Our clinic, an outpatient-based clinic that services a large rural area, has changed dramatically since the 2021 AONN+ Annual Conference. We have added 2 outreach clinics 3 days a month to outlying small towns. While we have added outreach services to our area, we have also seen an increase in referrals both for hematology and oncology as well as for specialty infusions. We have trained new nurses and medical assistants, and a few other staff have moved on. This required us to rearrange many duties to cover the increasing changes of the department. With all the growth and staffing changes, I have been unable to relinquish some of the ancillary roles that I currently perform which would allow me to focus more directly on navigation services.
Since I started in this navigator role 2 years ago, I have diligently tracked the time spent on prior authorizations, patient assistance funding, and copay cards. This includes time spent on application, follow-up, and the dates of start and completion. This has demonstrated our significant need for a dedicated financial counselor or financial navigator.
At the start of the year, I started tracking new patient referrals and the time spent scheduling and tracking down additional clinical information. The data shows how long it takes from time of referral to the time the physician can see the patient, and data also provides us information needed to obtain a referral coordinator.
Another aspect of tracking that came specifically from the AONN+ conference was tracking new patients and follow-ups that were specific to meeting patient needs and reducing barriers to care. We do not currently have a way to document this tracking in our current EMR (Meditech). I have used a simple spreadsheet to help keep track of patient needs.
I have also started receiving all of our distress screenings, and I am using this as a performance improvement project. Once I receive and review these, I call and speak to the patient. Many of the patients do not understand the use of a social worker and are hesitant to receive this referral. Many also get confused when they receive numerous phone calls from different providers throughout their cancer journey. By speaking to the patients, I identify the top areas of concerns and help to identify the appropriate referral or needs (pain management or social work). The number of social work referrals is also helping us identify this as a full-time need versus our current part-time social worker who works between both radiation oncology, medical oncology, and other areas.
Our EMR does not have tracking capabilities, and this is another problem that I have encountered with tracking my new patient navigations and follow-up. Our facility will be transitioning to Epic in October 2022, and we are currently in the training process for transition. I look forward to the additional ways I may be able to use this for reminders of when to contact patients for follow-ups. In our current situation, I follow-up with patients via phone calls or at their provider appointments in our clinics. This sometimes makes it difficult, as it is not a “scheduled” appointment only for the navigator. As many of our patients come from very rural areas, travelling 50 miles or more, I am also doing much of their treatment education at the time of these visits, many times on day one of treatment.
The AONN+ conference validated and improved my tracking of prior authorization work, distress screenings, social work referrals, and new patient referral documentation to show the need for additional staff in these areas. With the addition of Epic in October 2022 and the hiring of additional personnel, it will allow me to focus more specifically on these concepts to better our practice. My goal is by the beginning of 2023 we will have a streamlined onboarding process for new patients and a streamlined way of using our distress screenings to reduce the barriers to care and increase timely referrals to meet these needs.
I appreciate this conference and look forward to attending additional AONN+ conferences in the future.