Rambam Medical Center campus contains the National Poison Control Center (NPCC).
(photo credit: Courtesy)
As acute leukemia has to be treated quickly and appropriately and most patients wait in hospital emergency rooms for hours before being referred to outpatient clinics days later, Haifa’s Rambam Medical Center has instituted a new protocol to fast-track their treatment.
Most patients with acute leukemia find out about their illness in the evening after tests show a problem and their doctor calls. Some patients need to be treated in an emergency room, but others can wait for speedy treatment in an outpatient clinic. About a third of leukemia patients require urgent action. According to the Hematology Department at Rambam, the main hospital in the northern part of the country for treating leukemia patients, the hospital cares for over 100 new cases per year, which is onefifth of all cases in the country.
Acute leukemia is a malignant disease that develops very quickly. Without proper treatment, patients can reach a life-threatening condition within days of diagnosis. Only a major medical center is able to provide speedy diagnosis and treatment for such patients.
The success of Rambam’s pilot program, which has been operating for three years, is scheduled to be published shortly in an article in a medical journal.
“The logic behind this is quite simple,” explained Dr. Yishai Ofran, director of hematological hospitalization and head of the Leukemia Treatment Service in Rambam’s Hematology Department. “A person who reaches a health fund clinic, an IDF physician or a smaller hospital with complaints about a headache, weakness, fever and other symptoms, will likely be given conventional treatment for them. If the doctor orders a blood count, the lab results point to a problem and the doctor instructs him to rush to an emergency room and is kept overnight or is sent to an internal medicine department... But then it takes some time until the patient reaches appropriate treatment.
“When we realized that there was a trend and that these patients were paying a price, we decided to deal with the matter,” said Ofran.
The hematology team developed an algorithm to determine what type of leukemia is involved and what would be the optimal treatment. If an emergency room visit is unnecessary but next-day treatment is needed, the patient is told that there are indeed unusual findings that require further urgent clarification. An appointment is made for him at the hematological clinic the following morning instead of spending the night in the emergency room.
A senior hematologist will perform an examination of his bone marrow, and he will be diagnosed the same day and receive a treatment plan.
In many cases chemotherapy will start the next day. Even the referrals for payment by the health fund is arranged.
“All of our patients are happy about this move,” Ofran said.
“In the reality of a crowded hospital, these patients have a better alternative, which is more effective for both him and the hospital, and most important, is more respectful.”