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1

Intervention Plan Design: Lowering Readmission rates for Head and Neck Cancer Patients at University of Miami Hospital

Name

Capella University

Professor

August, 2022

Intervention Plan Design

Lowering Readmission rates for Head and Neck Cancer Patients at University of Miami Hospital

Research shows that approximately 20% of all head and neck oncology patients are readmitted within 30 days postoperatively. Some significant risk factors for 30-day readmission include transition to home or nursing facility care, wound infections, type of surgical procedure, lower socioeconomic status, tobacco smoking, and congestive heart failure (Goel et al., 2019). High head and neck oncology readmission rates are associated with increased healthcare costs, recurrent disease, emotional turmoil, and mortality. Additionally, the 30-day readmission rate is a significant surrogate measure of healthcare quality as it affects patient satisfaction. Based on these findings, it is crucial for healthcare providers to develop perioperative interventions to reduce the readmission rate for head and neck cancer patients. In an effort to reduce the readmission rate, this paper presents a holistic intervention plan that outlines the core components of an intervention plan. The paper further discusses the ethical and legal implications and the theoretical foundations relevant to the intervention. Finally, the paper highlights the stakeholders, regulations, and policies pertinent to the proposed intervention.

Intervention Plan Components

Defining the Major Components

This intervention plan will be implemented at the Head and Neck oncology unit at the University of Miami Hospital. This multidisciplinary intervention plan is bundle care consisting of two major components: comprehensive patient education and post-discharge phone-based care and follow-up.

One major cause of head and neck oncology readmissions is wound infections or complications (Chiesa-Estomba et al., 2022). Patient education plays a vital role in wound care and proper management of the surgical site. This is because head and neck oncology patients have unique post-operative needs that require specialized skills (Jabbour et al., 2017). The patient education component addresses post-operative care topics such as wound, tracheostomy, and gastrostomy care. Patient education also ensures that the patient and caregivers understand the diagnosis and treatment plan. For optimal outcomes, patient education will be delivered to the patient, family members, and any caregiver involved in the patient's care. A personalized patient education plan ensures that the patient and caregiver have the skills, knowledge, and attitudes to promote post-operative healing. This reduces readmissions as it fosters positive patient outcomes, decreases anxiety, and increases patient satisfaction.

The patient post-discharge care plan consists of telephone follow-up calls within 72 hours after discharge from the oncology surgical unit. During this telephone encounter, the nursing staff uses a post-discharge survey to inquire about the patient's health and address any emerging patient concerns. Questions asked in the telephone survey will address areas such as pain management, fever, alarm symptoms such as nausea or vomiting, and any patient concerns. The provider will also use the call to schedule and confirm any post-operative appointments. To augment the telephone call, patients will have an opportunity to share wound and surgical site photos or request for videoconference consultation with the provider. The post-discharge telephone follow-up calls are expected to reduce the 30-day readmission rate for head and neck cancer patients. This is because they allow the provider to review the patient's recovery progress and identify complications before they worsen.

Impact of Cultural Needs

It is crucial to understand the impact cultural needs and characteristics of a target may have on an intervention. Head and neck cancer patients have a multitude of cultural needs and values that should be considered in the intervention. For instance, head and neck patients may experience emotional turmoil like other oncological patients. To accommodate their emotional needs, the intervention's telephone follow-up survey will ask about the patient's psychological and emotional status. Appropriate mental health referrals will be made for patients who require psychological support.

Awareness of cultural aspects of caregiving that may impact the patient's post-operative care is crucial. For instance, the post-discharge plan should be home-based if a family has a collectivist culture and negative attitude towards nursing home care. The provider should also determine whether an individual or the whole family will carry out the patient's post-operative care. Who is responsible for the medical and other caregiving tasks? Who provides the patient's meals? Who handles the patient's financial needs? Who is responsible for scheduling follow-up appointments? To ensure optimal patient outcomes and reduced readmission, this intervention plan ensures the participation of all caregivers in the education intervention.

Theoretical Foundations

Evaluation of Theoretical Nursing Theories and Technologies

One of the theoretical nursing models that underpin this intervention plan is Orem's Self-Care Deficit Nursing Theory. This theory postulates that a patient's ability to self-care significantly enhances their health outcomes and well-being (Yip, 2021). Based on this theory, this intervention plan provides comprehensive patient education as a strategy to address self-care deficits and reduce readmission. Another relevant theory is Leininger's Transcultural Nursing Theory. This theory underscores the importance of providing culturally competent care. These intervention plan components provide culturally congruent care by considering the patient's cultural practices, beliefs, and values. One of the healthcare technologies relevant to this intervention plan is telemedicine. The second intervention plan component requires the use of telemedicine in post-operative follow-up. All participants will receive phone-based follow-up and optional teleconference consultations to address patient or wound care concerns.

