General Guidelines

  • Attending physicians from each subspecialty service are available to discuss a patient's admission should there be questions regarding initial care. If new admit pt requires IMC please reach out to subspecialty attending.

  • Coverage for ED admissions:

    • 7P-7A: Hos-Oncology 1 &2, APS, Advanced Heart Failure, SCTCT, Palliative Care, Medical Transplant & Medical Liver Transplant
      • 6A-7A: admit calls from ED go to Subspecialty attending, but SSXC is available to see the patients if needed to address stability.

  • Access Center Calls: Subspecialty attendings take the calls. If pt is going to arrive to UH between 7P-6A, the AC RN will alert Night Triage (ideally during initial discussion with subspecialty attending and OSH provider, but if delayed can be connected later to subspecialty attending).

  • Hospitalist overnight responsibilities for subspecialty admissions:
    • Call subspecialty attending when pt is unstable or if questions arise. Document the discussion in H&P ideally.
    • Update subspecialty signout on each new admit.
    • If you are on Admitter shift, give warm hand-off to SSXC at end of your shift for follow-up tasks.

  • Sign-out specifics

    • Admitter role: as above, give warm hand-off via page/secure chat to SSXC at end of your shift for follow up tasks, make sure subspecialty signout updated.

    • Night Triage (by 6AM):

      • Low acuity straightforward patients: no signout necessary
      • Active issues patients: send FYI page to appropriate service (attending).

    • SSXC (6A-7A): If pt has become unstable during 6A-7A period, unexpected abnormal lab values, etc, notify subspecialty service (attending).

Service Specifics

Stem Cell Transplant & Cellular Therapy (SCTCT, formerly BMT)

Refer to document in The Pulse B2.02 https://pulse.uwhealth.org/esc?id=kb_article&sysparm_article=KB0050377&table=kb_knowledge&searchTerm=b2.02

For Admission & Transfer Guidelines for SCTCT Patients Post-Cellular Therapy. The decision of which service (SCTCT, Hematology, Medicine service) is based on the type of cellular therapy received (autologous vs allogenic transplant, CAR-T therapy, etc), days out from therapy, relapse of disease, complications related to therapy (new symptoms of GVHD, late cytopenias). See Table 1.

  • If which service should be primary is in question, communicate with the SCTCT attending physician.

  • Not required to FYI the SCTCT attending physician overnight for admissions from the ER. Please contact if there are questions regarding chemo, infectious issues, concern for GVHD, immunosuppression issues, CRS, ICANS, etc.

Hospitalist-Oncology Service 1 & 2

  • Patients to be admitted to Hos-Oncology service: - Pts with solid tumors with neutropenic fever or complication from chemo. - Pts who need inpt chemo (these are typically daytime admits). - Pts who require medical care related to their cancer (obstructive pathologies from tumor, malignant pleural effusion, etc). - Pts with known cancer referred by outside oncologists to UW Onc who require admission for diagnosis or treatment of a solid tumor or its complications. - Pts requiring or likely to require Radiation Therapy during their hospitalization (painful bony mets, spinal masses, brain masses, e.g.). - Pts with suspected, but not yet diagnosed cancer being admitted for diagnostic eval (not gyn or Heme -- those would go to different services). Depending on Onc census these pts could also be Hos or Medicine pts.

  • Patients appropriate for Hos/Medicine admission:

    • Pts not followed by UW Onc who have a problem that may be due to a solid tumor.
    • Onc pts with medical needs not related to their malignancy (UTIs, afib w/RVR, CHF, etc.)
    • Pts who are post-op from surgery for their malignancy are to be admitted to a surgical service or medical service.
    • Patients may be triaged to EMH if their medical needs can be met at EMH. Oncology can video consult.
    • Patients preferred for Meriter are those that follow with providers previously located at 1SP, who include Dr. Robert Hegema, Dr. Saurabh Rajguru, Dr. Amy Stella, Dr. Johanna Poterala, Dr. Luke Zurbriggen, Dr. Elyse Harris, Dr. Trevor Donnie, locums physician Dr. Thomas Sweet, APPs Ali Colwell, Danielle Lima, & Nicki Seager.

Palliative Care

  • Patients to be admitted to Palliative Care: want comfort focused end-of-life care only.
  • If there is any ambiguity in goals or patient is not imminently dying the pt should be admitted to a Hos/Medicine service with Palliative Care consult.

Advanced Heart Failure:

  • Patients to be admitted to Advanced Heart Failure service:
    • Pts followed by UH Heart Failure clinic who are critically ill and require admission to cardiac ICU.
    • Pts who are s/p cardiac transplant or VAD placement.
    • Pts actively being evaluated for heart transplant or VAD.
    • Heart Failure on-call staff cell: 608-513-2687
    • VAD coordinator cell 24/7: 608-516-0348, pager 0737
  • Patients followed by Advanced Heart Failure clinic who are being admitted for heart failure exacerbation now typically go to Cardiology service. (See Cardiology Admit guidelines).
  • Patients appropriate for Hos/Medicine admission:
    • Pts who follow with Advanced Heart Failure admitted for something other than heart failure.

Medical/Liver Transplant (non-surgical)

  • Patients to be admitted to Medical or Liver Transplant Service

    • s/p renal or pancreas transplant presented with fever, AKI, concern for pancreas rejection (elevated amylase, lipase, hyperglycemia), unexplained abd pain, opportunistic infections, post-transplant malignancies.
    • s/p liver transplant presenting with fever or concern for rejection (elevated transaminases).

  • Appropriate for Surgical Transplant services (which we do not admit to): Any patient less than 90 days out from transplant. If patient declined by Surg Tx team, the Surg Tx team should call Night Triage to discuss the admit and service as exceptions do exist (acute rejection, gastroenteritis, etc).

Advanced Pulmonary Service & Interventional Pulmonary Service

  • Patients to be admitted to the APS service:

    • CF patients
    • Lung transplant patients anytime other than original transplant admission (for which they're on Thoracic Surgery service).
    • Pulmonary HTN pts on continuous IV or SC prostanoids.
    • Pulmonary HTN pts followed by Dr. Runo if they are admitted for pulmonary reason.

  • Questions on Interventional Pulm pts: page "Pulm Interventional Pulm Med IPM"

  • If APS staff needs to be called overnight: Mon-Fri page "after 2PM" staff; weekend page "After 5PM" staff.

10/3/2024 SMB edit