CKHS Nurses Improve Patient Outcomes Through Direct Access to Endoscopy and Colonoscopy
Crozer-Keystone Health System has ramped up the battle against colon cancer, the fourth most common cancer in the United States. Last year, more than 106,000 new cases of colon cancer were diagnosed nationwide, according to the American Cancer Society. About six percent of Americans will get this disease during their lifetimes.
Armed with new, state-of-the-art endoscopic equipment, expanded services and a direct access program designed to make it easier for patients to obtain a colonoscopy, Crozer-Keystone is increasing the number of people being screened for cancer and other gastrointestinal diseases in the communities served by the system.
The initiative to enhance the system’s endoscopy suites and improve services provided to the community began two years ago when a research study showed that the number of screenings performed in Delaware County was far below the national average.
“We believed that a segment of the population in the county was underserved due to lack of awareness, difficulty in obtaining appointments, or both,” says Trudy Mazzone, MS, BSRT (R), administrative director, Diagnostic Imaging & Cardiopulmonary Services, CKHS. “Our referring physicians confirmed that their patients were having difficulty making appointments. We determined that we needed to make several changes to meet our goals. One was adding more gastroenterologists to staff.”
In July 2009, two new physicians – Brian Copeland, D.O., and Monica Patel Zeitz, M.D. − began performing colonoscopies and other endoscopic procedures at Springfield Hospital and Crozer-Chester Medical Center. The task force anticipated that Springfield, in particular, would experience a significant increase in patient volume, and the nursing staff played a key role in ramping up to handle it.
Springfield Quadruples Patient Volume
Led by Janice Simons, RN, MSN, CNOR, director of Surgical Services at Springfield, a group of clinical nursing directors visited a comparable hospital in another community with an endoscopy unit similar in size to the one planned for Springfield. After observing patient throughput, the group made process, equipment and staffing recommendations which enabled Springfield’s Endoscopy Unit to quadruple patient volume over the past year while achieving a patient satisfaction goal of 95 percent.
The changes at Springfield include:
- A full-time technician, Bill Maddox, joined the staff to clean and maintain the equipment. This affords Ellen Crockett, RN, Springfield’s endoscopy nurse, more time to assist gastroenterologists with procedures and facilitate patient flow.
- The Department of Anesthesiology now handles anesthesia instead of the endoscopy nurse providing conscious sedation. “The Anesthesia staff can give propofol, a quick-acting anesthetic agent that enables the patient to fall sleep and wake up very quickly,” explains Crockett. “This enables us to provide care more efficiently.”
- The nursing staff streamlined patient monitoring by ordering vital sign monitors for each patient bedside compatible with monitors in the procedure room. Now, when patients go into the procedure room, they are already connected to a blood pressure cuff and EKG monitor wires, which improves patient flow.
- The Springfield nursing staff consulted other CKHS endoscopy suites regarding documentation to ensure implementation of best practices.
- New, state-of-the-art high definition endoscopic equipment was installed in June 2009.
Direct Access for Colonoscopies
To further encourage the community to be screened for colon cancer, some Crozer-Keystone physicians now offer direct access scheduling for screening colonoscopies. This means that a separate consultation visit at the physician’s office is not required prior to the colonoscopy. To be eligible, patients must be between age 50 and 75, asymptomatic, and in generally good health. CKHS nursing staff developed the Direct Access process in which the physician’s office staff handles the screening questionnaire and schedules colonoscopy appointments for eligible patients.
After the nursing staff ran a pilot with CKHS employees at Crozer and Springfield, Direct Access was first offered to the community in March 2010.
“Direct access has definitely increased our patient volume,” says Mary Kopp, RN, BSN, CPAN, Perioperative nursing director at Crozer. “Patients like the fact that they only have to take time off from work once instead of twice because the initial consultation is eliminated for those who are eligible.”
High Definition Endoscopy
To better serve the needs of the community, Crozer-Keystone invested the addition of state-of-the-art endoscopic equipment during the past year. “We‘re now using the newest generation of endoscopes, which incorporates high-definition technology as well as magnification,” says Immanuel Ho, M.D., chief of the Division of Gastroenterology at Crozer. “This means we can look more closely at smaller lesions and we can differentiate between tissue that looks malignant and tissue that looks benign.”
Much like the high-definition televisions now found in American living rooms, high-definition endoscopy provides a clearer image with greater detail and sharper focus. The result is more accuracy, greater efficiency, shorter procedure times and a better experience for the patient.
Another new technology that has improved endoscopic capability is narrow-band imaging which allows doctors to detect subtle changes to the intestinal tract surface, such as in the case of Barrett’s esophagus which can be the precursor to cancer. “Narrow-band imaging enhances our diagnostic capabilities and offers a significant benefit to our patients,” says John Seedor, M.D., chief of Gastroenterology at Taylor Hospital.
In addition to high-definition endoscopy, Crozer-Keystone offers other sophisticated technologies such as capsule endoscopy, endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS) and endoscopic mucosal resection (EMR).
“I am fascinated by the ways that we can help people through endoscopy,” says Judy Zenker, RN, CGRN, a 24-year endoscopy nurse veteran at Delaware County Memorial Hospital. “With ERCP, for example, if a patient has a bile duct tumor, we can place a stent to help them along. If someone needs gall bladder surgery, we can enable them to have a laparoscopic instead of open procedure by removing the stones from the bile duct.”
Zenker also takes every opportunity to promote the importance of screening colonoscopies. “This year, I turned 50 and had a big party,” she relates. “On my birthday cake, I had inscribed, ‘It’s time for colonoscopy!’ You can never overemphasize it.”
Highly Experienced Endoscopy Nurses
Crozer-Keystone hospitals have highly experienced endoscopy nurse veterans, many with over 20 years in the field. They are team players who assist physicians performing procedures and providing anesthesia, in addition to preparing and recovering patients. Their number one focus is patient satisfaction and patient safety, and they are dedicated to making every patient experience positive.
“Patients often say, ‘I was so afraid, and it was over before I knew it. The nurses really took my mind off things and helped me calm down,’” relates Kopp, whose staff at Crozer consistently earns patient satisfaction ratings in the 95 to 97 percent range.
“When patients are anxious about the procedure, I try to calm their fears by explaining every step of the process and addressing all their questions and concerns with compassion and respect,” says Ann O’Donnell, RN, BSN, a 32-year nursing veteran at Crozer.
“Our nurses are certified by the Society of Gastroenterology Nursing,” notes Mary Brennan, RN, BSN, MBA, CNOR, director of Surgical Services at DCMH. “They are very proactive in attending professional meetings and implementing new best practices.”
Patients who are diagnosed with colorectal cancer receive help and support from nurse navigators located in Crozer-Keystone’s Cancer Centers. Patti Hollenback, RN, BS, assists patients at Crozer, and Marge Franke, RN, supports patients at DCMH.
“We help patients work through the whole cancer care continuum from abnormal diagnosis to survivorship,” says Hollenback. “We support them as they deal with the reality of the diagnosis, and we provide the information and tools they need to make the best decisions for the next steps in their care. We recognize that cancer creates a lot of stress and upheaval in a person’s life and family, so we are there to ease some of that burden by helping them sort out priorities and make appointments for doctor visits and lab tests.”
Hollenback and Franke also work to raise awareness in the community, regularly participating in health fairs to provide education and promote cancer screening.