Oncology Night Role

Responsibilities of Oncology Night Hospitalist:

o The hospitalist will hold the admissions pager and assist with all admissions:

· All NP Onoclogy (Onc) admissions at night should go through the Night Oncology Hospitalist (pager 4531; pager number is listed in AMION under HEME/ONC on nights there is coverage)

· Hospitalist will communicate with MAPA on admissions via ER.  

-If patient is direct admit, BA will directly page the ONC Hospitalist at 4531.  Based on guidelines, will make triage decision.  If unclear based on e-mails and vitals, Hospitalist can go evaluate the patient.  If patient needs to be on teaching service, then ONC Hospitalist contacts MCR

· Hospitalist will assign admissions to NP’s

· After discussions with the MAPA and review of guidelines, night Onc hospitalist will make the final decision if patient is appropriate for NP Onc. The Onc NP cannot refuse to do an admission that is deemed appropriate by the Onc Hospitalist.

· NP’s (or moonlighter covering NP) will take 2 admissions each) then 1 to hospitalist, followed by 1 each to NP’s, if additional admits they will be given to hospitalist (e.g., 2 (NP),2 (NP),1 (MD),1 (NP),1 (NP), remainder- MD)

· NP’s to staff each patient they admit with the night hospitalist

· Hospitalist will see all onc admissions

o The hospitalist will assist with phone calls and acute issues overnight:

· No assigned patient at the beginning of the shift (MD will acquire an assignment as admissions occur throughout the night)

· Respond to RRT calls as necessary (NP will use clinical judgement for requesting, not every patient will require hospitalist assistance)

· Phase 1 Clinical Trial patients – hospitalist will round on each patient and assess for issues

· Patients transferring to teaching service – assist in transfer and management of patient issues

o Shift Report:

· 6:30 PM will have a face to face sign out with the BMT and Hem/Onc day NPs regarding patients that are critical, any CAR-T patients or items to follow overnight

· 6:00 AM will have a face to face sign out with the BMT and Hem/Onc night NPs regarding patients that are critical or items that need to be followed to relay to the day team

Note:

o The triage decision for the patient (NP ONC vs. Teaching) will be made between the ONC Hospitalist and the MAPA. The ONC fellow and/or attending does not need to approve of an admission to the service at night, and in these cases does not need to be called by the ED or MAR/MAPA for triage.

o The ONC fellow or the service attending should still always be called for any major clinical change (i.e., chemo reaction, new TLS, leukostasis, cord compression) or any other questions or concerns that arise.

o The CRS attending listed in AMION should be called immediately for any concerns with CAR-T patients.

Workflow:

1. ED admits patient.

2. MAPA triages the patient to NP ONC.

3. MAPA discusses patient with ONC hospitalist. ONC hospitalist accepts patient.

4. ONC hospitalist contacts NP and gives brief sign out.

5. Any NP concerns about the admission should be discussed collaboratively by both parties. The default will be to defer to ONC hospitalist.

6. ONC NP sees patient and contacts ONC hospitalist to discuss plan.

7. ONC hospitalist sees patient.

8. ONC hospitalist should contact NP if there needs to be an alteration in plan after seeing the patient.