Justification of Intervention Components

Based on Orem's Self-Care Deficit Nursing Theory, a personalized patient education plan reduces the patient's and caregiver's self-care deficit. The patient and caregiver will have the skills, knowledge, and attitudes to promote post-operative healing. Patients with knowledge of wound care and self-care routines have lower rates of infections and complications (Turkdogan et al., 2022). A study by Graboyes et al. (2017) demonstrated a direct association between patient education, adherence to the treatment plan, and reduced hospital readmission rates.

Through the videoconferencing and phone-based component, the provider can provide timely diagnosis and adjust the patient's treatment plan to reduce complications. By providing culturally competent care, the provider will provide wound care while reducing unnecessary ER visits or readmissions. A quality improvement study by Shah et al. (2021) demonstrated the efficacy of phone-based wound care and patient follow-ups in reducing head and neck cancer readmissions and ER visits. These two intervention plan components will reduce readmissions as they foster positive patient outcomes, increase patient education, decreases anxiety, and increases patient satisfaction.

Stakeholders, Policy, and Regulations

Various stakeholders, regulations, and policies may impact the proposed intervention plan components. Internal stakeholders of the intervention include the nursing and medical staff in the surgical oncology unit, such as nurses, nurse managers, physicians, surgeons, oncologists, and other clinical assistants. Other clinicians involved in ancillary support include nutritionists, psychologists, and physiotherapists. The internal stakeholders are crucial in implementing the intervention within the selected setting and target population. The hospital's management will be vital in providing leadership and resources to facilitate the intervention plan. Some of the external stakeholders of this intervention plan include the patients and healthcare insurance providers. The patients' participation is crucial as they are the end consumers of the intervention plan components. At the intervention, patient outcomes, such as the 30-day readmission rate, will determine the project's success.

One of the intervention plan components entails the use of videoconferencing as a patient follow-up strategy. Before implementing this intervention, it is crucial to determine whether the healthcare insurer reimburses for telehealth consultations. It is also essential to determine the modalities allowed as some providers only cover videoconferencing, not teleconsultation. The State of Florida allows the provision of telehealth services (Malouff et al., 2021). Out-of-state providers can provide telemedicine services if they acquire the required licenses. The University of Miami Hospital is a crucial stakeholder as the intervention will be carried out in this setting. The hospital has telehealth services through its UHealth Virtual Clinics (UHealth Virtual Clinics, n.d.). These telemedicine regulations at the state and organizational levels make it possible to use telemedicine in the intervention's post-operative follow-up component.

Ethical and Legal Implications

This implementation plan is expected to comply with and adhere to various legal and ethical implications of healthcare practice. These legal and ethical implications are crucial in protecting the patient's rights during the intervention. Some considerations include patient autonomy, confidentiality, nonmaleficence, beneficence, and justice (Varkey, 2021). The intervention will seek authorization from the institution's IRB before implementation. The intervention will demonstrate beneficence and nonmaleficence by showing that the intervention's benefits far outweigh any risks to the patient. Before receiving patient education and enrolling in the phone-based follow-up, all participants must give informed consent. To ensure patient autonomy, all participants will be informed about all the potential benefits and risks of participating in the intervention. To ensure patient confidentiality and privacy, the identity of all participants will be anonymized using identifiers (Shenoy & Appel, 2017). To comply with the ethical principle of justice, participants will be randomly selected and assigned to the intervention and control groups.

At the organizational level, the nursing ad medical staff will be trained and educated on how to comply with these legal and ethical considerations during the intervention. The healthcare team will be trained to implement the intervention without compromising patient confidentiality. They will also be trained to safeguard patient information to ensure only authorized personnel has access. To ensure that the intervention plan is holistic and patient-centered, the organization will provide collaborative channels and resources that comply with ethical and legal issues.

