Hematology-Oncology Inpatient Orientation

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<ul><li> 1. The Rules of the Road A Guide for Pediatric Residents and Medical Students on the Inpatient Hematology-Oncology Service 2006 - 2007 Academic Year Prepared By: George R. Buchanan, M.D. Jennifer Cox, M.D. Revised 1/30/2015 </li></ul><p> 2. Table of Contents Introduction.............................................................................................3 General Description of Unit...................................................................4 Types of Patients Admitted to 4-B.........................................................6 Hematology-Oncology Medical Staff....................................................7 Who Does What?..................................................................................11 Weekend and Night Call......................................................................13 Resident and Medical Student Education..........................................14 Work Rounds.............................................................................................................................14 Teaching Rounds.......................................................................................................................14 Evaluations:...............................................................................................................................15 Other Clinical Support Staff................................................................17 Resources...............................................................................................20 Interactions with Patients and their Families....................................22 Other Important Patient Care Issues..................................................23 Further Opportunities for Learning...................................................24 Daily Outpatient Clinic Schedule........................................................26 E-10 Phone List.....................................................................................27 Childrens Medical Center Phone List...............................................30 2 3. Introduction Please carefully review this material at the beginning of your rotation on E-10 at Childrens Medical Center, the home of the inpatient hematology, oncology and stem cell transplant components of the Center for Cancer and Blood Disorders (CCBD). The guidelines outlined here will help clarify the roles of each participating team member and, in particular, the facultys expectations of trainees while on E-10. Elective rotations for second- and third-year residents and senior medical students in hematology-oncology are offered in the outpatient clinic; information regarding these electives is available on request. 3 4. General Description of Unit: The E-10 inpatient unit has 22 beds (numbered E-10-401 to E-10-422), all private rooms. Five rooms (E-10-412 through E-10-416) are used primarily for our bone marrow transplant program, and are Hepa-filtered positive-flow rooms. Two other rooms (E-10- 404 and E-10-419) are negative-flow isolation rooms (used for children with chicken pox, shingles, etc). The conference room is used by nursing staff and physicians for conferences and rounds. Please try to keep it neat! Book bags and other materials should be stored on one of the shelves or other area designated by the charge nurse, not on the floor. The cabinets on the wall have shelves with notebooks containing copies of oncology protocols (C.O.G. and institutional) and hematology protocols. Also available are standard reference sources in pediatrics and hematology-oncology. A cart in the conference room holds the patients shadow charts (green/blue charts). Additional protocol and reference books are available on the sixth floor of the ambulatory (C) building in our outpatient unit physicians work station and Peggy Sartain Library/Conference Room. None of these materials should be removed from their respective areas. There are 2 HUC (Health Unit Coordinators) in the central area of E-10. The Communication HUC is responsible for handling pages and phone calls, and the Clinical HUC is responsible for order entry. At each HUCs desk there is a list of occupied room numbers, the nurse assigned to the patient, and the charge nurse for each shift. The scheduled admissions for each day are listed on the white board at the Clinical HUC desk. Behind the Communication HUCs desk, there is a dictation/work area with several computers and telephones, as well as work space for writing orders and notes. Blank forms are located either on the racks or in the cabinets behind the Clinical HUCs desk. Each patient area has a separate nurses station one for Rooms E-10-401 to E-10-411 (Engine Area), one for Rooms E-10-412 to E-10-416 (Transplant Area) and one for Rooms E-10-417 to E-10-422 (Caboose Area) There are 2 on-call sleeping rooms for housestaff located near the Train Elevators Rooms E-10-369 and E-10-370. The HUC has a key or you may call security. Please keep your belongings in the room. You may eat in the conference room, except between 0630 - 0730 and 1830 - 1930, as these are shift change times. Neither eating nor drinking at the HUC stations or any nurses station is permitted according to OSHA regulations. Please refrain from consuming snacks from the nourishment areas, as these are for our patients. However, you may help yourself to the coffee which can be found in the Nourishment Room near each Nurses Station. In addition, vending machines are available near the Wagon elevators. 