2 LEUKEMIA + 2 SOLID ONC: Q4 DAY CALL w/NIGHTFLOAT

Updated: October 13th, 2017

General Structure
2 “solid oncology” teams (A & C), each composed of 1 resident + 1 intern
2 “leukemia” teams (B&D), each composed of 1 resident + 1 intern
1 nightfloat resident

Call Structure
Each team will be on call every fourth day. Leukemia teams will admit malignant hematology (leukemia) patients only. Solid Onc teams will primarily admit solid oncology patients (Including MM and Lymphoma). However, if a liquid patient comes in on a solid call day, the solid team will admit these patients. Any leukemia admission will be handed off the next day to one of the leukemia teams. If a MM or Lymphoma patient comes in on a liquid day they will be admitted by the liquid team and passed onto the solid team the following day.

The night float will admit both solid and malignant hematology admissions at night and hand them off to the respective teams in the morning.

Rounding Structure
Rounds in the morning will include consistent start times for both the leukemia and solid attendings and teams.

Team Caps
The total team cap for each team is 10. However, teams should leave one spot available at all times for a malignant hematology (leukema/MM/lymphoma) admission. Teams may have to admit beyond their caps on their call day, the next day in the AM these patients will be re-distributed by the leukemia attending (to BMT/Chemo APN service or Solid Onc) to ensure the post call census is max at 10. Please alert the CROC (p2762) when you reach a cap of 10.

Admitting flow

The call team (intern+resident) will begin admitting patients at 7 AM.On leukemia call days, the leukemia team will admit up to 5 new admissions & 2 transfers or their overall team cap, whichever comes first.

Call residents (regardless of whether they are liquid or solid) should cover TWO pagers on their call day: (1) Solid Admitting – 4662; (2) Leukemia Admitting – 5385. Both these pagers must be covered by house staff at all time. Please do not sign over 4662 if you are capped so that the hospitalists may be able to reach the on call resident. Of note, we deleted the previous Attending Leukemia Triage Pager (8536) and the previous “Old” Oncology pager (9662) for simplicity. For all leukemia admissions, contact Leukemia attending directly, they may triage to the BMT/Chemo service.

On Solid Onc call days, the team will admit solid oncology patients up to 5 new admissions & 2 transfers or their overall team cap, whichever comes first. They will also admit any malignant hematology patients during this time-frame. Any leukemic patients will be passed off to the leukemia team on call the next day. Leukemia admission do count towards their cap. They should always leave at least 1 spot open for liquid oncology patients that may come in.

On Leukemia call days or when the Solid Onc call team has capped, all solid oncology patients will then be admitted by the hospitalist service (except Lymphoma and MM as above).

Nightfloat: The nightfloat will admit both solid and malignant hematology admissions at night and hand them off to the respective teams in the morning.  Night float comes in at 8 PM.

  1. On Solid Onc admitting days:
    1. If the Solid Onc team was “on call” that day, but did not cap, the nighfloat can admit the number of solid onc patients to fill these open slots (up to 2 patients max), and will pass these off to the post-call team in the morning on rounds.
    2. If the Solid Onc team was “on call” that day and did cap, the nighfloat will admit malignant hematology patients only.
    3. All leukemia admissions admitted overnight will be passed off to the leukemia team “on call” the next day. If they do not have cap room, this should be discussed with the Leukemia attending at 7AM to assist with solutions for possible alternative coverage models (chemo service, BMT, PA) vs. other leukemia team with backup from other senior residents if needed. Alert the CROC immediately.
  2. On Leukemia admitting days
    1. If the solid oncology team on call the next day has 7 patients or less, the night float can admit two solid oncology patients (essentially so the solid oncology team would have 9 patients, leaving one spot for a malignant hematology admission). If the solid oncology team on call the next day has 8 patients, 1 patient can be admitted; if the team has 9 or 10 patients, no solid oncology patients can be admitted.
    2. Any leukemia patients admitted by the nightfloat will be handed off to the post-call leukemia team the next day. If they have capped, distribution of these patients should be discussed with the Leukemia attending at 7AM (chemo service, BMT, PA, transfer of other inactive patients, other leukemia tea, PRN). Alert the CROC immediately.
  3. The overall max night float admitting cap is 4 patients (max 2 solid onc (including any MICU transfers) – refer to above). The night float may accept solid oncology MICU transfers on occasion via the 9100 Triage MD. If the NF resident is called upon to do this, this admission will count towards their solid admitting cap. On the nightfloat resident’s night off, the day call resident will stay overnight and complete cross cover and admission duties.

Cross Cover: Provided by the day call team until the nightfloat arrives. The nightfloat will cross cover for all solid & leukemia housestaff oncology services.

 

How to get chemo orders:

  • Leukemia – Leukemia Fellow – 6204
  • Solid Oncology/Supportive care – Supportive Oncology Fellow – 6202

If you are called about off-service patients, you can direct them to:

  • BMT – Transplant fellow Hem/Onc – 6201
  • Chemo patients/Hospitalists patients with HONC consult needing chemo – 6203