Optimizing discharge readiness to reduce health disparities for at-risk children with cancer in the Bronx.

407 Background: Transitions in care between hospital and home are overwhelming for patients and families, and often result in medical errors. Children with cancer are at an increased risk of adverse outcomes due to their immunocompromised state. Despite a robust therapeutic armamentarium, unfavorable outcomes secondary to disease- and treatment-related complications remain a challenge, and children with cancer are particularly vulnerable to these outcomes during transitions of care. At our institution, the pediatric oncology team noted that caregivers of patients with new pediatric cancer diagnoses often admitted to confusion regarding infection precautions, central venous catheter care, and medications when returning for follow up appointments. This experience is supported by data showing that caregivers of patients with leukemia feel subjectively unprepared to take care of patients after hospital discharge. The increasing prioritization of outpatient management in healthcare has shifted responsibility for identifying and managing emergencies and complications to caregivers. Methods: We initiated a comprehensive cancer-specific program through the use of quality improvement measures and four plan-do-study-act (PDSA) cycles to ensure consistency of healthcare provider-delivered education and improve caregiver knowledge of homecare instructions in a high-risk patient population. Results: Based on our recent publication, overall retention of key discharge information was greater in the intervention cohort compared to the non-intervention cohort (median total scores: 89 and 63, respectively; p=0.001). Improvements in the proportions of correct responses post-intervention were also observed across all subject matters: from 0.57 to 0.88 for fever guidelines (p=0.059), from 0.71 to 0.78 for signs of sepsis (p=0.65), from 0.57 to 1.00 for accurate choice of on-call number (p=0.004), and from 0.71 to 0.94 for antiemetic management (p=0.14). Conclusions: Our study demonstrated that standardized processes with a multi-disciplinary team and task allocation significantly improves ability of caregivers to retain important information after a new cancer diagnosis, with specific improvement in retention of fever guidelines and on-call contact instructions. During our intervention, it became clear that as team members change (residents changing cycle, oncologist going off service, nurses switching), having one point person is absolutely critical in ensuring discharge education continues. We anticipate that a dedicated patient navigator focused on consistent psychosocial screening and health literacy comprehension of key discharge details would lead to a marked improvement in cancer care delivery for children with cancer in the Bronx; specifically, discharge readiness, medication adherence, family satisfaction, and patient safety for children with cancer in the Bronx.