Medical Oncology Admission and Transfer Acceptance Guidelines

 

 

The below guidelines are meant to assist in determining what cancer patients should be admitted to an Oncology service. Please continue to use your judgment in accepting appropriate patients. If we have beds and a patient is likely to benefit from being on an oncology service, please accept them. If a cancer patient followed by a primary Stanford oncologist gets accepted to Medicine always reassess when appropriate to bring them to our service. Please feel free to call/email Sandy Srinivas (F Ground Unit Director, Pam Kunz (Med 10 Director), or Tyler Johnson (Assistant Med 10 Director) for any questions.

 

Oncology Admission Policy (from ER, outpatient clinic, ICU)

Patients with a tissue diagnosis of cancer will be admitted to MED 9 or MED 10 (Oncology), UNLESS:

(1) MED 9 and MED 10 are capped,1,2 OR

(2) The patient’s primary problem is treated by an alternate inpatient specialty service (e.g., primary problem of acute coronary syndrome, admit to General Cardiology),3 OR

(3) The primary malignancy is gynecologic,4 OR

(4) The primary malignancy is neurologic,5 OR

(5a) The patient’s cancer has been demonstrated to be in remission, OR

(5b) There is no reasonable suspicion that the patient’s primary problem is related to the patient’s prior malignancy6

(6) Escalate to Attending or Service Director for any debate of the above guidelines.

Policy for PAMF Oncology patients:

Patients with established7 PAMF primary care will be admitted to the PAMF service, UNLESS:

(1a) The patient is an established patient of a Stanford specialty service that has an inpatient service (e.g., oncology, hematology, cardiology, etc.),8 AND

(1b) The patient is presenting with a primary problem treated by the Stanford specialty service (e.g., Stanford oncology patient being admitted for chemotherapy), AND

(1c) The Stanford specialty service is NOT capped;9 OR

(2) The patient is in need of CCU-level care.10

 

If a patient has been accepted by PAMF (i.e., attending name given) from the ED and transfer to Stanford general medicine service is requested, it will be treated as an inter-service transfer and will need to be approved by the on-call chief medicine resident. Transfer requests from PAMF to specialty services (e.g., oncology) are handled directly by the services’ attending.

Oncology Transfer Center Policy (for Outside Transfers)

 

Who we accept:

1. Patients with an established Stanford Medical or Radiation Oncology Attending.

2. Patients with a new diagnosis of Burkitts/complicated lymphoma

3. Patients requiring higher level of oncology care (i.e. tubes/cyberknife/inpatient chemotherapy/radiation, etc)

 

Do not accept:

1. Patients with anticipated length of stay < 48 hours

2. Patients with advanced disease for whom we have nothing meaningful to offer

3. Patients who can be treated as outpatients (they should be encouraged follow up at the Cancer Center)

4. Gyn Onc patients - refer to Stanford Gyn Onc (unless patient of Dr. Sikic)

5. Neuro Onc patients – refer to Stanford Neuro Onc

6. Surgical patients prior to agreement from to a surgery attending (they can also go directly to surgical service depending on medical complexity)

7. If family wants transfer when patient has never been seen at Stanford, or terminally ill patients who have never been seen at Stanford before (often it is helpful to review plan of care and recommend they come when discharged, explaining that disease specialist oncology attendings don’t follow hospitalized patients).

 

General Transfer Patient Guidelines:

1. The MD requesting transfer is often a hospitalist. For non-Stanford patients, it is often more informative to speak to the outside oncologist as well.

2. Make sure that the patient is transferred to the appropriate unit- i.e. tele, floor. Patients should not be transferred from an outside ICU directly to the floor.

3. Let the Transfer center know that we need pathology slides/records/films on CD

4. When patient is accepted, attending immediately writes a brief accept note in EPIC (if a new patient, the transfer center will create an MRN+pre-admit encounter and page you) – include reason for transfer, anticipated needs/plan on arrival, your name and contact info. Page house staff for handoff if patient may arrive before your note is done. Note not required for immediately acute transfers (ED-ED for GI bleeding) but page housestaff.

5. On day of transfer (if different than day of acceptance), the transfer center should call to update you. We recommend you ask for a clinical update because patient stability and suitability for transfer may change. Document any updates in EPIC immediately by addending your prior note, and page resident on call for handoff.

6. If you leave service, sign out any accepted transfers to the new attending