Stoplight Tool Helps Patients Manage Chemotherapy-Induced Diarrhea, Reduces Hospital and ER Visits

A patient-friendly stoplight tool with 3 different colored zones helped patients undergoing chemotherapy manage diarrhea and reduce hospital and emergency department visits.

The diarrhea stoplight assessment (DSAT) tool represents a new cost-effective and user-friendly patient education platform to assist nurses in identifying and managing early cancer treatment–induced diarrhea, according to findings that were presented at the 47th Annual Oncology Nursing Society Congress. However, further research to apply the results in a larger data set of patients is still warranted.

The stoplight format of the patient education tool included 3 different zones: green, red, and yellow. Each color was associated with different interventions, and these tools are associated with improved symptom management and reduced readmissions for chronic diseases.

Ultimately, an analysis of hospital T-tests found that 30-day hospital readmissions were reduced in the intervention group (P <.001). Readmission rates were also lower in the retrospective group.

A follow-up analysis of the post-intervention group found that patients averaged 8.5 visits with reported chemotherapy-induced diarrhea (CID) stoplight levels (green, 92.4%; yellow, 5.70%; red, 1.9%)

In addition, activities of daily living were determined to be the life aspect most affected by bowel changes. On a scale where 0 represented “no impact” and 10 represented “extreme Impact,” the average score reported for activities of daily living (ADL) with bowel changes was 3.79. In comparison, the average score for energy was 1.52, mood was 1.86, family life was 1.26, and social life was 1.67.

“Research shows that diarrhea is a common side effect of chemotherapy treatment, and it can be a dose-limiting toxicity for many,” lead study author Rebecca Kirkpatrick, BSN, RN, OCN, Meritus Medical Center explained in a presentation of the findings. “Literature indicates that 50% to 80% of patients can develop diarrhea associated with their treatment, resulting in [emergency department] visits, 30-day hospital readmissions, and delays in their cancer treatment, potentially affecting their overall survival.”

“We found that the stoplight tool was effective in reducing 30-day admissions by [reducing] chemotherapy-induced symptoms at home,” she added. “Reduction of readmissions is important for immunocompromised patients by reducing costs and improving patient satisfaction and outcomes.”

Although previous research has shown that stoplight tools have been useful in helping patients manage chronic diseases, investigators noticed that there was insufficient research documenting the efficacy in patients with cancer.

Therefore, this study assessed the impact of the CID stoplight tool on hospital readmissions and emergency department (ED) visits over a 30-day stretch. The analysis included a retrospective chart review and post-survey. Overall, the study assessed 25 participants with cancer who received the intervention.

In the spotlight tool, a green day was described as a “good day.” This zone signifies that a patient has no increase in bowel movements over baseline and no changes in stool color or consistently. A green day also means that a patient can consume fruits and vegetables normally. Patients in this zone were advised to continue their normal activities, maintain their normal diet, and keep all regular doctor appointments.

A yellow day was described as a “bad day.” This zone signifies that a patient has experienced an increase in bowel movements over baseline and their stools are more liquid than normal. Patients experiencing a yellow day are not able to eat and drink normally and are experiencing stomach cramps or aches. The DSAT tool advises patients in the yellow zone to take diarrhea medication as instructed by their provider, stop using any laxatives or stool softeners, drink fluids, avoid fiber or other inflammatory foods, keep their skin clean, and to call their doctor as symptoms worsen.

A red day was described as a “very bad day.” This zone signifies that a patient is experiencing more than 4 bowel movements per day over baseline and these stools are completely liquid. Patients in the red zone are unable to make it to the bathroom on time, are experiencing severe adnominal pain, and are unable to eat and drink. These patients are also not experiencing any benefit from diarrhea medication. The DSAT tool advises patients in the red zone to call their doctor immediately: if they cannot reach their provider within 1 hour, they should visit the ED; if the patient cannot drive themselves to the ED, they should call 9-1-1.

Prior to initiating chemotherapy, participants identified CID zones at each treatment visit and at home as a guide for symptom management with assistance from their oncology nurses. Nurses were provided with the Systematic Therapy Induced Diarrhea Assessment Tool (STIDAT): a reliable diarrhea assessment tool used to monitor symptoms and CID impact on quality of life.

Thirty days after implementation, hospital readmission and ED visits data were collected though chart reviews.

“The DSAT was a cost-effective and patient-friendly education tool for nurses for early use of identification and management of chemotherapy induced diarrhea in the oncology population,” Kirkpatrick concluded.

Study authors noted that the project began at the start of the COVID-19 pandemic, which potentially limiting outcomes, adding that a confirmatory study with a larger sample size is warranted.


Kirkpatrick R, Rineheart V, Bert K, et al. Implementation of an evidence-based patient education stoplight tool to reduce cancer treatment-induced diarrhea. Presented at: 47th Annual Oncology Nursing Society Congress; April 27-May 1, 2022; Anaheim, CA. Abstract P340.