Transition of Hematology/Oncology Minor Procedures from OR to 2 North Sedation

Challenge:

An interprofessional team from the Children’s Blood and Cancer Center (CBCC), Dell Children’s Medical Center Surgical Services, Anesthesiology and Sedation, identified inefficiencies in existing processes as sources for possible delays in caring for pediatric hematology/oncology patients, with the potential to diminish the patient experience.

Intervention:

The interdisciplinary team created a new process for treating hematology/oncology patients requiring minor procedures with sedation in a new sedation area within Dell Children’s. Medical Center. The goals of the initiative were varied, including:

  • Reducing length of stay for minor procedural patients,
  • Decreasing total anesthetic/sedative dosing needs,
  • Possibly narrowing the risk of infectious exposures for immunocompromised patients with fewer transitions of care per sedation and
  • Opening additional opportunities in the operating room (OR) to accommodate pediatric subspecialist growth at Dell Children’s Medical Center.

Beginning the work in 2017, Jennifer Nicklaus, MSN, MHA, RN-BC, Anna Rivera, DHA, MSN/ED, RN, CPN, Mary Plummer, Allana Coleman MSN, RN, CNOR, Tara Monde BSN, RN, Amy Fowler, MD, Augustine Park, MD, William Corbett, MD, Daniel Ernst, CRNA, Brandi Dach, MSN, RN, CPNP, CPON, Monica McMath BSN, RN, CPN, Anne Raines MSN, RN, CPHON, Rebecca Orozco, BSN, RN, CPN, and Tara Adams, BSN, RN, CPON, developed a plan to transition patients receiving minor procedures with sedation from the OR to a new sedation area in 2North. CBCC leaders and providers informed families of the transition, Anne Raines provided education to inpatient and outpatient oncology nursing staff and Tara Adams updated order sets to include topical lidocaine placement prior to procedures.

Results:

Beginning in November 2017, patients began receiving minor procedures in the newly designated 2North Sedation area rather than the OR. From the transition in 2017 through May 2018, Anna Rivera and Rebecca Orozco collaborated with the Anesthesiology team and Oncology Providers to re-evaluate and optimize processes to further improve outcomes and efficiencies. This included expediting turnaround time of the procedure room, changing the way patients transfer from CBCC and 4N to the procedural area, and identifying a 3rd procedure room with in 2 North.

By partnering to utilize an innovative approach for procedural care in hematology/oncology patients requiring minor procedures with sedation, the CBCC, Surgical Services and Anesthesiology/Sedation team successfully improved procedural efficiency and reduced the amount of administered sedation for each patient.  Prior to the transition, the average total length of stay for patients from CBCC check-in to procedure discharge was 4 hours and 24 minutes. Following the transition, the total length of stay for the procedure was 3 hours 49 minutes. Also, prior to transition, the average Propofol dosage for patients was 5.94 mg/kg. Following the transition, the average dose was 4.95 mg/kg.