2016 Public Report of Outcomes




The HSHS St. Nicholas Hospital cancer program is committed to sharing outcomes of our efforts to continuously evaluate and improve the quality of care we provide. Through feedback from patients, our own observations, national and local trends and other sources, we continuously seek to identify ways in which we can improve our care.

HSHS St. Nicholas Hospital cancer program has been accredited by the American College of Surgeons Commission on Cancer for over 20 years and was most recently surveyed in 2016 as a Community Cancer Program.

The cancer program at HSHS St. Nicholas Hospital provides a broad scope of services, from cancer prevention outreach and education to cancer detection, treatment, palliative care and survivorship. Our program receives guidance and leadership from the Cancer Committee, which convenes regularly to ensure that we are meeting the standards outlined by the Commission on Cancer. These standards address education, treatment, clinical research, data collection, performance and quality improvement data.

At HSHS St. Nicholas Hospital we are committed to the design and implementation of quality patient care and treatment services. In this report we highlight the following studies to measure the quality of care and outcomes for our cancer patients:

Study Topic:
What is the central line associated blood stream infection (CLABSI) rate of oncology patients with implanted ports?
 
Objective:
On March 15, 2016, HSHS St. Nicholas Hospital, along with three other hospitals within the HSHS Eastern Wisconsin Division (EWD), initiated the “Journey to Zero” program. This program has an enhanced focus on patient safety and a commitment to work toward reaching zero harm goals in our care continuum. EWD chose to specifically focus on the early efforts of achieving zero events of infection in multiple forms. At the same time, anecdotal concern about increased incidence of infections involving implanted ports was expressed by cancer program staff.
 
Study Methodology:
A retrospective record review of all oncology patients who had implanted ports inserted during the previous fiscal year (7-1-15 to 6-30-16) was conducted. Comparative analysis was performed using Infection Related to Implantable Central Venous Access Devices in Cancer Patients.1
 
Summary of Findings:
Number of ports inserted = 68
Number of central line days = 9,674
 

 
  • Of the 68 patients who had ports inserted, 16 (23%) of the patients presented with CLABSI symptoms (fever, weakness, chills).
  • Of those 16 patients, eight (50%) of the patients were admitted to the hospital and had blood cultures drawn. All cultures were negative.
  • One patient had a surgical site infection: port was inserted on 12/8/15 and patient presented with pain, erythema and swelling on 4/7/16. Patient was not neutropenic in the 30 days prior. A peripherally inserted central catheter (PICC) was eventually placed.
  • Based upon the data above, our calculated CLABSI rate is 0.103
 
National Benchmark or Guidelines:
Reported rates of CLABSI vary widely, from 0.2 to 2.8 per 1,000 catheter days.2 The CDC notes rates as high as 5.2 to 5.7 per 1,000 catheter days. However, those rates were based on inpatient ICU stays3.

Discussion/Next Steps:
Based on the above data indicating that our CLABSI rate is lower than nationally reported rates, no process changes were recommended at this time. However, the importance of maintaining standard of care for port access is not to be dismissed in our continuing effort to maintain and/or improve our current rate of CLABSI. 
 
Study reported to Cancer Committee in November 2016.
 

1Maristela, P F., MD, MSc;  Pierotti, L. C.  MD, PhD;.Zerati, A. E., MD, PhD; Araujo, P. H. X. N., MD;  Motta-Leal-Filho, J. M,  MD,  Duarte L.P. G., RN; Ibrahim, K.Y.  MD, PhD; Souza, A. A. L. RN; Diz, M. P. E., MD, PhD; Pereira, J.  MD, PhD; Hoff, P. M., MD, FACP; Abdala, E.  MD, PhD.  (2013). Infection related to implantable central venous access devices in cancer patients.  Infection Control & Hospital Epidemiology34(7), 671-677.  doi: http://dx.doi.org/10.1086/671006
 
2Gorski, L., Hadaway, L., Hagle, M. E., McGoldrick, M., Orr, M., & Doellman, D.  (2016).  Infusion therapy standards of practice. Journal of Infusion Nursing, 39(1S).
 
