Enhancing the Pediatric Experience in Radiation Oncology. October, 2015

Transcription

1 Enhancing the Pediatric Experience in Radiation Oncology October, 2015

2 Julie A. Sussi, CAO, MA Crystal Swalwell, Nurse Manager, BS

3 Introduction Challenges in caring for the Pediatric Patient Staff anxiety Parent s anxiety Adult setting Lack of Physician training in residency

4 Challenge of Caring for the Pediatric Patient Staff Anxiety Limited training for nurses No formal courses for Radiation Therapists and the emotional part of treating Children Lack of Physician Training Parent s Anxiety Adult setting- Pediatric Patients are only 2% of the overall volume in Radiation Oncology. Patient anxiety

5 The James at The Ohio State University has always taken care of the Pediatric patient. Clinically, this group was given superior care. Books and toys were given as a way of distraction. Experience for the patient was smaller. Technology wasn t as big of factor Add photo of corner of old waiting room

6 The Ohio State University Largest university in USA 62K students; 40K faculty & staff 14 colleges Most comprehensive health sciences campus in USA Comprehensive Cancer Center NCI Comprehensive since member investigators OSU, Nationwide Children s & Cincinnati Children s Five (5) scientific programs Twenty (20) Shared Resources The James Cancer Hospital The Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute 6

7 270+ Members in 12 of 14 Colleges Arts & Sciences Pharmacy Public Health Vet. Medicine Food, Ag. & Environ. Edu. Human Ecology Business Medicine Nursing Engineering Dentistry Law The Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute 7

8 The New James 8 The Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute 8

9 The New James The 21 st Century Cancer Hospital Third largest cancer hospital in the country Sub-specialized, multidisciplinary clinical care model 21 floors and 1.1 million square feet 306 inpatient beds (includes 36-bed BMT unit) 14 Operating Rooms 6 Interventional Radiology Suites 7 linear accelerators in a unique, above-ground radiation oncology floor; Pediatric unit Dedicated early-phase Clinical Trials Unit Unique, integrated Cancer Emergency Department The Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute 9

10 RADIATION ONCOLOGY PROGRAM 7 LINAC Vaults 1 Brachytherapy room 1 MRI 1 CT & 1 PET-CT 30 patient exam rooms Consultation rooms Pre/Post recovery rooms Dosimetry Team work rooms Clinical faculty offices Meeting rooms Wishard Health Services

11 Radiation Space for Pediatrics Prior to transition to Current space-30,000 square feet

12 The Ohio State Department of Radiation Oncology

13 RADIATION ONCOLOGY PROGRAM ADDED 2010 Affordable Healthcare Act (ACA) awards a single $100M grant for public academic medical center improvement OSU received award December 2010 HOK directed to study options for siting 80K SF Radiation Oncology program Building foundations partially complete, building steel ordered

14 The project was in process when the HRSA grant was awarded. The Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute 14

15 The OSU Department of Radiation Oncology shows enormous Growth over 7 years

16 Pediatric Statistics for The Ohio State University FY15 Pediatric Data Age_Diagnosis Age Count of Age Column Labels Row Labels Grand Total Cancer - Bone Mets 1 1 Cancer - Endocrine Cancer - Genitourinary Cancer - Head & Neck Cancer - Hematology Cancer - Hematology-Lymphoma 1 1 Cancer - Neuro Oncology Cancer - Sarcoma 1 1 #N/A Grand Total

17 Pediatric Statistics for The Ohio State University FY15 Pediatric Data MRN by Diagnosis Row Labels Count of MRN Cancer - Bone Mets 1 Cancer - Endocrine 6 Cancer - Genitourinary 10 Cancer - Head & Neck 2 Cancer - Hematology 18 Cancer - Hematology-Lymphoma 1 Cancer - Neuro Oncology 10 Cancer - Sarcoma 1 #N/A 4 Grand Total 53

18 Dedicated Pediatric Team consists of: MD s-guiou, Haglund, Martin-Add pictures Involvement in Nationwide s tumor board Dedicated Pediatric nurses Pediatric specific competencies and PAL s certification. PAC-U nurses have specific training. Two linac s dedicated in treating the Pediatric Population. Therapist competencies, and Lead therapist dedicated to program

19 How we Enhanced the Pediatric experience Change of Hospital anesthesiologist to one from Nationwide.

20 Other ways we Enhanced Our program Primary Pediatric Nurse is with the patient through Consult, Treatment and Recovery. Huge undertaking and included extensive training for the Radiation Oncology Nurse. Office assistant who is supporting a program, not just a physician Consistent Radiation Therapists treating the pediatric patient

21 Radiation and Oncology Pediatric Concepts PEDIATRIC COMFORT CONCEPT Patient selects Animal Friend to stay with them throughout treatment journey Use projected graphics, permanent installation or digital interface Animal Friends per Nationwide Children s Hospital design guidelines

22 Radiation and Oncology Pediatric Concepts PEDIATRIC JOURNEY WITH PROJECTED GRAPHICS

23 Radiation and Oncology Pediatric Concepts PEDIATRIC JOURNEY -- EXAM Projected Graphic Flat Panel Interactive Display Animal Friend Selected by Patient

