Overview:

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The UCLA Hematology Oncology (HO) Team is a subspeciality service consisting of two senior residents, one fellow, and one attending. The majority of the patients on the HO Team will be patients with liquid tumors and hematopoietic stem cell transplant (HSCT) recipients. Most solid tumor patients will be followed at the SM Hospital by the general ward service, although exceptions do apply.

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CAPPING PLAN:

The H/O service caps at 16 patients (8 patients per resident). The H/O team accepts overflow patients from the Silver team as follows:

• At 16 pts, Silver team capped. All admissions will overflow to Heme/Onc residents and will be staffed by Consult Attending (with exception of weekends, in which the Silver Attending will staff these patients with Heme Onc residents)
• If Gold team is very light (e.g., < 5 patients) and Heme/Onc service is busy (e.g., > 8 patients), may consider overflow to Gold instead. In general this is to be avoided since Gold residents will then need to round with 3 attendings.
• As attendings will have decreased continuity of care, patients placed on overflow should be those expected to have short stays, surgical co-follows, video EEG admits etc. whenever possible
• Overflow patients expected to have prolonged hospitalizations will be transferred back to Silver team on resident switch days only (=Thursdays), to preserve resident continuity. This should only happen when Silver census is below 14.

• ​Overflow patients expected to have a short stay should remain on overflow team to be discharged. 

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Rounds and Daily Schedule:

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• You should arrive to receive sign out by 6AM.

  • Of note, you may not receive sign out for 15 minutes or so, as the HO team is typically one of the last teams to receive sign out by the night team; however, you should still arrive at 6AM and begin pre-rounding while you wait to receive sign out. 

• If following Silver overflow patients, please touch base before rounds with the Pediatric Hospitalist Consult attending to arrange a time to meet for family-centered rounds (ex. 10 or 11 am) based on anticipated end time of HO rounds and the Pediatric Hospitalist Consult attending's schedule.

• Daily rounds begin at 8AM, except on Fridays, when rounds begin after Grand Round at 9 AM.

• On occasion, the attending may have you round earlier or later on the weekends, please check in with the fellow if you have any questions on rounding times.

• The HO fellow will meet with the charge nurse, SW, and case manager daily for IDR rounds at 11:30 AM. Please be sure to update the fellow prior to IDR rounds for any discharge or nursing care concerns you may have.

• Please attend noon conference from 12:00-1:15 PM daily.

• In the evening, you should be ready to sign out to the night team by 5 PM.

 

Daily Responsibilities:

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• Discuss any urgent patient issues (i.e. worrisome labs, vitals, fever, bleeding, etc) with the fellow prior to rounds to ensure that issues are addressed promptly.

• Review the MAR and all orders written overnight for your patients prior to rounds.

• See all patients prior to rounds.

• Add pager number in CareConnect to all of your patients as "Primary Resident”

• Arrive at noon conference on time every day.

• Be prepared to start floor rounds on time everyday

• Present succinct presentations during rounds.

  • Please refer to HO presentation tips for more information

• Call consults prior to noon.

• Update parents (daily if in-house, q 2-3 days via telephone per parental discretion).

• Complete all notes prior to evening sign-out with the goal of going home immediately after evening sign-out.

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Discharge Planning

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• Begin discharge planning on the day of admission (start prescription forms, d/c instructions, home health needs, etc.). Orders should be done and pended in CareConnect day/night prior to discharge to speed up discharge process. Ideally, all discharges should be ordered prior to 10am.

• Begin parent teaching and/or ensure teaching is given to parents when discharge is anticipated.

• Contact case manager/discharge planner regarding home health needs as soon as possible.

• Notify all involved subspecialty services about discharge plans at least 1-2 days prior to discharge.

• Set-up all necessary subspecialty follow-up appointments by the day prior to discharge - for some patients this may involve calling and making the appointment for the family rather than giving the family the appointment number to call. This will be specified by the attending.

• Complete discharge paperwork (home health orders, Rx forms, school notes, etc.) by the day prior to discharge.

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H/O CareConnect Tips

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Special Notes on Hem/Onc Admissions/Patients:

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For patients admitted for routine chemotherapy, please try to remember these on admission. Ask your RN if you have questions about it. This includes:

1. Heparin Flush 100units/ml 500 units as needed for port-a-cath flush

2. NS Flush for line care

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Patient admitted for fever and neutropenia or already admitted and becomes febrile and neutropenic, there is an orderset to use: PED HEM ONC FEBRILE NEUTROPENIA ADMISSION IP

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Bone Marrow transplant protocols

Allogeneic Cord: click me

Allogeneic Standard : click me

Non-myeloablative Allogeneic: click me

Autologous: click me

Non-myeloablative Haploidentical: click me

Myeloablative Haploidentical: click me

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