The Oncology position is going to be 100% outpatient, with no inpatient responsibilities at all. On average it will be about 70% Oncology/30% Hematology, but this does very by provider. This is going to be a very bread-n-butter oncology program with a lot of Breast, Colon, Lung and Prostate cancer. There is not a lot of Malignant Hematology, no Autologous or Allogenic transplant and a lot of higher acuity cases are sent out. Often times we do the follow-up after those cases and continue the care, but the actual cases are done in Seattle.
Clinic Set-Up
The Oncology clinic is on the 3rd floor of the hospital and has its own wing. In the clinic there are 8 Infusion Bays, 3 Exams rooms for Hem/Onc providers and 3 Exam rooms for Wound Care. When patients are there for treatment, they will be seen by the provider in the infusion suite instead of a clinic room, if there is not one available. 75% of the nursing team is OCN Certified and they are working to get the remaining certified.
In the infusion center, our patient care flow is; nursing team will administer all infusion treatment, the NPs will respond to infusion reactions and oversee the activity and needs of patients in the infusion suite. For emergent situations, the provider will be notified, and the ED Response Team (Physician, Nurse & RT) will respond and assist.
NP does the acute triage they leave time in her schedule to fit those patients in. During the initial chemo introduction, patients are explained they can call the triage nurse anytime 8-5, and she will consul them on all symptoms they are going through, as well as helping with prescription refills so physicians don’t have to take those calls.
Nurse team in the infusion center administers all the treatment and oversee the non-oncology patients. The Nurse Practitioners oversee all care of Oncology patients getting treatment and the physicians do most of the consults. The initial consult will almost always be conducted by one of our Oncologists, and basic follow-ups can be seen by the Nurse Practitioner. They will do 8-10 patients visits per day, as well as taking most of the phone calls
We do have a pharmacy onsite that does all the mixing by pharmacists. In addition to that we have a full team of Social Workers, financial counselors and spiritual guidance. We can do the draws for genetic testing onsite, but have to send it out for results. All basic labs are also done onsite, with specialty labs needing to be sent out.
Call:
Call is going to be 1:5, phone call only. Our full call team consists of 4 Hematology/Oncologists and the 2 Nurse Practitioner. Weekday call is taken from 4:30pm – 8am Monday – Thursday. Weekend call starts Friday at 4:30pm and goes until Monday at 8am. The call volume is very light, and most times there are no calls at all. According to Dr. Murphy, “I generally get 2 or less calls per weekend when I am on call, so it’s like I am not even on call as I can take it from anywhere.”
There is not a situation that would require a provider to ever come into the hospital and there is no requirement on how far away from the hospital a provider can be when on call. Anything that is emergent will be transferred to Seattle by the ED or hospitalist after they consult the Oncologist. Dr. Abrams gave the example, “If I have an acute leukemia patient and they present in the ED, they will call me and we will just transfer, I don’t have to come in and see them.” Do not do refill requests via after hours call, strictly emergent services. Calls are very infrequent overall. The triage nurses do a great job of getting patients to call in during the day and the only time I get called is if there is an emergency, but that is rare.