1. Early Identification and Early Intervention
Janet Benedict PT, CLT-LANA Elmhurst Memorial Healthcare, 155 E. Brush Hill Road, Elmhurst, Illinois 60126
Background
Reporting Period: January 1 – June 30 (Annually )
Results
The Rehabilitation Department at Elmhurst Memorial Healthcare (EMHC) noted there was a lack of compliance of patients completing lymphedema therapy treatment. This led to a study which identified the lymphedema stage at referral and any barriers to completing treatment.
Data analysis revealed that the lower the stage of lymphedema at the time of referral, the greater the compliance of the patient in completing therapy.
Elmhurst Memorial Healthcare launched an Early Identification and Early Intervention Lymphedema Program (EI & EI Program) with the following goals:
increase awareness of lymphedema
increase referrals for treatment
increase referrals of stages 0 & 1 when intervention is more cost effective and there is greater compliance of the patient to complete the therapy
Following the educational sessions:
overall referrals increased 31% from 2012 to 2013
of those referred in 2012, 65% of them were stages 2 & 3 and 35% were stages 0 & 1
by 2013, stages 2 & 3 only accounted for 46% of those referred and stages 0 & 1 referrals had increased to 54%.
Number of Patients Referred for Lymphedema Management
Conclusion
Education can improve awareness of lymphedema and increase referrals for treatment especially in the early stages (stage 0 and stage 1) of lymphedema.
Method
Education regarding the EI & EI program was provided to the various stakeholders within the organization. (The Nurse Practice Council, the Department of Surgery, the Department of Medicine, and the Quality Improvement committee.)
Education sessions included:
reviewing the current state of evidence related to lymphedema
defining lymphedema
describing the stages of lymphedema
reviewing current patients’ characteristics that were treated for lymphedema at EMHC
specific treatments for lymphedema available
References
Armer et al. Lymphedema Following Breast Cancer Treatment, Including Sentinel Lymph Node Biopsy. Lymphology 27 (2004) 73-91
Fleysher, Larisa A. Keeping Breast Cancer Survivors Lymphoedema-Free. British Journal of Nursing. 2010, Vol 19, No 13.
Norman et al. Lymphedema in Breast Cancer Survivors: Incidence, Degree, Time Course, Treatment, and Symptoms. Journal of Clinical Oncology January 20, Vol 27, No 3.
Stout et al. Breast Cancer-Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a Traditional Model of Care. Physical Therapy January Vol 92, No 1.
Yen et al. A Contemporary, Population-Based Study of Lymphedema Risk Factors in Older Women with Breast Cancer. Ann Surg Oncol (2009) 16: