The academic oncology hospitalist—a model for improved teaching and patient care

Abstract

19630 Background: The care of hospitalized cancer patients in academic institutions is usually assigned to residents and fellows with supervision by a “rotating” attending oncologist. This approach ensures that, at a minimum, each patient’s care is reviewed and supervised by an attending physician. This model, however, has several shortcomings including: 1) lack of continuity of care 2) limited time for teaching 3) limited knowledge of diseases outside of the research or clinical interests of the attending 4) lack of consistent clinical leadership and 5) communication problems when the attending physician is in clinic, meetings, or research activities. Methods: We felt that a model in which a senior medical oncologist with an interest in patient care, teaching, and clinical research serves as the full time director of the inpatient oncology service would address these challenges. The organizational chart for this model will be presented. In this model, the attending oncologist meets with the “post call” intern/resident team, fellow, and hospitalist each morning to review and discuss all patients admitted to the service in the prior 24 hrs. The afternoons are spent visiting patients, reviewing the status of all patients on the service, and evaluating high acuity new admissions. An oncology core curriculum lecture series was developed with daily lectures. The trainees are encouraged to attend additional conferences as time permits. Results: The program was initiated in November 2005 and has been a universal success. Patient satisfaction has improved significantly and the number of graduating residents pursuing fellowships in oncology has increased from 3–4 to 7–8 per year. The attending physicians are able to continue their clinic schedules and research activities without interruption. We are planning to review this experience to evaluate additional changes in patient outcome such as length of stay, efficacy of symptom control, and readmission rates. Conclusions: Our model of inpatient oncology care has improved patient satisfaction, teaching, and faculty utilization. It lends itself to develop clinical trials of inpatient cancer care. We suggest it be considered in academic cancer centers to achieve similar goals. No significant financial relationships to disclose.