP-led clinic would then further evaluate and collaborate with the multidisciplinary HEART team members, including nurses, physicians and supportive oncology staff.
Results: Using the Paired-Samples t-test, we showed a significant increase in nurses knowledge and confidence after the training; average scores rose from 14.00 before training to 21.23 after training. The statistical test produced a result (t(4) = -19.24, p < .001), with a 95% [CI: -8.24 to -6.16], demonstrating the training effectively enhanced the nurses perceived knowledge and confidence levels. This improvement was crucial for managing complex care needs of patients receiving chemoRT. Adopting the HEART team protocol reduced EDV by 14%.
Conclusion: Adaptation of the HEART team protocol significantly improved nursing knowledge in early detection of high-risk patients and understanding of critical symptoms. Furthermore, appropriate referral to the HEART team reduced EDV. Expanded implementation of training using the HEART team protocol may provide guidance for the CMS recommendations in reducing EDV for this high risk patient population.