General Structure
2 “solid oncology” teams (A & B), each composed of 1 resident and 1 intern.

 

Call Structure
Team A is on call Mondays and Thursdays.

Team B is on call Tuesdays and Fridays.

Teams admit only Solid Oncology patients (including MM and Lymphoma)

 

Rounding Structure
Both teams (A&B) take turns rounding with one Solid Oncology attending. Rounds should start by 8-8:30am and should end by 10:30am. If rounds are routinely running past 10:30am, please alert the Chiefs ASAP.

 

Team Caps
The total team cap for each team is 10 patients.

On call days, teams can admit up to 7 patients, with no more than 5 being new patients who require an H&P and the rest being ICU transfers or overnight holdovers.  

 

Admitting flow

  • The call team (intern and resident) will begin admitting patients at 7 AM.
  • Solid Oncology patients can be admitted from 7 AM to 7:30 PM on call days, with up to 2 of those new admits after 5pm (only 1 of which after 6:30pm).
  • The on call team will take up to two Solid Oncology patients who were admitted by the hospitalist teams overnight (cold handoffs). These two patients will be added to the on-call oncology team’s Epic list by 9100, and the on-call resident should then page the FCP for these patients at 7am to receive sign out. These hand-offs must be completed by 7:30am so these patients can be presented on rounds that day.
  • When patients transfer from hospitalist to housestaff, please cancel the “consult to hospitalist oncology” order, and also change the service name from “Hospitalist Solid Tumor” to “Hematology/Oncology House-staff Solid Tumor”.
  • Pre-rounds MICU transfers: The Solid Oncology call team can accept transfers from MICU to be staffed by the oncology attending on the day of transfer if the patient is in the floor bed by 7am, 9100 has triaged the patient to housestaff oncology, and the oncology team is notified before rounds. If the oncology attending is staffing the patient on the day of transfer then a representative from the MICU team will present the patient in person or by phone to the oncology team and attending during rounds.
  • Patients with a new mass consistent with a malignancy but has not yet undergone formal tissue biopsy and are here for malignancy work up can be accepted to hem-onc housestaff solid tumor and hospitalist solid tumor service.
  • On your call day, you can admit up to 7 patients, with no more than 5 being new patients who require an H&P and the rest being transfers or overnight hold-overs.  
  • All admissions should all go through 9100. Please page 9100 at the beginning of each call day to let them know how many patients you are open to take.
  • On your call day, you should ALWAYS cover the Solid Admitting pager, 4662. When you are capped or not on call, you should sign the pager over to 9100.
  • Patients may be accepted from the ORAC (in the old Mitchell ED, next the COVID clinic). Please ensure these patients have beds prior to seeing them. Once you confirm they have a bed, you can go see the patient in ORAC.

 

Cross Cover:

On HONC call days (Mondays, Tuesdays, Thursdays, and Fridays), the non-call HONC team will sign out to the call HONC team when they are done with their work for the day.

On non-HONC call days (Wednesday, Saturday, and Sundays), both HONC teams can sign out to the on-call Cardiology team when done with their work for the day for CCD patients. For Mitchell patients, on Wednesdays, HONC will sign out to the Gens DF taking cross cover and on Sat/Sun HONC patients in Mitchell will be signed out to the Gens long call intern.

 

End of Service Sign Out: Signout emails at the end of your service should always be sent to both the oncoming team member you are signing out to and the intern/resident remaining on service when you leave.

 

NIGHTFLOAT

– Solid Oncology patients in CCD will be covered by the Cardiology Night Float team overnight. Solid Oncology patients in Mitchell will be covered by Gens Night Float. These teams arrive at 8PM and should get sign out on the HONC patients from the on-call HONC team (M/Tu/Th/F) or the on-call Cards team (W/Sa/Su).

-No Oncology patients will be admitted overnight, after 6pm.

-HONC teams should pick up sign out from the Night Float teams by 7am each morning.

 

Bone Marrow Biopsies or Intrathecal Delivery

  1. If you need to order a bone marrow biopsy or intrathecal chemo, this can be accomplished by asking the APPs on the BMT service. They have someone assigned to help with procedures (p30002). As a reminder, this is not a procedure service, so please ask kindly for their assistance in doing the bone marrow bx. Ask your attending what studies they want from the biopsy and the APPs (or your attending!) can help you with how to order them. If you need other help, you can also ask the heme fellow (p5330). It is your responsibility to make sure the patient is consented for a bone marrow biopsy prior to the team doing the Bx. Your attending can help you with the consent process (ideally done during rounds).
    • Call 21314 and ask to schedule a bone marrow biopsy – they can tell you what time slots are available
    • Discuss with BMT team what time would work best for them from available options
    • Call heme lab back and sign the pt up (they need name, MRN, room number)
    • Figure out with your attending whether the pt needs premeds – usually Ativan and or pain med, but not always necessary
    • Also discuss with your attending how long they should be off anticoagulation; if you need guidance, ask the BMT team for help as well

    There might be other things that the APPs would like you to do, so please ask how you can help them in doing the biopsy!

Inpatient Chemotherapy Orders

  1. For chemotherapy orders: If a patient with an existing diagnosis requires inpatient chemo and follows at UCMC, please contact the outpatient attending as they will be primarily ordering inpatient chemotherapy if needed. You can email the attending or page if urgent. The faculty have been notified about this as well.  If the outpatient team is unavailable or cannot order the chemo or the patient does not have an established outpatient onc team, then you can page hematology consults p5330 for assistance. The primary Onc service attending may be able to help consent and put in chemo orders with the pharmacists help (attending-dependent). However, if you need help from an onc fellow for chemo consents or orders, please consult hematology consults p5330, not the chemotherapy fellow.

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
  • Leukemia- 5385

 

Updated 8/12/22