Implementing the Edmonton Symptom Assessment Scale: A Quality Improvement

Background: Hematopoietic stem cell transplant (HSCT) patients experience a significant symptom burden that is often under-recognized and inconsistently assessed in clinical practice. Standardized symptom assessment tools, such as the Edmonton Symptom Assessment Scale (ESAS), have demonstrated effectiveness in improving symptom management and provider awareness in oncology settings. However, the routine implementation of such tools remains a challenge. Local Problem: An inpatient Bone Marrow Transplant (BMT) unit within an academic medical center lacked a standardized method for assessing and communicating symptom burden. Symptom tracking was inconsistent, leading to provider awareness and patient symptom management variability. Despite evidence supporting structured symptom assessment, there was no established workflow for assessing symptoms regularly or integrating a standardized tool into daily practice. Methods: A quality improvement (QI) initiative was implemented to introduce the ESAS in the BMT unit. The intervention involved educating providers on ESAS utilization, integrating the tool into existing workflows, and evaluating provider perceptions of its usefulness. Data collection included pre- and post-intervention surveys assessing provider confidence and awareness, adherence tracking of ESAS utilization, and qualitative feedback on barriers to implementation. Interventions Providers participated in structured training sessions on ESAS administration and interpretation. Printed ESAS forms were incorporated into daily workflows, and biweekly reminders were provided to reinforce adherence. A retrospective review of completed paper ESAS forms assessed the frequency of ESAS use over a designated period. Results: The ESAS was used in 103 out of 158 eligible instances (65.19%). 78.6% (n=11) of providers reported that ESAS improved their awareness of patient symptoms. Post-intervention, 93.3% (n=14) of participants supported the continued use of the ESAS. Key barriers to adherence included provider forgetfulness, lack of integration into the electronic health record (EHR), and limited resources to address identified symptoms. Conclusion: Implementing a standardized symptom assessment tool improved provider awareness and confidence in symptom management for BMT patients. While ESAS was well-received, adherence challenges highlight the need for systemic changes, including EHR integration and sustained provider education. Future efforts should optimize workflow integration, explore automation strategies, and assess patient-reported outcomes to enhance long-term impact and sustainability. Ongoing collaboration with institutional leadership will ensure successful implementation and widespread adoption.