References

Chiesa-Estomba, C. M., Sistiaga-Suárez, J. A., González-García, J. Á., Sarasola, E. L., Vilanova, A. V., & Altuna, X. (2022). Unplanned Hospital Readmission and Visit to the Emergency Room in the First Thirty Days after Head and Neck Surgery: A Prospective, Single-center Study. International Archives of Otorhinolaryngology, 26(01), e103–e110. https://doi.org/10.1055/s-0041-1730340

Goel, A. N., Raghavan, G., St John, M. A., & Long, J. L. (2019). Risk Factors, Causes, and Costs of Hospital Readmission After Head and Neck Cancer Surgery Reconstruction. JAMA Facial Plastic Surgery, 21(2), 137–145. https://doi.org/10.1001/jamafacial.2018.1197

Graboyes, E. M., Kallogjeri, D., Zerega, J., Kukuljan, S., Neal, L., Rosenquist, K. M., & Nussenbaum, B. (2017). Association of a Perioperative Education Program With Unplanned Readmission Following Total Laryngectomy. JAMA Otolaryngology–Head & Neck Surgery, 143(12), 1200–1206. https://doi.org/10.1001/jamaoto.2017.1460

Jabbour, J., Milross, C., Sundaresan, P., Ebrahimi, A., Shepherd, H. L., Dhillon, H. M., Morgan, G., Ashford, B., Abdul-Razak, M., Wong, E., Veness, M., Palme, C. E., Froggatt, C., Cohen, R., Ekmejian, R., Tay, J., Roshan, D., & Clark, J. R. (2017). Education and support needs in patients with head and neck cancer: A multi-institutional survey. Cancer, 123(11), 1949–1957. https://doi.org/10.1002/cncr.30535

Malouff, T. D., TerKonda, S. P., Knight, D., Abu Dabrh, A. M., Perlman, A. I., Munipalli, B., Dudenkov, D. V., Heckman, M. G., White, L. J., Wert, K. M., Pascual, J. M., Rivera, F. A., Shoaei, M. M., Leak, M. A., Harrell, A. C., Trifiletti, D. M., & Buskirk, S. J. (2021). Physician Satisfaction With Telemedicine During the COVID-19 Pandemic: The Mayo Clinic Florida Experience. Mayo Clinic Proceedings. Innovations, Quality & Outcomes, 5(4), 771–782. https://doi.org/10.1016/j.mayocpiqo.2021.06.006

Shah, M., Douglas, J., Carey, R., Daftari, M., Smink, T., Paisley, A., Cannady, S., Newman, J., & Rajasekaran, K. (2021). Reducing ER Visits and Readmissions after Head and Neck Surgery Through a Phone-based Quality Improvement Program. Annals of Otology, Rhinology & Laryngology, 130(1), 24–31. https://doi.org/10.1177/0003489420937044

Shenoy, A., & Appel, J. M. (2017). Safeguarding Confidentiality in Electronic Health Records. Cambridge Quarterly of Healthcare Ethics: CQ: The International Journal of Healthcare Ethics Committees, 26(2), 337–341. https://doi.org/10.1017/S0963180116000931

Turkdogan, S., Roy, C. F., Chartier, G., Payne, R., Mlynarek, A., Forest, V.-I., & Hier, M. (2022). Effect of Perioperative Patient Education via Animated Videos in Patients Undergoing Head and Neck Surgery: A Randomized Clinical Trial. JAMA Otolaryngology–Head & Neck Surgery, 148(2), 173–179. https://doi.org/10.1001/jamaoto.2021.3765

UHealth Virtual Clinics. (n.d.). Retrieved August 31, 2022, from https://umiamihealth.org/en/treatments-and-services/virtual-clinics

Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

Yip, J. Y. C. (2021). Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem’s Self-Care Deficit Nursing Theory. SAGE Open Nursing, 7, 23779608211011990. https://doi.org/10.1177/23779608211011993

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1

Implementation Plan Design

Name

Capella University

Professor

September, 2022

Implementation Plan Design

The purpose of intervention plans is to utilize an evidence-based approach to achieve practice change and improve patient health outcomes and satisfaction. A successful implementation plan design requires a sound and reasonable approach to translating evidence-based research into clinical practice. This intervention addresses the clinical question of the high 30-day readmission rate for head and neck oncology surgical patients at the University of Miami Hospital. This paper presents an intervention plan design that outlines the management, leadership, delivery technology, stakeholders, policy regulations, and timeline considerations.