4 5. Floor Plan of E-10 1: Communication HUC 2: Clinical HUC NS: Nursing Stations 5 6. Types of Patients Admitted to E-10 Virtually all children admitted to E-10 have an oncologic or hematologic disease. You should read about or otherwise become familiar with each of these disorders during your stay on E-10. There will be educational lectures and materials provided throughout the rotation, but it is expected that you will also take the time to learn more about issues specific to the patients you are assigned to follow. o Oncology Patients The most common diagnoses are leukemia, brain tumors, lymphomas, neuroblastoma, Wilms tumor, osteosarcoma, Ewings sarcoma, germ cell tumors, rhabdomyosarcoma, hepatoblastoma, and histiocytic disorders. Children with cancer are usually admitted to the hospital for one of four reasons: (1) initial diagnostic evaluation, (2) complications of treatment, (3) terminal care, and (4) administration of scheduled chemotherapy that cannot be given in the outpatient arena. Most patients admitted for chemotherapy treatment only will be admitted to the 6-bed chemotherapy unit on E-8, and will be followed primarily by Pediatric Nurse Practitioners. o Hematology Patients The most common hematologic diagnoses are sickle cell disease, ITP, hemophilia, aplastic anemia, and chronic neutropenia. Children with sickle cell disease are most commonly admitted for (1) management of painful episodes (crisis), (2) chest syndrome/pneumonia, (3) aplastic or splenic sequestration crisis, or (4) elective surgery. Hemophilia patients are admitted either for (1) unusually severe bleeding events or (2) are receiving factor replacement because of a surgical procedure. o Stem Cell Transplantation (SCT) Patients There will usually be between 3 and 6 patients admitted to the stem cell transplantation service at any given time either for the transplant itself or for post-transplant complications. Transplant patients are followed by the pediatric housestaff. The senior resident will be responsible for assigning these patients at the time of admission to one of the PL-1s, or, if the inpatient service is very busy, the senior resident will follow up to 2 transplant patients. On weekends, transplant patients followed by a PL-1 will continue to be followed by the housestaff, but transplant patients followed by the PL-3 will be followed by the fellow. 6 7. Hematology-Oncology Medical Staff The clinical care, teaching, and clinical research activities on E-10 are under the direction of attending physicians of the Center for Cancer and Blood Disorders at Childrens who are full-time faculty physicians at the University of Texas Southwestern Medical Center at Dallas. NAME OFFICE OFFICE # (214) PAGER # (927) 206- George Buchanan, M.D. Division Chief Director of Clinical Hematology UTSW: G3.222 CMC: A03.319 648-8594 456-2379 9450 Naomi Winick, M.D. Director of Clinical Oncology UTSW: G3.210 648-2912 8696 Robert Bash, M.D. Associate Medical Director CMC: C06.677 456-2773 8645 Jennifer Cox, M.D. Division Education Coordinator CMC: E10:371.2 456-8062 8226 Patrick Leavey, M.D. Director, Pediatric Hematology-Oncology Fellowship Program UTSW: G3.240 648-8062 9156 Victor Aquino, M.D. UTSW: G3.234 648-8800 9173 Jim Amatruda, M.D., Ph.D. UTSW: NB8.218B Lab:NB8.218A 648-1645 648-4023 or 648-4920 (972) 451- 2406 Dan Bowers, M.D. UTSW: G3.238 648-8822 9280 Scott Cameron, M.D., Ph.D. UTSW: NA5.602A Lab:NA5.234/504 648-5152 648-1855 9189 Shelley Crary, M.D. CMC: A03.362 456-3194 9772 Janna Journeycake, M.D. CMC: A03.316 456-8556 9286 Matt Porteus, M.D., Ph.D. UTSW: F3.118B Lab: K3.108 648-7222 648-9558 9062 Charles Quinn, M.D. UTSW: G3.106 648-9298 9157 Zora Rogers, M.D. UTSW: G3.224 648-6332 9328 There are three distinct clinical services on E-10: oncology, hematology, and stem cell transplantation. Each of them will have a designated attending physician. The rotations of the attending physicians will be two weeks in duration. The beginning and ending of 7 8. the rotations will be synchronized with the four-week rotations of third-year medical students. Hematology-oncology fellows: Fellows in hematology-oncology are fully-trained pediatricians who are taking an additional three to five years of training to become board certified hematology-oncology specialists. As part of their training experience, fellows have a series of rotations on E-10 during the day, and they