Providing a Safety Net for Bone Marrow Transplant (BMT) Survivors: Nurses and Telephone Triage

Topic Significance & Study Purpose/Background/Rationale 

Long term follow-up (LTFU) of patients transplanted in an NCI-designated Cancer Center is a key ingredient for improving ongoing quality of life and overall survival. The telephone triage consult service at the Seattle Cancer Care Alliance answers the BMT-related questions of post-transplant survivors and their local providers after discharge from the Center.  LTFU Telephone Triage is staffed Monday-Friday by registered nurses (RNs) who manage approximately 80 calls per week from a population of over 5,600 transplant survivors.  This successful service demands expertise in the recognition of signs and symptoms of late acute and chronic Graft versus Host Disease (GVHD), infection, and other complications of transplantation. This department is an essential link in providing optimal post-transplant care in the survivor’s local community. 

Objectives

1. Symptoms of transplant complications are caught early and appropriately treated to promote quality long term survival.
2. Collaboration between telephone triage team, survivors, family, and local providers  improves quality of post-transplant care.

3.   Meaningful research can be done to improve LTFU patient outcomes.

Methods, Intervention, & Analysis 

Essential elements for a successful LTFU RN Telephone Triage service are: establishing and maintaining an organized service; teaching survivors how to access the service during their departure education; ensuring an accessible service; staffing with a dedicated, multidisciplinary team including support staff, transplant-experienced RNs, Attending Physicians with post-transplant expertise, and other specialty consultants; holding thrice weekly  rounds for reviewing cases and formulating clinical recommendations; developing tools used to streamline patient monitoring such as the LTFU flow sheet, LTFU charts, RN Sign-outs, Center-specific LTFU clinical practice guidelines; cultivating positive working relationships with local medical providers; and utilizing sophisticated electronic systems.

Findings & Interpretation 

Continued access to LTFU experts is critical in assisting survivors and their local practitioners in managing care.  Telephone triage serves as a safety net for these survivors with complex and unique needs after transplant. 

Discussion & Implications 

Patient satisfaction for the LTFU service is high and meaningful research continues to improve outcomes as we identify new areas for intervention from this population. The ultimate metric of success of the telephone triage team work is seen in the exceptional 1-yr and 5-yr survival outcomes at the Seattle Cancer Care Alliance.