QLIF-24. ASSESSING THE BENEFICIAL IMPACTS OF THE NEURO-ONCOLOGY HOSPITALIST PRACTICE MODEL: PILOT RUN AT UC IRVINE

Abstract

INTRODUCTION: Current practice model of neuro-oncology focuses on seeing neuro-oncology patients in clinic and spending limited time in the inpatient setting. A mid-level provider or a trainee usually rounds on the neuro-onc patients and briefly discusses the rounds with a neurooncologist during, before, or after busy clinic. Alternatively, the primary service has a quick discussion with the neuro-oncologist, who is also seeing patients in a busy clinic or doing research. The benefit of the current practice model is increased outpatient efficiency and productivity. However, without the specialized neuro-oncology expertise in the inpatient service, the primary teams sometimes conduct extensive unnecessary clinical testing or discharge the patients without addressing significant medical and neurological comorbidities. METHODS: Believing the inpatient management of neuro-onc patients is equally important as outpatient neuro-onc patient care, the UCI neuro-oncology program initiated a neuro-oncology hospitalist practice model in 2015. By being actively involved in the care of the neuro-onc patients in hospital, a neuro-oncology hospitalist helps identify tumor versus non-tumor cases, triage surgery versus non-surgery cases, and assists post-surgical care. The neuro-oncology hospitalist almost always spends sufficient time with the patients and their families to explain the potential diagnosis, treatment plan, and roles of the involved medical teams, to prepare the patients and families for their stressful first clinic visit. In addition, the neuro-oncology hospitalist guides the discharge plan, attends all family meetings, discusses the goal of care, communicates among the cross functional teams, orders inpatient chemotherapy and evaluates the adverse effects. RESULTS AND CONCLUSION: This new inpatient neuro-oncology hospitalist practice model has shown benefits for our neuro-onc patients and the hospital: it shortens the length of stay, increases DRG score, satisfaction of the patient, family, and the variety of the primary and other consulting services. Benefits of this model over a longer period shall be further investigated.