Title : Virtual infusion improves patient care and expands a rural workforce
Abstract:
Rural and underserved communities in South Dakota have limited access to immediate, oncology expertise. Although many rural facilities in South Dakota have infusion centers that administer anti-cancer therapies, those facilities do not have direct oversight by an oncologist or oncology- trained advanced practice professional. Due to the complexity and high-risk associated with anti-cancer therapies, and the potential for infusion reactions, oncologists in tertiary care centers often restrict the administration of many these agents off site. This safety features forces patients to travel to the tertiary care setting to receive their prescribed treatment. The Virtual Infusion Project was a three-year project designed to demonstrate that an oncology-trained advanced practice provider (APP) located in a tertiary care infusion center could provide direct oversight for three rural infusion centers though telemedicine, a dedicated telephone and the electronic medical record. Pre- and post-implementation data measured the activity changes in the rural infusion centers and estimated the travel hours, miles and cost savings patients and their families saved by receiving their care closer to home. Patients, nurses and providers completed satisfaction surveys. The team tracked medication variances, infusion-related hospitalizations, and adverse events to evaluate program safety. APP oversight along with rural infusion nurse training increased the comfort level of the prescribing oncologists. The tertiary care infusion center transitioned 127 patients to a site closer to home over a two-year period, as compared to 85 in the baseline data. This translated into over 1,062 infusion visits as compared to 677 prior to implementation. Collectively, patients and their families saved over 65,456 miles, 1,757 hours in travel time and $65,791 in cost savings by receiving treatment closer to home. The rural infusion centers safely administered complex treatments that were previously restricted to the tertiary care setting. There were five medication variances in the two-year period related to workflow issues. The checks and balances put in place during the implementation phase were effective as no error reached the patient. There were no sentinel events or hospitalizations related to infusion reactions in the rural settings. Patient, physician, APP and nursing satisfaction survey scores were high. The project demonstrated that an oncology APP based in a tertiary care center could safely provide direct oversight for patients receiving oncology care in a rural infusion center. The oncologists, confident in the level of care provided in the rural infusion centers, willingly transitioned patients receiving complex anti-cancer therapies to a site closer to home. The success of the project revolved around creating a seamless care-delivery model. Standardized policies and procedures, quality telemedicine equipment and a fully trained staff were paramount to the project’s success.
Take Away Notes:
• Describe how an oncology certified nurse practitioner based in a tertiary care center uses telemedicine technology to provide direct oversight for patients receiving treatment in rural infusion centers
• Identify key components of a successful virtual infusion program
• Describe the benefits rural infusion centers obtain by having direct access to an oncology APP
• Identify cost savings rural patients receive through care delivery at a site closer to home
• Identify problems encountered in the program development and strategies used to overcome them
