2 LEUKEMIA + 2 SOLID ONC: Q4 DAY CALL w/NIGHTFLOAT
Updated: April 2nd 2018
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
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.
Eligible for house staff services:
Solid – Patients with non-hematologic malignancies. Should have a tissue diagnosis and not be in remission >= 3 years
Liquid – Hematologic malignancies other than as below (myeloma, lymphoma, BMT)
Myeloma/lymphoma – Patients with diagnosis of myeloma or lymphoma without recent stem cell transplant or planned chemo
See the bottom of the page if called about the below or refer to 9100
BMT – Patients with planned or post stem cell transplant. Includes the CAR-T population. Managed by the BMT APNs
Chemo – Uncomplicated planned chemo admissions with minimal active medical issues. Typically head and neck cancer and lymphoma. Managed by the Chemo PAs
Rounds in the morning will include consistent start times for both the leukemia and solid attendings and teams.
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.
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.
- On Solid Onc admitting days:
- 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.
- If the Solid Onc team was “on call” that day and did cap, the nighfloat will admit malignant hematology patients only.
- 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.
- On Leukemia admitting days
- 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.
- 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.
- 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. The leukemia APNs will also sign out to the day call team no earlier than 6pm.
MICU to Leukemia Transfers on Solid Onc admitting days: When Leukemia patients are transferred out of the MICU, they may be accepted on to the Leukemia post-call team until 8AM of the post-call day (the beginning of the following Solid Onc call day). Between 8AM-3PM of the Solid Onc call day, they should be covered by the on-call Solid Onc team and count towards their cap. Transfers arriving to the floor after 3PM of the Solid Onc call day should be covered overnight by the MICU. Patient’s accepted by the Solid Onc call team will be handed off to the on call Leukemia team the following day. Alterations to this sign out procedure are negotiable between the MICU and Solid Onc residents on a case by case basis.
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
How to reach the BMT/Chemo teams
- BMT 8894
- Chemo 4837
- Can also reach out to the fellow in the section above