Assessment of the Need for a Hematology-Specific Fellowship Curriculum for Advanced Practice Providers Using a Needs-Based Survey.

PURPOSE: Subspecialty training programs rarely are available for advanced practice providers (APPs). New curricula are needed to prepare APPs with the skills and knowledge required to deliver high-quality care in hematology and blood and marrow transplantation (BMT). METHODS: A Web-based needs assessment survey was distributed to APPs currently working in hematology and BMT at three Mayo Clinic sites (Rochester, MN; Scottsdale, AZ; and Jacksonville, FL). The survey assessed participants' perceptions of readiness to practice in hematology after completion of their APP education and identified APP learning needs. RESULTS: Of 68 APPs, 49 (72%; 34 nurse practitioners, 15 physician assistants) completed the survey. Twenty-eight APPs (57%) were new graduates, and 17 (35%) had no prior experience in hematology/BMT. All APPs held a master's degree or higher (doctorate, 31%). Thirty-nine (80%) reported that less than 5% of their APP school curriculum was hematology focused. More than 90% felt unprepared to practice in hematology or BMT after their APP education and believed that hematology-specific training could improve their competency as providers and positively affect job satisfaction. APPs reported that they would like more formal training in the following areas of clinical focus: malignant and benign hematologic disorders, hematopathology, palliative care, transfusion medicine, infectious disease, and hematology-related pharmacology. They also preferred the following learning strategies: active learning from patient care, case-based teaching, and experience during hospital rounds. CONCLUSION: This needs-based assessment project confirmed the necessity to develop a hematology-specific fellowship for APPs and helped to optimize the curriculum.

Transition of Care for Inpatient Hematology Patients Receiving Chemotherapy: Development of Hospital Discharge Huddle Process and Effects of Implementation.

PURPOSE: To develop a care model to decrease incidence of preventable errors in the complex multidisciplinary care of hematology inpatients at the time of discharge. METHODS: An interactive, multidisciplinary, structured discharge process was developed. Multiple focus groups were held to establish the strengths and gaps. A checklist was created for common follow-up needs. Outcomes measured included: dexamethasone received at discharge, antiemetics prescribed, hospital readmissions, number of patient telephone calls received postdischarge, chemotherapy letters created, pegfilgrastim arranged, and peripherally inserted catheter care arranged. Using a pre-post study design, we compared outcomes of patients after the checklist was implemented in June 2014 (n = 41) with a historical cohort of patients admitted to hematology for chemotherapy 1 year earlier in June 2013 (n = 42). RESULTS: Compared with the historical data, improvement was noted for all checklist items except number of hospital readmissions and number of nursing telephone calls. In June 2014, 100% of patients received pegfilgrastim, compared with 88% in June 2013 (P = .02). Antiemetic prescriptions after chemotherapy improved from 40% (June 2013) to 70% (June 2014; P = .004). Two areas did not show improvement: number of readmissions (12 v 21; P = .26) and number of telephone calls after discharge (nine each for June 2013 and 2014; P = 1.0). CONCLUSION: There was significant decrease in preventable errors demonstrated after implementation of our care model. Developing a systematic approach to hospital discharges can lead to improvements and serve a model for other inpatient wards.

Molecular diagnostics, personalized medicine, and the evolving role of the cytotechnologist: an institutional experience.

The role of cytotechnologists has focused primarily on the microscopic examination of cytologic specimens for diagnosing disease. Cytotechnologists currently evaluate a wide assortment of both gynecological and nongynecological cytology specimens. However, the Pap test remains the primary test for most cytology laboratories. Recently, human papillomavirus testing and newer cervical cancer screening guidelines have reduced the number of Pap tests, resulting in some anxiety and concern among the cytology community. However, as Pap test volumes continue to decrease, molecular oncology and ancillary testing volumes continue to increase with the advent of new biomarkers and associated personalized therapies. This change in clinical practice has resulted in evolving roles for many cytotechnologists. Cytotechnologists have skills based not only in morphology but also in understanding concepts of disease including neoplasia. These skills allow cytotechnologists to excel in many other types of laboratory testing. This article discusses how the roles of the cytotechnologist have recently expanded at our institution to include involvement in DNA ploidy analysis, quantitative immunohistochemistry, fluorescence in situ hybridization, circulating tumor cells, and molecular oncology testing. Lastly, this article discusses how these newer roles benefit both the cytotechnologist and the clinical laboratory.