Management and Leadership

This intervention requires the collaboration of a multidisciplinary team involved in the management of head and neck oncology patients. Research has established that when compared to fragmented health care, multidisciplinary surgical care results in better health outcomes, reduced healthcare outcomes, and better patient-reported outcomes (Davis et al., 2021). The multidisciplinary team involved is the surgical oncology unit's nursing and medical staff. These include nurses, nurse managers, physicians, surgeons, oncologists, and clinical assistants. Other clinicians involved in ancillary support include nutritionists, clinical psychologists, and physiotherapists. Some of the leadership and management strategies required to promote multidisciplinary collaboration include:

· Collaborative communication: Effective communication channels are required to ensure the success of this intervention plan (Kumar et al., 2019). The project will create communication channels that foster teamwork, morale, and team trust. Some skills that will be encouraged include empathy, active listening, and positive reinforcement through rewards.

· Collaborative practice: All interdisciplinary care team members will have an opportunity to contribute their skills, expertise, and experience to the implementation plan. This ensures that all aspects of the intervention are holistic and patient-centered.

· Shared and collectivistic leadership: This ensures that all resources within the organization are maximized, and individuals with diverse backgrounds are given an opportunity to lead and apply professional judgement (Aufegger et al., 2020). Decisions will be made in an open, honest, and democratic manner, where the common goal is to improve patient outcomes.

Collaboration of a multidisciplinary surgical care team is required to promote the delivery of individualized and high-quality patient care to head and neck cancer patients. Through shared leadership, collaboration, and collectivistic leadership and management strategies, the patients will benefit from the experience and education of different providers (Reid et al., 2021). For instance, the nursing and nutrition team may collaborate to design a treatment plan that promotes wound care and recovery. There will also be decreased medical errors and workflow redundancies, and potential health complications will be identified before they worsen.

Delivery and Technology

This project's organization uses a clinic-based head and neck discharge and follow-up plan. This intervention plan proposes an evidence-based discharge and follow-up bundle with two major components: comprehensive patient education and post-discharge phone-based care and follow-up. To increase project effectiveness, this project will be delivered in four phases. Phase 1 will involve a needs assessment to identify the staff and patient population attitudes and health literacy levels. Phase 2 involves testing and tailoring the proposed head and neck discharge and a follow-up plan to the identified staff and patient needs. Phase 3 involves staff education and training to ensure they understand how to implement the intervention. Phase 4 involves the actual project implementation at the Head and Neck oncology unit. One of the key assumptions of this intervention plan is that the hospital will provide all the resources required to implement the four project phases. These resources include dedicated staff, time, equipment, and resources. Another assumption of the intervention plan is that the needs assessment will demonstrate willingness among the staff to implement a practice change project.

Phases 2 and 3 of this implementation plan require using the internet and internet-based devices. This is because the needs assessment will be conducted using online surveys, while the staff training will be on an online web-based platform. Phase 4 (implementation) entails using a phone-based follow-up call and videoconferencing (optional). Current telemedicine technologies (telephone and video consultations) will be crucial in enhancing the delivery of the intervention plan. During the phone-based follow-up call, the nursing staff uses a post-discharge survey to inquire about the patient's health, schedule post-operative appointments, and request videoconference consultation if needed. One of the emerging healthcare and digital technologies that may support this proposed intervention plan is artificial intelligence (AI). Several studies have established the role of image-based artificial intelligence (AI) algorithms in optimizing wound assessment, care, and healing (Anisuzzaman et al., 2021).

Stakeholders, Policy, and Regulations

The implementation of this intervention plan requires the collaboration of various stakeholders. The internal stakeholders, such as the nurses, surgeons, oncologists, nutritionists, and clinical psychologists, will be responsible for implementing the intervention in the target population and setting. The external stakeholders, such as the patients and healthcare insurers, will be crucial in facilitating the intervention implementation plan design. The patients are core stakeholders of this intervention as they are the target population. Therefore, patient needs must be considered in the intervention plan design. For instance, the patient needs assessment will determine whether the phone-based follow-up will be carried out via phone calls or SMS.

This intervention utilizes post-discharge phone-based care and follow-up intervention, with the option of requesting a videoconference consultation. Because the intervention plan requires telemedicine technology, it must be implemented based on two policy regulations: The Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009 and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These two federal regulations ensure that patient health information is protected and kept confidential (Moore & Frye, 2019). Additionally, the project will seek approval from the University of Miami Hospital IRB by demonstrating adherence to ethical principles and standards. These existing policies will ensure that the intervention plan protects the rights and privacy of the patients. 

