A new community thoracic nurse specialist role for postoperative care

A chest team introduced community nurse specialists to reduce hospital stays and patient readmission rates. This initiative won the Surgical Nursing category at the 2021 Nursing Times Awards

Summary

A new role has been created for a specialist thoracic nurse from the Macmillan Community at South Tees Hospitals NHS Foundation Trust, to travel to patients’ homes to provide social and emotional support after lung cancer surgery. Thanks to the new positions, the department’s readmission rates have decreased and the patient experience has improved.

Quote: Stockdale S et al (2022) A new community thoracic nurse specialist role for postoperative care. Nursing schedules [online]; 118:7.

Authors: Stacey Stockdale, Hayley McNaught, Leanne Connelly and Rachel Calvert are all Macmillan Thoracic Specialist Nurses, South Tees Hospitals NHS Foundation Trust.

Introduction

Patients undergo thoracic procedures for diagnostic, therapeutic and palliative purposes for both benign and malignant disease, and the South Tees Hospitals NHS Foundation Trust Chest Service supports around 800 patients a year who undergo these procedures.

In July 2020 the department, in conjunction with Macmillan Cancer Support and South Tees Cancer Services, created a new role for a Community Thoracic Specialist Nurse, with the aim of providing holistic care for chest patients. The role was to actively support patients and their families by ensuring continuity of care throughout the thoracic surgical journey. The need for specialist chest care had been identified before July 2020, but the project started at this point because the Covid-19 pandemic increased the demand for community chest care to reduce both the length of hospital stays for patients and their readmission to hospital. rates.

Closing gaps in service delivery

Our department had already identified a gap in service delivery before the pandemic began: patients were discharged from hospital after thoracic surgery and often they were not seen until their routine six-week postoperative clinical examination. The spread of the coronavirus in 2020 has made it imperative to discharge postoperative patients as quickly as possible; lung cancer patients are at increased risk of becoming infected with Covid-19 and it was feared that they would experience higher morbidity and mortality rates than the general population (Passaro et al, 2021) .

Our department therefore risked seeing the gap we had identified widen. To address this issue and improve patient care, we have developed the role of a Community Thoracic Nurse Specialist to visit patients at home 24-48 hours after discharge. The specialized knowledge of the thoracic surgical nurse would enable her to:

  • Examine patients;
  • Manage their symptoms;
  • Reassure and support patients and their families.

Setting up the service

Our team worked closely with South Tees Cancer Services and Macmillan Cancer Support to draft a Community Thoracic Nursing Service proposal, which was quickly approved. Macmillan Cancer Support provided a grant of £50,000 in 2020, which was renewed in 2021. South Tees Hospitals NHS Foundation Trust funded costs such as a laptop, phone and travel costs, and we are arranged for a pool car to be used for this service only. Additionally, the trust has agreed to take over funding for the service in the future.

The process was not without challenges, such as obtaining the appropriate equipment quickly and developing an integrated database linked to medical, hospital and community care services. This database is linked to all thoracic services, including pre-assessment, surgery, discharge and all follow-up examinations (both in the clinic and in the community); it also makes it easier to support the nurse specialist role during annual leave and other staff absences. With the support of the trust, we were able to overcome these challenges, ensuring we had adequate equipment and supplies to manage patients in the community.

Service execution

Funding for a specialist thoracic nurse from the Macmillan community was introduced and the position is now fully integrated into the team, with four nurses providing thoracic patients with community support on rotation. As the Covid-19 pandemic has limited hospital visits for inpatients, the ability to care for patients in the community – where they can see their families and caregivers – dramatically improves patient care and satisfaction. . Additionally, community thoracic nurses are able to review and manage each patient’s condition at home in a more personalized way than before.

This new role allows the nurse to:

  • Support patients as they transition to community care after early discharge;
  • Provide expertise – including early intervention for psychological and emotional support – in the patient’s home;
  • Answer questions relating to surgery and anticipated recovery;
  • Manage symptoms, for example by optimizing analgesia;
  • Help patients manage their own symptoms, such as shortness of breath;
  • Identify and treat wound problems;
  • Provide patients with their postoperative histology results and inform them of any further referrals for further treatment.

The service takes a holistic approach to patient care and our specialist nurses follow each patient’s journey from pre-assessment to treatment and recovery.

“The judges were impressed with this service, which was clearly patient-focused, and the team was inclusive in their involvement of both patients and staff in the development of services” (Comments from the judges)

Results

This service aimed to support not only the physical health of chest patients, but also their psychological well-being. Nurses specializing in community thoracology have identified ways to improve the quality of life and comfort of patients at home; for example, they have organized Macmillan grants to allow patients struggling with basic care to buy essential equipment, such as beds or kitchen appliances.

The implementation of this role has led to a significant reduction in the length of hospitalization for thoracic patients: it is now an average of 4.1 days in our service, compared to a national average of 6.6 days before the pandemic (Richens , 2018). We believe this may decrease further over the coming year as during the Covid-19 pandemic the majority of patients were admitted the day before surgery as our department begins to return to its routine practice of admit them on the day of surgery. .

Additionally, our early data shows a reduction in hospital readmissions from 36% in 2019 to 11% in 2021 (Lim, 2022). We recognize that readmission rates will never be zero; however, when complications requiring hospital care are recognized during home visits, thoracic specialist nurses can arrange direct admission to the thoracic department, thus avoiding patients having to travel to risk areas, such as the emergency room and admission units.

Patient Feedback

Since the start of the initiative in 2020, 400 new patients have been cared for by this specialized nursing service. We made 520 home visits, 460 phone calls and 80 pre-assessments or clinical examinations. Patient feedback has been overwhelmingly positive; in particular, patients say how invaluable they find the service in terms of reassurance and support. One said:

It is important to have a sense of follow-up after major surgery, as it is uncharted territory and one can feel anxious..”

Conclusion and future plans

An unexpected difficulty we encountered during this project was that the physical and mental health of several patients was worse than expected. We recognized that these lower levels of health needed to be addressed urgently, as many patients were also struggling with the isolation caused by the pandemic. One of the benefits of our service is its ability to provide face-to-face support and care, which we hope will encourage a positive recovery.

Since the introduction of this specialist nursing service, we have constantly adapted to a rapidly changing world, achieved our main goals of improving patient care and exceeded our initial expectations. As we continue to navigate the pandemic, we will ensure that we continue to support patients after thoracic surgery to the best of our ability. We plan to disseminate our project both locally and nationally as an example of good practice, and other teams have already shown interest in replicating this service.

Key points

  • A variety of chest procedures are used to diagnose and treat benign and malignant diseases
  • The Covid-19 pandemic has increased the time between thoracic surgery and routine postoperative clinical examination
  • Lung cancer patients have an increased risk of Covid-19 infection and higher morbidity and mortality rates than the general population
  • Receiving community care allows patients to see family members while inpatient visits are limited
  • The role of the community thoracic nurse specialist can reduce length of hospital stay and readmission rates

Tips for setting up similar projects

  • Talk to all the teams that would be involved in the service
  • Planning and operating procedures are vital
  • Establish ways to accurately record data and be clear about what data needs to be collected
  • Establish ways to quickly collect patient feedback
  • Build relationships with referral teams and community teams
  • Keep an open mind, as you will constantly adapt to change

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