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Continuity of care in interventi


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									The Physician Assistant’s Role in the
 Interventional Oncology Practice

         Tamara Wahlin, PA-C, MSHS

      The Interventional Radiology Center

  Johns Hopkins University School of Medicine
             Baltimore, Maryland
Why are Physician Assistants Beneficial?

   Improve   clinical practice
   Focus physician’s time
   Improve communication between both
   patient and referring physicians
   Positive impact on clinical outcomes
Typical Day

Morning Conference
 Inpatient Rounds
Morning Conference
Present day’s procedures
   Bring attention to any concerns (labs, anatomy,
   medical concerns such as diabetes, prior biliary stents,

Previous day’s procedures
   Communicate procedural findings with patient
   Anticipate post-procedural complications
Inpatient Rounds

  Prepare patients for discharge
     Convert from PCA to oral pain meds
     Write post-procedure prescriptions
     Arrange follow-up care needs
  Triage complications
     Order additional tests, medications, obtain
      consults, contact referring physicians
  Communicate back with IR physician
Procedural Role
 Primary operator for placement and removal of
  central venous catheters (Davol, Pheresis, Hickman,
  Hohn, PICC and Mediport catheters)
 Routine exchange of percutaneous biliary tubes,
  percutaneous nephrostomy tubes and abscess
  drainage catheters
 Catheter maintenance and wound care

 Primary assistant in more complicated procedures
  Thorough History and Physical Exam
  Screen patient for candidacy for procedure/
   clinical trial
  Explain procedure in detail as well as
   reasonable expectations, side-effects,
   anticipated recovery
  Establish relationship with patient which is
   essential for providing good clinical care
Scheduling of Procedures

 Dictate clinical note mandatory for insurance pre-
 Meet with procedure schedulers and communicate
  scheduling needs (lab testing, imaging, other testing,
  anesthesia consults)
 Consult with referring physicians (coordinate timing
  of procedure with other treatments such as systemic
Follow-up Visits

 Assess clinical/functional status
 Review imaging and lab studies

 Discuss imaging and lab results with patient

 Schedule further procedures

 Communicate with referring physicians regarding
  treatment planning
Imaging review

   Meet weekly with diagnostic radiologists to
    review tumor imaging response to therapy
      Clarification of findings/detailed review and
       comparison with other imaging
      Incidental findings
Multidisciplinary Tumor Board

  Organize logistics of the meeting
  Document discussed cases

  Tabulate new patient referrals

  Present and discuss cases

  Communicate results with patients
Pre-procedure planning
  Order chemotherapy drugs from pharmacy
  Coordinate pre-procedure medications (sodium
   bicarbonate, correct anti-coagulation issues,
   transfusion of blood products, routine meds, bowel
  Review Allergies/drug interactions
  Organize medical records/ imaging
Telephone Triage
  Serve as primary contact for post-procedural
   questions and complications
  Prescribe additional medicines as needed
  Order additional testing, labs, imaging
  Communicate with referring physicians to assist
   in post-procedure care (especially for long-
   distance patients)
  Arrange care for complications (hospital
   admissions, f/u visits)
Clinical Communication Liaison
  Communicate with office administrative staff
   for clinical questions, concerns (peer-to-peer
   reviews for insurance authorization)
  Communicate with patient scheduling nurses
  New referral (often self-referral) triage

  Gatekeepers of clinical information
  Document histories, outcomes, survivals

  Maintain clinical database

  Quality assurance

  Clinical trials/protocols
Interventional Oncology Patients require significant
clinical care before, during and after interventional

    Physician extenders (PA’s and NP’s) can be a
     valuable part of the Interventional Oncologist’s
     team to help manage these clinical needs.
    Physician extenders help lighten the clinical load of
     the Interventional Oncologist thereby freeing them
     for interventional procedures.
Our PA’s

 Jillyn Hebert
 Jessica Foltz
 Don McCord
Tamara Wahlin

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