3Marschall, J., Leone, C., Jones, M., Nihill, D., Fraser, V.J. and Warren, D.K. (2007).  Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study, Infection Control & Hospital Epidemiology, 28(8), 905–909.  doi: 10.1086/519206.


Study Topic:
What are the self-identified needs of cancer survivors?
 
Study Methodology:
An adopted from of the Mayo Clinic Cancer Center Cancer Survivors Survey of Needs was mailed and/or distributed to cancer survivors in November 2015. This included questions using Likert scales as well as several open-ended questions. Raw data was tabulated in early 2016. Analysis of data began in July 2016 and is reported in aggregate form.
 
Summary of Findings:
  • 231 cancer survivors responded to the survey.
  • 71 was the median age.
  • 58% of respondents were female; 42% male.
  • 67% of survivors were diagnosed in the last five years.
  • Surgery alone was the most common treatment modality.
  • Overall quality of life was rated very well, at 8.46 (on a sale of 0-10, with 10 indicating “as good as it can be”).
  • The top three emotional issues identified based on average severity rating:
    1. Uncertainty
    2. Stress
    3. Sense of normal
  • The top three social issues identified based on average severity rating:
    1. Financial concerns
    2. Health insurance
    3. Debt from bills
  • The top three physical issues identified based on average severity rating:
    1. Fatigue
    2. Balancing/strength
    3. Sleep
  • The top three spiritual/other issues identified based on average severity rating:
    1. Long-term effects
    2. Keeping primary care provider informed
    3. End of life concerns
  • The top three topics respondents wanted to learn about:
    1. Nutrition
    2. Cancer health screenings
    3. Safe exercise
  • The top three learning methods identified by respondents:
    1. Written material
    2. Connecting with a specialist
    3. Internet
National Benchmark or Guidelines:
Numerous studies have been conducted to examine the most prevalent issues among cancer survivors. Many of these have been conducted with individuals diagnosed with a specific cancer diagnosis (i.e., breast or prostate) or at a specific stage of survivorship (i.e., early stage or in remission). These results cannot be generalized because they are not representative of the broad population of cancer survivors. The results of our study were compared to a nationwide study, The American Cancer Society’s, “Study of Cancer Survivors” 1. Similar themes of unmet needs were identified. However, because of differing survey instruments, it was determined that it would be preferable to compare our study results with those of the Mayo Clinic2 since the basic survey instrument utilized was the same with a few minor additions/alterations added for our purposes. Detailed comparison is available but overall results were very similar (HSHS SNS QOL – 8.45 and Mayo Clinic QOP = 8.44; some overlap of the top three issues in the physical, social, emotional, spiritual/other domains, etc.).  Like other cancer survivors nationwide3, the most preferred information source for our patients is printed materials.
 
Immediate Opportunity for Improvement:
As a result of this study, the cancer committee decided that we should enhance the HSHS St. Nicholas Hospital web site to include information on the following topics:
  • Nutrition
  • Anew℠ Cancer Survivorship
  • Cancer Rehabilitation
 
 
1 Burg, M. A., Adorno, G., Lopez, E. S., Loerzel, V., Stein, K., Wallace, C., & Sharma, D. B. (2015). Current unmet needs of cancer survivors: analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II. Cancer, 121(4), 623-630.

2 Ness, S., Kokal, J., Fee-Schroeder, K., Novotny, P., Satele, D., & Barton, D.  (2013).  Concerns across the survivorship trajectory: results from a survey of cancer survivors. Oncology Nursing Forum, 40(1), 35-42.

3Playdon, M., Ferrucci, L.M., McCorkle, R. et al. (2016).  Health information needs and preferences in relation to survivorship care plans of long-term cancer survivors in the American Cancer Society’s Study of Cancer Survivors – I.  Journal of Cancer Survivorship, 10: 674.  doi:10.1007/s11764-015-0513-4