The Significance of a Leukemia and Lymphoma Nurse Navigator

Background: VCU Health identified a need in the unique and acute population of patients who have leukemia and lymphoma. The leukemia and lymphoma nurse navigator (LLNN) position was created to help close the gaps in care of this population. The role has developed and changed over the years to meet the specific needs of the patients and institution.

Objective: The LLNN position was created to meet the unique needs of the leukemia and lymphoma patients by increasing the communication from inpatient and outpatient and assist in transitioning patient care; decreasing the length of stay (LOS) to meet or more closely match the national standard set by Centers for Medicare & Medicaid Services (CMS) of 17 days for inductions and better align with the standard associated with other National Cancer Institute cancer centers; assisting in transitioning inpatient chemotherapy protocols to the outpatient setting safely; and most importantly, giving the patients someone who would be with them throughout their journey no matter where they are in the healthcare continuum.

Methods: The LLNN attends daily inpatient rounds to collaborate with the team on patient care. They meet with all new inpatients prior to discharge as well as new patients in the clinic on a daily basis. The LLNN works with the team to begin transitioning patients to the clinic during their induction treatment. This move shorted the inpatient LOS to better align with benchmark metrics set by CMS. Stable patients were then able to have count recovery at home with the clinic supporting them. Lastly, we moved 3 inpatient chemotherapy regimens to be administered in the outpatient clinic and are currently working on moving a fourth.

Results: Preliminary feedback from patients has been positive. Formal surveys to measure patient satisfaction as well as assessment of readmission rates for this specific population will provide additional support of the process. Successfully decreasing inpatient LOS has had a large impact on the outpatient clinic volume. Additional resources have had to be added to support this volume. The increased volume has affected the lab and treatment room related to an increase in transfusions and chemotherapy, all of which were previously administered inpatient. Additional staff education had to be performed to orient staff to the new regimens as well as to inform them of the heightened acuity of the patients who would be presenting during their nadir period. New patient education was developed in neutropenia in the outpatient setting.

Conclusion: The implementation of the LLNN has improved the communication between the inpatient unit and outpatient units. It has increased patient satisfaction, and the addition of a second LLNN will be beneficial in increasing patient satisfaction and meet the needs of the patients across the care continuum. LOS has successfully decreased in the acute leukemia patient being induced with chemotherapy.