A bone marrow transplant on an outpatient basis? For some patients, yes
Six, to date; more soon. Outpatient bone marrow transplants, that is.
Finding new ways to deliver quality care with the greatest benefit is a priority for a patient-centered institution like City of Hope. For example, not every bone marrow transplant patient needs to check into the hospital for treatment. In fact, some might even benefit from remaining outpatients.
City of Hope's new day hospital is designed to address their needs.
Studies have shown that day hospitals can meet clinical standards for bone marrow transplants without compromising patient quality of care. They allow patients to be treated as outpatients rather than inpatients, which lets them go home after their treatment. The result can be greater patient satisfaction and an improved patient experience.
The day hospital at City of Hope also addresses the growing demand for bone marrow transplant services. According to the National Marrow Donor Program, the number of transplants will double by 2020.
Early focus on myeloma patients
City of Hope's day hospital initially is treating multiple myeloma patients who undergo autologous blood stem cell transplantation ("autologous" means the transplant uses the patient's own cells) and meet a strict set of requirements, according to Shirley Johnson, R.N., M.S., M.B.A., chief nursing and patient services officer. These patients tend to have better tolerance of pretransplant therapies.
Patients also must reside within an hour’s drive of the Duarte campus to ensure they are within reach of care should any complications arise. For patients who live farther away, on-campus housing may be an option.
“Transplant patients can sometimes develop a fever or other symptoms indicating a potentially life-threatening issue,” Johnson said. “We want to be able to address that quickly, usually within 60 minutes, to help ensure the patient’s safety.”
In addition, patients must have access to a caregiver that can attend to their needs 24 hours a day, seven days a week during treatment. The caregivers receive extensive training so they will know how to act in the patient’s best interests.
“The service is really a team effort involving our care providers, the patient and the caregiver,” Johnson said.
Teamwork leads to initial success
To date, six patients have been treated in the day hospital, located in the outpatient surgical center on the third floor of the Michael Amini Transfusion Medicine Center. All of the patients are doing well, and patient satisfaction with the service is high, according to Mary Perrin, R.N., B.S.N., clinical nurse manager of the day hospital.
Johnson credits the launch and initial success of the new program to careful, patient-centered planning and input from patients, physicians, nurses, an array of clinical specialists and administrators.
“We had over 90 team members participate in the planning process, and always at the forefront of our minds were the patient’s needs,” she said. “We want to ensure every outpatient will have the same stellar outcome that they would have received as an inpatient.”
Stephen J. Forman, M.D., Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation, commended the efforts of the team.
“Launching a new service like this requires broad cooperation. The vision and leadership of Dr. Amrita Krishan and Dr. Leslie Popplewell in developing the day hospital and the work the entire team put in to make it happen demonstrate the unique spirit and patient focus we have here at City of Hope,” he said.
An opportunity to learn and expand services
Following the trial phase with myeloma patients, the day hospital will begin to accept other patients who normally would receive inpatient treatment, as well. The team will evaluate this next step in the coming months.
In the meantime, Johnson has published an article detailing the process used to develop the day hospital so others can learn from our efforts. The paper appears in the July-September issue of Nursing Administration Quarterly.
City of Hope has the largest program for leukemia, lymphoma and myeloma in California and, according to national data from the Center for International Blood & Marrow Transplant Research, our outcomes for bone marrow transplants are unparalleled.
Data from the CIBMTR is widely considered the best basis for comparing bone marrow transplant performance. All transplant centers in the country must provide the same type of information, with the same type of documentation. In this federal database, only 12 centers out of 169 performed above expectations in 2013. City of Hope was one of those centers.
City of Hope is the only center in the nation to have achieved nine consecutive years of what CIBMTR describes as “over performance.”