Haematology/Oncology, Northampton General Hospital
I am a Physician Associate working in Haematology at Northampton General Hospital. Having worked closely with cancer patients during this current pandemic, it has become clear to me that they are particularly vulnerable at this time and require careful planning in delivering care appropriately and safely. The majority of elective cancer treatment within Haematology/Oncology has been pushed back and for those presenting with acute conditions, such as acute myelogenous leukaemia or multiple myeloma with organ involvement, becoming an inpatient can be a difficult and daunting prospect.
Our unit has its own front line service for patients on active treatment called the assessment bay area. This is a perfect way of shielding our patients from the busy emergency department. Acute cancer related illness can be treated, managed and, if needed, admitted directly from here, although COVID-19 has made this process very challenging. Many cancer patients present with coryzal symptoms such as a dry/productive cough and/or fever, which can potentially be indicators of neutropenic sepsis. COVID-19 is therefore something that has a very high index of suspicion in nearly all our acute presentations, creating challenges in streamlining a safe and efficient flow for these patients through our unit, whilst protecting other COVID negative patients. When assessing these patients, we have a low threshold for requesting a COVID screen given the significantly immunocompromised status of nearly every patient passing through. Missing a diagnosis of COVID here is not really a risk we can afford to take.
Our multidisciplinary team has worked brilliantly together with plenty of new and innovative ways to overcome these challenges. We have adapted our initial telephone triage service. For instance patients on ongoing maintenance treatment plans are effectively managed as less risk than other patients on full chemotherapy regimes in an attempt to improve shielding. Our cramped office has meant social distancing has not really been possible and a thus a new area has been opened to create a larger, safer working space for staff. A specific de-isolation protocol has also been implemented. For inpatients with clinical symptoms suggestive of COVID and a negative test result, this involves re-testing patients after 48 hours and looking for lymphopenia and x-ray changes representing COVID-19. Only if negative can these patients be de-isolated from a negative pressure side room. These changes are starting to turn the tide in our fight against COVID-19.
In my role as a Physician Associate in Haematology, I feel privileged to be part of the long term care of individual patients attending the unit regularly for chemotherapy. This often includes patients with malignancies such as AML, CML, Multiple Myeloma and Lymphoma, some of which go on to have a transplant as further consolidation treatment. On a normal day I usually see these patients on the ward round, present and flag up new patients requiring consultant review, perform procedures, request imaging and discuss our patients with other specialties.
I am often a familiar face and point of contact for these patients during their admission, someone they can talk to in length about their anxieties and someone they can discuss their progress made so far with treatment. Being a part of the pathway of these patients is something I enjoy immensely and so it has been difficult for me to see some of our patients succumb to COVID-19. Although these experiences have not been easy, they have driven our whole department to work together more closely than ever, improving the identification of COVID-19 and safety of all patients coming through. We will prevail over the current crisis and many learning opportunities for strengthening our future practice will be made.