Guide for Sending Patients to PM by Ambulance (RAC/Leukemia)

About the Leukemia Rapid Assessment Clinic (RAC)

The Acute Leukemia Rapid Assessment Clinic (RAC) is an outpatient clinic located at the Princess Margaret Cancer Centre (PM). There are limited acute care services available at PM with no emergency department or Intensive Care Unit (ICU) on-site.

We accept referrals for patients with suspected or confirmed diagnoses of acute leukemia, high-risk myelodysplastic syndrome (MDS) or accelerated/blast phase myeloproliferative neoplasms (MPN).

The goal of consultation is to assess the patient, provide a preliminary diagnosis and discuss treatment options all in one visit, if possible. A second visit may be required. A bone marrow aspirate and biopsy will be repeated during this visit.

Up to two (2) family members/friends may accompany the patient to PM. Family members should avoid coming to hospital if they have any of the following symptoms:

• Diarrhea
• Fever and/or chills
• New or worsening cough within the last 24 hours

Referral Criteria

Patients must meet the following criteria:

• Be conscious and alert
• Not admitted in ICU
• No major ongoing bleeding
• Stable blood pressure (greater than or equal to 90mmHg systolic); not requiring fluid resuscitation or inotropes
• Oxygen saturation greater than or equal to 93% with maximum O2 supplementation of 4L/min via nasal prongs
• No recent onset of chest pain unless investigated by the referring facility
• Able to walk and transfer with 1 person assist maximum
• Must have OHIP coverage - if not, alternative arrangements for payment must be communicated and accepted prior to referral
• Potential infectious sources considered, and appropriate isolation requirements implemented and communicated

For Patients who do not meet the above criteria:

• Referring hospital/physician should discuss options for direct admission to PM or ICU with the Leukemia Physician on-call.

Referral Process

Please call 416 946 4501 ext. 3155 and ask for the leukemia physician on-call if the patient is admitted and you want to arrange consultation for the following day and/or discuss medical management until appointment in RAC at PM.

Please fax a completed Medical and Radiation Oncology New Patient Referral Form to New Patient Referrals Department at fax: 416 946 2900.

The attending Hematologist will triage the referral and the administrative assistant will arrange the consultation appointment time (typically within 24 hours).

The patient or the referring hospital/physician will be contacted directly by the administrative assistant to review appointment details, what to expect, answer questions, etc.

For Admitted Patients:

• Must be accompanied by a nurse
• Must be transferred by ambulance and directed to Urgent Care Clinic (2nd floor; opens at 9:00am)
• Referring hospital/physician must complete and fax the Patient Transfer Summary Form within one hour of sending the patient by ambulance
• Bring all required medications for the day

Hold the patient's hospital bed unless otherwise notified.

• Bed availability is not guaranteed due to a waitlist at PM for induction chemotherapy.
• Inpatients sent to RAC are typically sent back to the referring hospital to await transfer to PM for treatment if medically appropriate.

Communicating Changes in Clinical Status:

• To ensure patient safety, timely communication of changes in clinical status is required.
• The referring hospital/physician MUST notify the Leukemia physician on-call of any clinical changes or deterioration prior to transfer.

What to Send With the Patient

• Patient Transfer Summary Form
• Ontario Health Insurance Card (OHIP)
• Do Not Resuscitate (DNR)/No cardio-pulmonary Resuscitation (No CPR) Documentation (if applicable)
• Patient's current chart, list of medications, and any required medications for the day
• Lunch or meal for the patient
• Provincial Transfer Authorization Centre (PTAC) number​