Optimizing Nurse Navigator Caseloads in a Pediatric Multidisciplinary Clinic Using a Novel Pediatric Patient Acuity Tool!

Introduction: Patient navigation programs assist in the management of patients with complex medical problems. Whereas ample literature exists about the implementation of nurse navigators in adult oncology clinics, there is sparse information relating to the outpatient pediatric subspecialty setting.

Objective: To create a model for outpatient pediatric subspecialty nurse navigators using a pediatric patient acuity assessment tool.

Methods: A retrospective review of literature was used to determine current practices in navigator caseload management. Meta-analysis, primary studies, and institutional personnel guides were compared, mostly in the adult oncology literature. We explored multiple factors by which caseload can be defined, including total patients per navigator, average time per patient, duration of navigation, number of calls per patient, and acuity tool models.

Results: Patient acuity stood out as the primary method for determining nurse navigator caseloads. Using existing adult acuity tools, we developed a novel pediatric patient acuity tool (PAT) by modifying a preexisting adult PAT to model caseloads for each pediatric nurse navigator. Our acuity tool considered multiple factors: patient status, complex care needs (feeding tube, physical therapy, tracheostomy management), frequency of contact or poor psychosocial support to generate the PAT score. Patients were then stratified into low, moderate, high, or very high acuity based on this scoring system. The PAT score had the advantage of correlating to the time commitment per patient visit, which can be used to determine the length of patient time slot scheduling and thus be used to generate caseloads. Baseline models indicated that caseloads started with 100 low acuity patients and then adjusted to fit the needs of the subspecialty clinic.

Conclusions: Patient acuity is an excellent metric for patient navigation caseload management. Using the PAT score, pediatric nurse navigators can manage a caseload of pediatric patients of varying acuity and complexity. In addition, this score allows for an objective dynamic caseload management system that can be customized to the unique needs of each pediatric multidisciplinary clinic and nurse navigator.