An innovative off-campus infusion suite designed to improve experiences of patients with cancer.

The Brooklyn Infusion Center of Memorial Sloan-Kettering Cancer Center was established in 2010 to better meet the needs of patients with cancer living in the Brooklyn neighborhood and surrounding areas. A multidisciplinary team comprising clinical, administrative, planning, and other representatives were charged to identify and develop a location that would provide oncology care for patients closer to home and improve the patients' experience. The primary objectives were to provide patient-centered care that accommodates the patients' preference to receive treatment closer to home and to take advantage of technology to establish processes that will provide safe, efficient, convenient, and high-quality care in a cost-effective manner. To achieve these objectives, no laboratory processing or pharmacy services were included in the plan for the Brooklyn location. This allowed the elimination of most of the challenges involved with same-day blood draws and chemotherapy orders. In addition, computer technology is used for teledermatology and other medical visits to maintain the continuity of the patients' care with their multidisciplinary teams at the Manhattan, NY, location. The data presented will illustrate how these processes have improved patients' experiences by reducing wait times for treatment, providing treatment closer to home, and implementing a truly patient-centered nursing care model.

Structuring survivorship care: discipline-specific clinician perspectives.

INTRODUCTION: Several models for survivorship care are prominent within the cancer literature; however, there is little empirical research that examines what oncology clinicians perceive to be the best approach to caring for cancer survivors, what services survivorship programs should include, and how prepared they feel to care for cancer survivors. METHODS: An IRB approved web-based survey of all clinical staff was conducted at a NCI designated comprehensive cancer center with a 49.8% response rate (N = 377). Data were summarized using frequencies and relative frequencies, and pairwise tests of statistical significance were utilized to evaluate differences between clinician type groups. RESULTS: Overall, the largest proportion of respondents preferred a disease-specific survivorship model (37.6%). This preference was specifically observed in oncology physicians and nurses. When asked where specific survivorship services should be provided, respondents indicated a preference for services directly related to survivors' medical treatment (i.e. information about late effects) to be delivered in a disease-specific survivorship clinic, and ancillary services (i.e. nutrition and fertility counseling) to be housed in a centralized comprehensive survivorship clinic. Physicians felt that they have significantly more information, training, and resources to care for cancer survivors than did oncology nurses. DISCUSSION/CONCLUSION: These results indicate that oncology clinicians prefer a combination of survivorship care delivery models where continuing medical needs are met in disease-specific clinics, and comprehensive wellness services are offered in a centralized comprehensive survivorship clinic. Results also suggest that planning for survivorship initiatives should include additional resources, education, and training for clinical staff. IMPLICATIONS FOR CANCER SURVIVORS: These findings underscore the need for a universally accepted definition of cancer survivorship, and support a model for delivering care to cancer survivors that is a blend of the disease-specific and comprehensive survivorship programs.

Quality improvement project to determine outpatient chemotherapy capacity and improve utilization.

Nurses in chemotherapy administration settings are constantly challenged to increase utilization while maintaining patient safety. A performance improvement project was carried out to identify barriers to patient throughput and opportunities to improve utilization while not compromising patient safety. We found ways to safely increase the number of patients from 92 to 108 per day; however, patient tardiness and staff vacancies had a negative impact on patient wait times and nursing staff overtime.

Cognitive dissonance theory and motivation for change: a case study.

Managers frequently seek ways to create effective and lasting change among employees. When attempting change, each manager must consider what will motivate a particular employee at a particular time. To create lasting change, it is believed that a change in attitudes, beliefs, or values may be necessary. Cognitive dissonance is purported to be a powerful motivator for change. People find consistency comfortable and prefer to be consistent in their thoughts, beliefs, emotions, values, attitudes, and actions. When inconsistency exists, an individual feels an imbalance or dissonance. To reduce this feeling of imbalance, individuals may change their attitude or behavior to regain the feeling of consistency. This article explores cognitive dissonance theory and discusses a situation in which it was used to produce effective and lasting change in a nursing work unit.

A 'perfect day' in ambulatory care. Case study: a work redesign method to improve access.

A nationwide network of community-owned health systems and their physicians invited several health care practices in New York to participate in a collaborative effort to explore advanced-access scheduling to improve same-day appointment availability. Roswell Park Cancer Institute, Buffalo, accepted.