24 SERVICE ELEV Sup port Supp ort Sim ulat or Sup port Induction PEDIATRIC FIRST TIME FLOW Z.1 A A.3 B Dosimetry PET-CT CT Simulation SHELL Vault 1 VARIAN TrueBeam On Deck Vault 2 VARIAN TrueBeam On Deck Vault 3 VARIAN TrueBeam On Deck Vault Vault 4 4 Vault Vault 5 5 Vault 6 Vault 6 VARIAN VARIAN VARIAN VARIAN VARIAN VARIAN TBI TrueBeam STx TrueBeam STx TrueBeam On On Deck Deck Exam/Consult On On Deck Deck On On Deck Deck On Deck Vault 7 VARIAN TrueBeam MRI AGV C D E Exam/Consult Module 1 (8) Interaction PUB ELEV AGV Wait Recept odule 3 (8) M PUB ELEV Brachy 4E G On-Treatment Elevators

25 SERVICE ELEV Supp ort Ind ucti on (3) PEDIATRIC ON-TREATMENT FLOW Z.1 A A.3 B Vault 1 VARIAN TrueBeam On Deck Vault 2 VARIAN TrueBeam On Deck Vault 3 VARIAN TrueBeam On Deck Vault 4 VARIAN TrueBeam STx On Deck Vault 5 VARIAN TrueBeam STx Vault 6 Vault VARIAN VARIAN TBI TrueBeam Exam/Consult On Deck On Deck On Deck Vault 7 VARIAN TrueBeam MRI AGV C D EXAM Brachy E PUB ELEV AGV Wait Recept odule 3 (8) M PUB ELEV 4E G On-Treatment Elevators

26 Research and Discovery Nationwide Children s Tour Interviews with Nationwide about pediatric-specific considerations Overview and history of branding

27 Patient Considerations Patients generally not directly accessible due to privacy concerns Wide age group Parents must be considered as well Worked very closely with OSUMC to learn about patients through interviews with Doctors + Nurses Created an online survey for young patients support group OSUMC staff facilitated survey + feedback Gained a large amount of insight to create plan for Staff review

28 Technology Touch Screens Custom Enclosures Ambient Lighting Focused sound Projection Disposable NFC bracelets

29 Development 6 months of software + hardware development Replicated environment in office Coordinated with AV Integrators Site visits for hardware testing Animation Tests Remote management

30 Launch 12 x 4.5 Touch Wall with Sound domes and NFC in waiting room 3 Exam Room Touch Screen Units with NFC and Ambient lighting Interactive NFC enabled projection in Induction room Vinyl treatments for waiting room and exterior hallways Custom modified networked brass bell

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32 Development Dollars for the Pediatric Patient Popular for donors Advanced technology has brought increased awareness to the Department of Radiation Oncology Expect donations to the entire department to increase Current development funds for Pediatrics: Care Bear and Comfort Robes A.J. Hawke Fund Sunshine Fund Bonner Fund for Young Cancer Patients

33 Development Donors request that we report how we spend their money We do this by: Taking a picture of a patient with the donated gift Therapists sign note card to be sent to donor

34 The Pediatric Waiting Area and Exam Rooms are Unique because of the Interactive Technology Technology goal is to improve the patient experience. Does technology improve patient outcomes?

35 Outcomes Patient satisfaction scores are based on surveys on those over 18 years of age. Finding ways to get satisfaction data for service of the Pediatric Population OPOnc_ServiceLineScorecard_RadOnc Fiscal Year Question Rollup Mean Score Response Count IDX Department Name 2014 Overall Assessment RADIATION ONCOLOGY JAMES ONC RADIATION ONCOLOGY JCBC RADIATION ONCOLOGY TREATMENT JAMES Fiscal Year Question Rollup Mean Score Response Count IDX Department Name 2015 Overall Assessment RADIATION ONCOLOGY CCCT 2 ONC RADIATION ONCOLOGY JAMES RADIATION ONCOLOGY JCBC RADIATION ONCOLOGY TREATMENT CCCT RADIATION ONCOLOGY TREATMENT JAMES 2015 FY is from 7/01/13-5/31/

36 Studies The role of positive distraction in neonatal intensive care unit settings., M McCuskey Shepley Distraction strategies Used in Obtaining an MRI in Pediatrics: A Review of the Evidence., Vicki Netzke-Doyle

37 Other studies: Effects of Interior Design on Wellness: Theory of Scientific Research, Robert S. Ulrich, PhD. 1. Sense of Control 2. Social Support 3. Positive Distractions in Physical Environments 4. Nature as Positive Distraction: Stress Reducing Effects We are creating a better environment for the pediatric patient, by facility design alone

38 Next steps: Work towards determining measurable outcomes How to measure if our patients are doing better? What does that mean? Less anesthesia? Less anxiety? Are they satisfied?

39 Lessons Learned Induction rooms not utilized for anesthesia as anticipated New technology should be added to the CT room. This is the initial visit where anxiety is high. New technology should also be added in the Inpatient holding area. Many of our Pediatric patients come as an inpatient, and spend time in this area. Difficulty of added technology in treatment rooms. High energy x-rays destroy technology.

40 Questions?