Reply To: Outpatient clinic location

  • Marcia Bettenhausen

    December 4, 2019 at 12:23 pm

    We have a similar situation – our current “hospital” has 3 campuses….. each about 5 minles apart:  1.  Ortho hospital/clinic , 2.  OP surgical/medical inpt/adult onc, 3.  Trauma/cardiac/neuro/childrens.

    Our cancer center (housing adult and peds clinic and infusion and radiation oncology) is attached to the 2nd campus.  Support services on each campus varies – for instance blood bank and pathology is at the ortho campus, full lab is at our campus, some labs are done at the 3rd.  This campus does have other clinics attached to it, that include some peds services but no inpt peds or hospitalists are on this campus.

    For the most part it does work well – much work has gone into an efficient courier service for labs, specimens, and blood products.  For emergencies – we use the campus RRT (which is all adult based and includes ACLS/PALS nurses from the adult infusion center and the adult oncology NPs as well) with the addition of an anesthetist who would have peds training/PALS.  Our peds onc providers are all PALS, we have PALS nurses, and a crash cart.  We use our local EMS to transport any emergencies to the Children’s Hospital – we have used this for septic shock, anaphylaxis, admission required after emergency reaction medications.  We do have lab and xray on site – but our sedated imaging would be at the Children’s hospital. 

    The hardest part is the provider coverage – We are currently a 3 MD, 1NP onc practice.  Our goal is one MD at the hospital with the NP, and 2 MDs in the clinic.  Our NP is flexible and covers clinic when one MD is gone for CME/vacation — or that MD will leave the NP at the hospital after morning rounds, and come to clinic to see more patients.  It has led to less efficiencies – a struggle as we grow, and we definitely need a 4th MD and I also want an infusion NP!!  ​ We have had to become better at labs checked “day prior” – so that direct admits can happen efficiently, and we have had to allow our charge nurses to really own the infusion schedule, so that things get done in the clinic day.  Our patients are given the options to see their “primary” doc before an admit for chemo – or for results, or see the “doc on the campus” that day.  That is a struggle – some are very attached to one MD.

    Let me know if there is anything else I can answer.


    Marcia Bettenhausen, BSN,CPHON,RN
    Fargo, ND
    Original Message:
    Sent: 12-04-2019 12:01 PM
    From: William Copeck
    Subject: Outpatient clinic location

    Our health system is preparing to build a new off site cancer center. It will be several miles from the main campus and will hold all of the adult services. There is a question about moving the peds program there as well to best utilize the space and house all cancer services in one location.
    Are there any peds programs out there that have their services provided at a location away from the hospital? If so how do you handle emergencies, especially emergency admits?
    Do you have functioning pharmacies and blood banks in the off site locations? Are lab and radiology services available on site?
    How well (or not well) does being off campus work for you?
    How do your providers handle shuttling between the hospital and the ambulatory location?
    Any input is appreciated.

    [Bill] [Copeck],
    [Nurse Manager]
    [St. Joseph’s Children’s Hospital]
    [Paterson], [NJ]