Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
Consultant physicians working with patients - Royal College of ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>Consultant</strong> <strong>physicians</strong> <strong>working</strong> <strong>with</strong> <strong>patients</strong>Many <strong>patients</strong> and their carers are taught to administerpart <strong>of</strong> their treatment at home, including coagulationfactors for inherited bleeding disorders, subcutaneousheparin, iron chelation and home chemotherapy.Patients on OACs may self-test at home, <strong>with</strong> dosingsupervised by a nurse specialist by telephone.4 Interspecialty and interdisciplinary liaisonMultidisciplinary team <strong>working</strong>Multidisciplinary team (MDT) meetings for <strong>patients</strong><strong>with</strong> haematological malignancies, severe bleedingdisorders, haemoglobinopathies andpregnancy-associated haematological problems areroutine in haematology practice. Laboratory-focusedmeetings <strong>with</strong> biomedical and clinical scientists alsotake place.Working <strong>with</strong> other specialtiesHaematologists work in joint clinics <strong>with</strong> clinicaloncologists, orthopaedic surgeons, obstetricians andpaediatricians depending on the relevant patient groupand may consult <strong>physicians</strong> from a number <strong>of</strong>disciplines when treating <strong>patients</strong> <strong>with</strong> complexhaematological disease. Close liaison <strong>with</strong> primary carespares many <strong>patients</strong> hospital visits and allowsmanagement in the community.5 Delivering a high-quality serviceWhat is a high-quality service?A high-quality service is dependent on evidence-basedmanagement, appropriate staffing and access toadequate facilities.Specialised facilitiesThe facilities required are dependent on the clinicalservice provided. For hospitals that care for <strong>patients</strong><strong>with</strong> haematological cancers, facilities should beorganised as set out in the document Improvingoutcomes in haematological cancers. 3 Specialist unitsmay require facilities for therapeutic apheresis andcytopheresis. Hospitals that deliver intrathecalchemotherapy must have a designated clinical area inwhichthisisperformed. 6Out<strong>patients</strong>Facilities should guarantee a rapid turnaround <strong>of</strong> bloodresults and should have an appropriate environment inwhich to deliver sensitive information to <strong>patients</strong> andtheir families.Day careHaematology day-care areas are crucial for patientreview and the delivery <strong>of</strong> blood products, certainchemotherapy regimens and infusional treatments(bisphosphonates, intravenous iron, immunoglobulin,coagulation factors and monoclonal antibodies). Goodday-care facilities greatly relieve pressure on inpatientbeds and are more acceptable to <strong>patients</strong>.In<strong>patients</strong>The number <strong>of</strong> dedicated beds and isolation roomsneeded and the requirement for filtered air and positivepressure rooms depends on the level <strong>of</strong> inpatient care<strong>of</strong>fered, particularly the predicted length <strong>of</strong> neutropeniaand the degree <strong>of</strong> immunosuppression. Facilities shouldbe appropriate for the age <strong>of</strong> the <strong>patients</strong> as outlined byNICE. 7Units that provide a specialist service for <strong>patients</strong> <strong>with</strong>inherited bleeding disorders and haemoglobinopathiesshould have adequate day-care facilities for review andtreatment <strong>of</strong> <strong>patients</strong> and access to appropriateinpatient facilities.Workforce requirements: clinical and support staffThe haematology team <strong>of</strong> a district general hospital(DGH) should have the following members. It should include at least three whole-timeequivalent (WTE) consultant haematologists; theseshould work as part <strong>of</strong> a team that may cover morethan one site. There will be either a nurse consultant or a number<strong>of</strong> clinical nurse specialists that may havesubspecialist expertise in areas <strong>of</strong> blood transfusion,haemoglobinopathies, venous thromboembolicdisease, haemophilia or bone-marrowtransplantation. Outpatient facilities and staffing and in<strong>patients</strong>taffing should be as outlined in Table 2. The service should also include access to apharmacist <strong>with</strong> a special interest in chemotherapy,a data manager, specialist palliative care, a dieticianand physiotherapists.Service developments to deliver improvedpatient careHaematologists maintain and improve quality <strong>of</strong> carefor their <strong>patients</strong> and the laboratory duties for which130 C○ <strong>Royal</strong> <strong>College</strong> <strong>of</strong> Physicians 2013