Oncology admission pathway and protocol, updated 8-27-12.d…

Oncology Patient Admission PathwayPatientHomeOutside Hospital, NursingHome or Hospice TransferOncology or PCP OfficeMed Onc alerts EDMD re. patient ontheir way to the EDED VisitDirect Admission by PrimaryOncologist or HospitalistED MD givesclinical inputto oncologistor hospitalistEDAdmissionED Physician writes TransitionOrders (expedites care) at thedirection of the Admitting PhysicianBed Mgmt assigns patient to a bedbased on admission ordersEstablished July 17, 2012Admitting Physicianmanages patient

Emergency Department Oncology Patient Admission ProtocolA. Objective: To ensure Emergency Department physician has accurateinformation about the patient’s condition; i.e., extent of condition, code status,and recent treatment1. Patient sent to Emergency Department by medical oncologist(a) Medical Oncologist calls the emergency department to alert them about theirincoming patienti. If very straightforward case, medical oncologist asks to speak to chargenurseii. Otherwise, the medical oncologist calls the Emergency Department atx8500 and asks for the Physician Manager. The Emergency Departmentphysician manager is available 24/7/365 to take information about thepatient. The Emergency Department physician manager will create a prearrivalnote in the Emergency Department system, which is merged intothe patient chart. This note is visible to the Triage RN, Registration, andthe treating ED Physician(b) The Emergency Department physician communicates the patient’s status tothe hospitalist at time of admission. Hospitalist also to look for the note in thepatient’s folder under Notes Review>>” Emergency/Urgent Care” >>“Ambulance/EMS”2. Patient arrives in the Emergency Department without advance notice by medicaloncologist(a) If a patient is actively undergoing cancer treatment and their presentingsymptoms are potentially related to their cancer or treatment, the EmergencyDepartment physician will attempt to contact their medical oncologist(b) If a patient arrives without advance notice by medical oncologist, and theircondition is not related to their cancer diagnosis, the Emergency Departmentphysician will call the medical oncologist if they need their help at that time.Otherwise, the Emergency Department physician will proceed as usualB. Objective: To expedite management of appropriate oncology patients from theEmergency Department to the oncology floor.1. If patient is to be admitted to the hospital and meets clinical criteria for admissionto the oncology floor, Emergency Department physician writing Transition Orderswill do the following to ensure Bed Management appropriately places the patienton the oncology floor:(a) Choose “Med/Surg” under the pull down for bed type AND(b) In the “additional Instructions/Comments” specifically request OncologyFloor AND(c) Include something in the “Reason for Admission” field that includes theironcologic diagnosis (e.g. fever, severe sepsis, hx AML)

2. Clinical Criteria for Admission to an Oncology Bed(a) Inclusion Criteriai. To minimize the risk of infection, the following oncology patients whomeet one or more of the following clinical criteria require promptadmission from the emergency department to the oncology floor uponreceipt of an admission order:• chemotherapy injection• acute leukemia• febrile neutropeniaii. Patients with the following diagnoses have second priority for admissionto an oncology bed from the ED if 2 or more are available:• chemotherapy related complications• sickle cell (until another unit is open for management of PCA patients)• admitted DVTiii. Other oncology patients may be admitted to an oncology bed when one isavailable if they meet the following criteria:• need inpatient medical/surgical level of care• complications from chemotherapy• hematological conditions• all disease processes that are typically cared for by an oncologistiv. Patients with a sickle cell diagnosis and who do not meet one of the abovecriteria may qualify for admission to an oncology bed if 3 or moreoncology beds are available(b) Exclusion Criteriai. Patients who require monitoring or critical careii. Patients who only need observation3. Nursing and Bed Management Supporting Processes(a) Bed Management to look for patient condition under admission diagnosis andlocation under transition order to identify patients who need to be admitted tothe oncology floor versus another medical/surgical unit(b) Bed Management to keep one private room oncology bed open, whenpossible, for emergency admission of patients meeting clinical criteria forprompt admission to the oncology floor. This would be the last med/surgebed to be filled in the hospital(c) Upon the bed being filled, the oncology floor charge nurse to continuallyidentify which patient to move out of an oncology bed in order toaccommodate a patient meeting criteria for prompt admission to an oncologybed (see # B.2.(a).i., above) and notify Bed Management of same(d) Prior to moving a patient out of an oncology bed to accommodate anadmission meeting the prompt admission criteria under # B.2.(a).i., above,Bed Management to confirm the patient's identity, in case the patient's statushas changed and the oncology floor charge nurse has identified an alternatepatient to move out of the oncology bed(e) Bed Management to call the admitting physician to clarify patient's need forimmediate admission to an oncology bedEstablished 7/17/12Updated 8/29/12