provide night and weekend coverage as well (see below). The hematology-oncology fellows (as well as pager numbers) during the 2006-07 academic year are as follows: FELLOW YEAR PAGER NUMBER Cindy Neunert, M.D. 3rd 972.206.9285 Tamra Slone, M.D. 3rd 972.206.9615 Jennifer Wright, M.D. 3rd 972.601.8666 Laura Klesse, M.D., Ph.D. 2nd 972.206.9712 Jason Litten, M.D. 2nd 972.451.1161 J. Allyson Niece, M.D. 2nd 972.206.8795 Mark Hatley 1st 972.451.1110 Tim McCavit 1st 972.451.1195 Martha Stegner 1st 972.206.8170 Cristina Tarango 1st 972.206.9266 Physician Consultants: As is expected with children who have complex medical issues, other pediatric sub-specialists are frequently consulted to provide expertise in their fields. The most commonly consulted services are Infectious Diseases, Endocrinology, Nephrology, Cardiology and Gastroenterology. Housestaff are generally responsible for arranging these consults after discussion with the Attending and/or Fellow covering the patient in question. Two special cases are the Pediatric Surgeons and the PICU. o Pediatric Surgery: As a general rule, we utilize the University Pediatric Surgery group for the majority of our hematology/oncology patients Drs. Guzzetta, Garcia, Hicks, and Megison. Initial consultation with the surgeons is generally made by the hematology-oncology Attending or Fellow directly contacting the Attending Pediatric Surgeon or fellow. o PICU: Given the serious nature of their illnesses and the intensity of their treatment, it is not uncommon for hematology-oncology patients to become critically ill, and require transfer to the Pediatric Intensive Care Unit. While in the PICU, these patients are primarily cared for by the PICU team, with hematology-oncology consultation. Upon their return to E-10, they are once again followed primarily by the hematology-oncology 8 9. team. Except under emergent conditions, the PICU should not be contacted by the housestaff unless directed to do so by the Attending or Fellow on the service. Dr. Mulne: Some children with brain tumors (and occasionally other diagnoses) are managed by two private physicians, Drs. Arlynn Mulne and Ammar Morad. They are not members of the faculty or of the Center for Cancer and Blood Disorders. However, as members of Childrens attending staff with privileges in hematology-oncology, they admit their patients to E-10. These private patients of Drs. Mulne or Morad are cared for by the housestaff and students but are not covered by the other staff physicians or fellows. All questions regarding their patients should be directed to either Dr. Mulne or Dr. Morad. Housestaff: The housestaff assigned to E-10 is typically made up of a senior resident (PL-3) and 2 or 3 first-year residents (PL-1s). The hematology-oncology division is in compliance with university and hospital guidelines regarding resident hours and patient numbers. o Senior Resident: The Senior Resident is responsible for closely mentoring the interns and students as they give care to the patients and overseeing all of the general pediatrics issues, including I/Os, antibiotic coverage, laboratory and imaging tests, nutritional support, etc. This is particularly important for the more seriously ill patients. During months where there is no fellow for one of the inpatient services, the Senior Resident will be responsible for meeting with the Attending on that service prior to Rounds to review any pertinent overnight events and/or lab results. o First-Year Residents: There will typically be either 2 or 3 first year residents assigned to the inpatient hematology-oncology service. They will be responsible for the day-to-day management of up to 10 patients each, including admissions and transfers. Every patient needs a complete daily progress note and documented physical exam using the designated form. Interns are generally not responsible for following children admitted for routine chemotherapy on E-8, who are followed by an Oncology APN. Medical Students: Generally 2 or 3 third-year medical students (MS3) will be assigned to the inpatient hematology-oncology service each month. MS3s will typically follow 2 4 patients at any given time, and will be responsible for seeing those patients daily and writing a detailed progress note each morning. It is expected that the MS3 will present these patients to the Attending in rounds. Although it is generally expected that each medical student will prepare at least one more detailed presentation over the course of the month, specific requirements will be determined by the Senior Resident and the Attending Physicians. Medical students are expected to attend all teaching sessions, as well as general pediatric teaching sessions arranged by the senior resident. On occasion, 1 or more fourth-year medical students (MS4) will do an elective rotation on the inpatient Pediatric Hematology-Oncology service. These students will function 9 10. essentially as sub-interns, following their own patients, but closely supervised by the PL...</p>