You will be accepting patients typically routing through EMH or UH EDs, the various Oncology specialty clinics, the Cancer Symptom Management Clinic (CSMC) now located at Eastpark, and included in conversation regarding Access Center patients coming from OSH.

Step 1:

Assess stability of patient to determine level of care (General Care, Intermediate Care, or ICU) depending on vitals and medical conditions identified in the ED or clinic setting. If patient meets ICU criteria or is high risk for decompensation and is currently IMC, redirect the caller to connect with Critical Care.

Step 2:

Determine ideal hospital location:

  1. University Hospital (UH): The accepting service will typically be Hos-Onc 1 & 2. If Hos-Onc is capped (refer to service structure document for exceptions to cap), redirect to Triage (who would then either accept to Hos Med or GMed). UH is ideal location for patients that follow with UW Oncology and require the ancillary services that UH provides that are not available at Meriter/EMH. Examples -- complex GI or IR procedures, complex immunotherapy reaction, Rad-Onc, Surg Onc or Neurosurg services among others.

    a. If accepted to Hos-Onc 1 & 2: you are potentially the admitter depending on the time of arrival. Give advice to the current location of patient care if anything Onc specific needs to be initiated before transfer (such as additional labs, antibiotics, etc).

  2. EMH: Patients at East Park Medical Center (across street from EMH) and the EMH ED are ideal to target to stay at EMH if they are being admitted for simple conditions in the setting of the cancer, or non-cancer reasons (ex falls, minor trauma), in which they do not need UH complex subspecialty care.

    a. If accepted to EMH inpatient, please connect to the appropriate EMH admitter and give handoff.

  3. Meriter: this will be the least frequent location to redirect inpatients and is mainly for the patients who follow with the Oncology providers that would consult at Meriter. As of Oct 2024 those providers are: Dr. Robert Hegeman, Dr. Saurabh Rajguru, Dr. Amy Stella, Dr. Johanna Poterala, Dr. Luke Zurbriggen, Dr. Elyse Harris, Dr. Trevor Dennie, Ali Colwell APNP, Danielle Lima APNP, Nicki Seager APNP.

    a. If Meriter has beds and can accommodate the needs the patient should go there.

    b. If Meriter does not have beds the patient should either be admitted to UH or EMH as per above.

Step 3: If accepted to Hos-Onc, consider placing appropriate admission orders and prep the H&P as able, even if the patient is to arrive after your shift is over. This will be tremendously helpful to your admitter colleagues. You may not always have time to do this. When discussing patients with an OSH via the Access Center, please write a JOA note. This will be helpful to our night triage and admitting colleagues.

Tips:

  1. Don't feel pressured to make a snap decision. Triage is nuanced and should take a little bit of time. However, clinic patients do need a quicker destination decision if admission request is in the afternoon, as there are not staff to remain w/ patient after hours.

  2. Feel empowered to reach out for advice to your Hos-Onc colleague, the Onc APPs, the EMH admitter (to clarify EMH questions) or UH Triage. Kyle Schmidt is the lead for this service and can be reached via email or text (620 899 0674) for non-urgent questions or concerns.