Creating an Electronic Referral to Help Identify Patients with Breast Cancer Needing Navigation Services

November 2021 Vol 12, No 11
Melissa Douglas, BSN, RN, CBCN
University Hospitals Seidman Cancer Center, Cleveland, OH

Background: The oncology nurse navigator (ONN) plays a central role in decreasing distress and increasing satisfaction in patients with breast cancer.1 Since 2018, multiple quality improvement projects to enhance patient navigation across the continuum of care for patients diagnosed with breast cancer at University Hospitals of Cleveland have occurred. As the specialty of oncology nurse navigation continues to grow, a frequent question is, “How does an ONN identify patients needing navigation services?” With the broad scope and multiple services offered throughout the care continuum, there is a lack of a standard process for proactively identifying patients who may benefit from navigation.

Objectives: To determine the best way to identify patients needing navigation services and to create a standardized and efficient way to notify the ONN.

Methods: A team consisting of ONNs, breast care nurses, and leadership from the hospital’s breast health center was formed to determine the best way to identify patients and notify the ONN. The team started by labeling several points along the continuum of care where the assistance of an ONN would be beneficial. The literature suggests that the time between diagnosis and treatment is a stepping stone into cancer care.2 With this, the team decided that the best time for a patient to be introduced to the ONN is following initial diagnosis.

Next, the ONNs examined the process of how patients with newly diagnosed breast cancer move from positive biopsy to surgical oncology consult. After review, a referral was determined to be the most appropriate way to notify ONNs of patients needing navigation.

Options for a referral included sending an e-mail to the ONNs or creating an electronic referral within the electronic medical record (EMR). After evaluating how each process would be implemented into the workflow, it was decided that an electronic referral was the preference.

The ONN worked closely with IT to create an “RN Navigation Referral” in the hospital’s EMR system. In-services about the new referral and workflow were provided to the surgical team. The new electronic referral process began on February 17, 2020, with 3 breast ONNs monitoring the referrals placed. The ONNs were able to identify patients needing navigation and begin to follow patients throughout their cancer journey. The ONNs engaged with breast health leadership to continue encouragement and reminders to staff to utilize the new electronic referral.

Results: From the time of implementation to present, surgical providers placed 577 RN Navigation Referrals. In this initial phase, 575 patients were navigated by the ONNs. The median number of encounters has increased from 2 to 5 as patients are now followed from initial diagnosis throughout treatment. In addition, the ONNs have received positive feedback from both patients and providers.

Conclusions: This process improvement project shows that an electronic referral can be used as a standardized and efficient way to identify patients with breast cancer needing navigation services. With this knowledge, the next goal is to replicate this process for other disease teams.


  1. Johnson P, Bongiorno AW. Efficacy of the breast cancer navigator role in reducing distress in newly diagnosed breast cancer patients: a pilot study. Journal of Oncology Navigation & Survivorship. 2018;9(5):182-190.
  2. Blaseg KD, Daugherty P, Gamblin KA. Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (First Edition). Pittsburgh, PA: Oncology Nursing Society; 2014.
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Last modified: December 17, 2021

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