Timeline

This intervention plan will be implemented for a period of four months (16 weeks) at the Head and Neck oncology unit at the University of Miami Hospital. The first four (4) weeks will be dedicated to conducting a departmental needs assessment, staff education, and troubleshooting the proposed bundle care. The next eight (8) weeks will be allocated for the project execution and implementation. This involves identifying project participants, implementing the oncology unit's discharge and follow-up bundle care, and collecting patient outcomes. Some of the project's primary patient outcomes include the 30-day readmission rate and compliance to wound care protocols. The next four (4) weeks will be allocated for analyzing the collected patient health outcomes to determine the impact of the intervention. During this period, the results of this project will be presented and disseminated to various stakeholders within and outside the organization. Some factors that may negatively impact my projected timeline include institutional bottlenecks, staff resistance, high project attrition rate, lack of required resources, and poor compliance with the project protocol.  

References

Anisuzzaman, D. M., Wang, C., Rostami, B., Gopalakrishnan, S., Niezgoda, J., & Yu, Z. (2021). Image-Based Artificial Intelligence in Wound Assessment: A Systematic Review. Advances in Wound Care. https://doi.org/10.1089/wound.2021.0091

Aufegger, L., Alabi, M., Darzi, A., & Bicknell, C. (2020). Sharing leadership: Current attitudes, barriers and needs of clinical and non-clinical managers in UK’s integrated care system. BMJ Leader, 4(3), 128–134. https://doi.org/10.1136/leader-2020-000228

Davis, M. J., Luu, B. C., Raj, S., Abu-Ghname, A., & Buchanan, E. P. (2021). Multidisciplinary care in surgery: Are team-based interventions cost-effective? The Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 19(1), 49–60. https://doi.org/10.1016/j.surge.2020.02.005

Kumar, H., Morad, R., & Sonsati, M. (2019). Surgical team: Improving teamwork, a review. Postgraduate Medical Journal, 95(1124), 334–339. https://doi.org/10.1136/postgradmedj-2018-135943

Moore, W., & Frye, S. (2019). Review of HIPAA, Part 1: History, Protected Health Information, and Privacy and Security Rules. Journal of Nuclear Medicine Technology, 47(4), 269–272. https://doi.org/10.2967/jnmt.119.227819

Reid, M., Lee, A., Urbach, D. R., Kuziemsky, C., Hameed, M., Moloo, H., & Balaa, F. (2021). Shared care in surgery: Practical considerations for surgical leaders. Healthcare Management Forum, 34(2), 77–80. https://doi.org/10.1177/0840470420952485

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2

Lowering Readmission rates for Head and Neck Cancer patients at University of Miami Hospital

Name

Capella University

Professor

September, 2022

Lowering Readmission rates for Head and Neck Cancer patients at University of Miami Hospital

Evaluation of Plan

a. The Goal of the Intervention Plan

This intervention is focused on achieving two major outcomes concerning lowering the admission rates for head and neck cancer patients at the University of Miami Hospital. The first major outcome expected of this project is to reduce wound infections and complications in head and neck cancer patients through patient, family, and/or caregiver education on wound care and proper management of the surgical site. According to Jabbour et al. (2017), head and neck oncology patients present with unique postoperative needs relating to wounds, gastrostomy, and tracheostomy care. By the end of the project, therefore, patient, family, and/or caregiver education having the required skills, knowledge, and attitude, should facilitate faster postoperative healing, thus lowering readmission rates .

Another expected outcome includes an increase in head and neck cancer patient survival rate. According to Chilkuri et al. (2021), compliance with pre-treatment, treatment, and post-treatment can help in increasing the cancer patient's survival rate. The survival rate can be increased by reduced postoperative signs and symptoms such as pain fever nausea and vomiting among other symptoms upon the implementation of the post-discharge care component of the project. This outcome can be attained by the use of telemedicine where the multidisciplinary team at the oncology surgical unit inquires via telephone about the patient's health and address any emerging patient concerns (Jabbour et al., 2017). Video conferencing between the patient or caregiver and the oncologist surgical unit is expected to minimize the 30-day readmission rate for head and neck cancer patients at the facility.

a. Evaluation Plan

Project Outcome Variable	Indicator
Quality Improvement	1. The 30-day Readmission rate for head & neck cancer patients
	2. Patient Satisfaction Score on care provided post-discharge
Education	1. Number of patients/caregivers/family members educated on wound management & proper management of the surgical site
Prevention	1. Rate of post-discharge telemedicine uptake through follow-up on head and neck patients
	2. Head and neck cancer patient survival rate

Discussion

Advocacy

The nurse plays several critical roles in leading change and driving

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