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LAC+USC Medical Center
Founded in 1878, the LAC+USC Medical Center is the primary
teaching facility of the Keck School of Medicine of the University
of Southern California. The Medical Center ranks as one of
the largest acute care facilities in the United States and
provides world-class medical care to the indigent population
of Los Angeles County, ensuring the most comprehensive training
for our Fellows. The LAC + USC Medical Center was recently
moved to a new state-of-the-art, one billion dollar, 600-bed
hospital and outpatient center on an 85-acre site.
The Division is responsible for an 18-bed inpatient ward
(7B), which houses patients with hematologic malignancies.
The ward is essentially filled at all times, with patients
who have complex hematologic malignancies, and bone marrow
failure. Attending physicians are assigned to this unit on
a monthly basis, and make formal rounds five days per week,
and informal rounds two days per week. In addition, the ward
is managed by a Hematology fellow and four general medicine
interns.
Hematology is also responsible for two consultation services.
The consultation services are responsible for seeing all patients
with general hematology problems, as well as those with hematologic
malignancy and AIDS-related malignancies, or AIDS-related
hematologic disorders. A Hematology faculty member is assigned
to each consultation service, with formal rounds made four
days per week on each service, and informal rounds made on
the remaining days. Each consultation service is also managed
by a Hematology fellow, by two general medicine residents,
and by one or two medical students, taking electives in Hematology
during that month.
Hematology is responsible for four clinics per week at the
LAC+USC Medical Center. On Thursday mornings, the Division
is responsible for a general hematology clinic (4P21), which
cares for patients with problems of anemia, neutropenia, and/or
platelet abnormalities. Patients with coagulation problems
are also seen in these clinics. On Monday and Thursday afternoons,
the Division is responsible for two half-day clinics in the
Rand Schrader HIV/AIDS Clinic (5P21). Patients with AIDS/lymphoma
and general hematologic problems associated with HIV are seen
on Monday afternoons, while patients with AIDS related Kaposi’s
sarcoma are seen on Thursday afternoons. Each of these clinics
is staffed by two full time members of the Hematology faculty,
who provide direct hands-on care. On Tuesday afternoons, the
Division is responsible for a large clinic which cares for
patients with hematologic malignancy. Six full time attendings
are present in this clinic, which is also staffed by all Hematology
fellows, as well as the interns who are currently rotating
on the hematologic malignancy service. Chemotherapy is administered
on an outpatient basis during this clinic, and complex medical
problems are also handled.
Aside from the formal clinics discussed above, the Division
is also responsible for staffing a daily Infusion Center/Day
Hospital at LAC+USC. Patients are seen in this clinic for
receipt of blood products and chemotherapy, and for performance
of various required procedures such as bone marrow biopsies.
Patients who become ill between clinic visits are also seen
on a walkin basis in this Day Hospital area. The Day Hospital
is staffed by Hematology fellows, with back-up from the Hematology
faculty.
USC/Norris Cancer Hospital
The Hematology Division is responsible for seeing private
patients with various types of hematologic malignancy at the
USC/Norris Cancer Hospital. Our Divisional members see patients
on a daily basis in the clinic and Day Hospital, where they
supervise the administration of chemotherapy, stem cell collection,
and other procedures. Patients are admitted to the hospital
as needed, and the inpatient Norris service is the responsibility
of one Hematology faculty member, on a rotating monthly basis.
One Hematology fellow is also responsible for the inpatient
service, as well as two general medicine residents. Patients
are also seen in the Day Hospital, for blood product support,
infusions of chemotherapy, and other required procedures.
The Hematology faculty is also responsible for providing consultations
as required by other services on patients who have been hospitalized
at the USC/Norris Cancer Hospital.
Averaged over the past few years, approximately 250 admissions
and approximately 2,600 inpatient days were supervised by
members of the Division (with a 10.8 day average length of
stay). Close to 4,000 outpatient visits were conducted and
approximately 3,500 Day Hospital visits were conducted.
Stem Cell Transplantation Program
Hematology is responsible for an active Stem Cell Transplantation
(BMT) program, which is managed through USC/Norris Cancer
Hospital. Candidates for autologous stem cell transplantation
are screened at the Norris Cancer Hospital. Our program has
been able to sustain an increase in our autologous stem cell
transplant activity over the past years. The Hematology Division
is also responsible for peripheral blood stem cell collections
and our program was awarded membership in the Federation for
Accreditation of Hematopoietic Cell Transplantation (FAHCT).
The bone marrow transplantation unit at Norris has five
isolation rooms with six beds, all of which have HEPA filters
and positive pressure environments. Because of the increase
in volume of transplant patients and since more patients with
acute leukemia are referred to our Center, the five isolation
rooms did not meet our needs. Therefore, three rooms on the
3rd floor of Norris, adjacent to the BMT unit, were modified
to become additional isolation rooms with HEPA filters and
positive pressure, allowing us to provide the same level of
care as in the formal BMT unit. However, the increase in number
of beds is still not sufficient, as we now have a waiting
list for BMT, as well as a need to place the patients with
severe neutropenia outside of an isolation bed. Our long term
plan is to expand the BMT unit further. In the meantime, we
will continue to efficiently manage patient admissions and
discharges so as to maximally utilize the nine isolation beds
that are currently available to us.
The clinical outcome of our BMT patients continues to be
excellent. Out of 210 bone marrow and stem cell transplants
performed since 1992, there have been 5 transplant related
deaths (2%). Our autologous SCT survival rate, 100 days post-transplant
for 2003-2004, was 96%. Median survival for all autologous
transplant patients is 51 months. These survival rates are
comparable to those established by the finest institutions
in the United States.
USC University Hospital
The Division of Hematology is responsible for seeing patients
with various hematologic problems on a consultative basis.
One fellow and one faculty are assigned to this rotation on
a monthly basis. In 2003-2004, a total of 132 consultations;
163 follow-up consults; and 131 subsequent hospital visits
for total of 426 patient encounters were conducted at USC
University Hospital
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