Transitions of Care Policy of the Hematology/Oncology Fellowship Training Program
The hematology/oncology fellowship-training program recognizes the importance of effective transitions of care as essential to the safe and continuous management of the patient at times of hand-offs between health care providers. The program is committed to full adherence to the official Transitions of Care policies of Virginia
Commonwealth University Health Systems (VCUHS) and its Graduate Medical
Education (GME) program, which can be found on the GME website, http://www.medschool.vcu.edu/gme/policies/index.html
Specific Procedures for Transitions of Care within the Hematology-Oncology
Fellowship Training Program
Inpatient Oncology and Hematology Services:
In an effort to promote safer care during vulnerable transitions of patient responsibility, the Internal Medicine Residency Training Program has adopted and fully implemented the IPASS Handoff Bundle. IPASS is a standardized approach to handoffs in inpatient settings, created through a multi-site research study that has proven that implementation of a bundle of interventions to improve resident physician communications during handoffs of patient care can reduce adverse events as well as improve verbal and written communication without a negative impact on provider workflow or handoff duration.
I- Illness Severity
P- Patient Summary
A -Action List
S- Situation Awareness and Contingency Planning
S- Synthesis by Receiver
It is the expectation of the Internal Medicine Residency Training Program that all residents follow the accepted standardized method of transitioning care/handoff in following settings:
1) Transition from the ED to the Floor or ICU
2) Transition from one team/service to another team/service
3) Transition from one resident to another within the same level of service (i.e. night service, weekend service)
4) Transition from differing levels of care (i.e. ICU to floor, floor to ICU)
The use of IPASS based-electronic documentation (CORES 4.0 “RAMS” at VCUHS, IPASSbased electronic format at McGuire VA Hospital) has been adopted as a standardized

method to maintain a written sign-out/handoff for use when transitioning patient responsibility from one provider to the next.
It is the expectation of the hematology-oncology training program that both the inpatient Hematology and Oncology service teams be responsible for maintaining an accurate, quality, and up-to-date electronic handoff in the inpatient setting. The
Hematology-Oncology fellow is responsible for assisting in the supervision of the information entered by the Internal Medicine housestaff to ensure accuracy of the information and for directly maintaining the electronic handoff when assuming primary responsibility for the patient care on days the Internal Medicine housestaff are off.
The use of an electronic written sign-out/handoff in no way replaces that of a verbal sign-out/handoff when transitioning patient responsibility. It remains the policy of the training program that verbal communication must occur during any transfer of patient care.
When transitioning patients from inpatient to outpatient setting or other nonhospitalized setting, it is expected that verbal communication with outpatient providers should occur within 48 hours of discharge (or as soon as the outpatient facility reopens in the event of closure due to weekends/holidays). It is the expectation of the
Hematology-Oncology training program that the Hematology-Oncology fellows on the inpatient Hematology and Oncology service teams provide direct verbal communication to the referring provider and, if not the same, to the provider who be responsible for managing and following up any unresolved or ongoing hematologic or oncologic at the time of discharge.
Written communication in the form of a discharge summary, should be completed within 48 hours of discharge.
Ambulatory Hematology-Oncology Clinics
When transitioning a patient from the outpatient setting to an inpatient setting, it is the expectation of the hematology-oncology training program that direct verbal communication should be initiated with the inpatient provider assuming care as soon as such provider has been identified. Additionally, written documentation of the patient encounter or communication should be entered into the electronic records in a timely manner as soon as possible in accordance with institutional policy.
When transitioning a patient from one provider to the next within the Fellows
’
Continuity Clinics, including the transition of the patient care at the time of completion of training (or transfer from the program), the continuity of the supervising clinic faculty member will aide in maintaining continuous care and a safe transition between
Hematology-Oncology fellows. The expectations of the Hematology-Oncology Training
Program are as follows:

1.
All electronic medical records are up-to-date and completed in advance of the fellow ’ s departure from the program
2.
While geographic distance may prohibit face-to-face communication during the transition, the outgoing fellow will make direct verbal contact with the incoming fellow to provide direct sign-off of all patients with ongoing chemotherapy, new/progressing disease for whom diagnostic testing is actively underway, and any other patient requiring within the first 30 days of the transition any known active follow-up and management decisions.
Transition of Care Training
Fellows: All incoming Hematology-Oncology training program fellows will be required to participate in a training session regarding transitions of care as part of the orientation at the start of the fellowship training.
Faculty Members: All faculty members who supervise housestaff on inpatient services in which transitions of care occur will be required to undergo faculty development training conducted by the core training program regarding the IPASS methodology as well as training program expectations regarding transitions of care. These will occur at the beginning of each inpatient rotation block. All new faculty will be oriented by the core
Internal Medicine training program to the expectations during yearly new faculty orientation sessions. These expectations will be reinforced at the annual program update with additional faculty training as necessary at faculty educational program retreats.
Monitoring
The fellows will receive feedback on their transitions as part of their peer assessments completed by the fellows of one another annually.
As per the program’s policy, all evaluations will be stored in a trainee’s individual portfolio in New Innovations to monitor performance and growth.