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School of Medicine
It’s no secret that some cancer treatments extend over many weeks and have grueling side effects. We have developed treatment models that get you out of the hospital and back to your family sooner (Inpatient/Outpatient Program or IPOP). In addition to a team of remarkable nurses, we provide case managers, social workers and financial counselors to help lift some non-medical burdens from you and your family.
Our nurses, many of whom who have worked here for 20 years or more, are committed to the management and improved care of cancer patients. Several of our nurses have started as nursing students or nursing assistants and grown from there. During a yearlong training program, our newer nurses dive into all aspects of cancer care. All nurses working our units are prepared to handle the spectrum of patients, from those newly diagnosed, to those who are on ventilators or other equipment, to those who are dying. Specialized educational and mentoring programs prepare oncology nurses for practice in subspecialties, like blood and bone marrow transplant, infusion therapy or clinical trials.
Nurses here contribute heavily to the science and knowledge of oncology as we pioneer advanced approaches to patient care, such as our inpatient/outpatient continuum of care program, or IPOP. Read Nursing Excellence story on how Johns Hopkins nurses help patients manage medications
Patients undergoing bone marrow transplant or other therapies who need inpatient care are treated on one of our hospital units by a multidisciplinary team specialized in the treatment of patients with blood and bone marrow cancers. The nursing staff is highly trained in the care of these patients and in critical care. The units are capable of providing conventional and intensive care. All rooms are private with special air-filtering to decrease the risk of infections. Some patients, including those undergoing bone marrow transplant, now receive their treatments and transplants as outpatients in our Inpatient/Outpatient unit.
Inpatient/Outpatient Program (IPOP)
Launched in 1995, the Inpatient/Outpatient Program (IPOP) is a patient-focused health care delivery model that helps critically ill cancer patients undergoing bone marrow transplant or other cancer treatments -- once an exclusively inpatient process – move from the hospital to nearby homelike apartments, the Hackerman-Patz Patient and Family Pavilion (if a patient's home is more than one hour from Johns Hopkins Hospital) as their medical condition warrants. Patients participating in many different bone marrow transplant or research protocols come to the IPOP clinic each day for care and spend their nights in residential living facilities—or in their own homes—with a family member or close friend extensively trained by IPOP nurses to serve as their personal caregiver. If patients have complications like fevers, organ dysfunction and graft-versus-host disease, they are admitted to the hospital. As they recover, they can move back to the clinic, with the same primary medical and nursing teams caring for them in either location.
For our patients undergoing blood and marrow transplants, a number of standard of care and research clinical trials are available in the IPOP/HIPOP clinic, including:
- autologous transplants
- donor lymphocyte infusions
- allogeneic “mini” or non- myeloablative transplant and “standard” or myeloablative transplant
These therapies are used to treat a variety of malignant and non-malignant disorders. In addition, we offer a variety of cutting-edge mismatched transplant protocols which explore the efficacy of 2nd and 3rd generation donors.
"We wanted to add some normalcy to our patients' lives at such a difficult time," says Gina Szymanski, nurse manager for the IPOP clinic and one of the members of the medical team that created the program. "If we can keep patients out of the hospital with family or people they know in nearby facilities, they do so much better in terms of quality of life and health and wellness measures."
As a result of making these changes, our IPOP patients on average spend less than 10 days of their total stay in an inpatient bed. Patients and families benefit from the opportunity to remain an outpatient for much of their stay and appreciate the enhanced continuity of care.
IPOP/HIPOP Eligibility Criteria
Eligibility criteria are related to:
- type of treatment
- pre-existing conditions
- functional status
- ability to communicate and follow instructions
- the availability of a consistent caregiver to stay with the patient.
For our transplant patients, a preliminary screen for eligibility is included as part of the initial referral evaluation; however, a final decision to proceed with transplant will not be made until the patient and his/her caregiver come to Baltimore for an evaluation.
The IPOP/HIPOP Treatment
The IPOP/HIPOP treatment pathways include the same components as for inpatient care; the blood and marrow transplant and hematologic malignancy processes remain the same. If admitted to the IPOP/HIPOP clinic, the patient and caregiver will come to clinic each day and spend their nights at home (if they are within 1 hour of the Hospital) or in a nearby residential living facility, such the Hackerman-Patz Patient and Family Pavilion.
The IPOP/HIPOP clinic is another phase of care on the care continuum. It does not replace the traditional inpatient or outpatient long term follow-up clinic, but provides a flexible option for patients to move back and forth between IPOP/HIPOP clinic and the inpatient units or long term follow-up setting. Complications such as fever, organ dysfunction, and graft-vs-host disease are events that may trigger moving a patient from the IPOP/HIPOP clinic to an inpatient unit. When the patient recovers from their acute episode, it is back to the IPOP/HIPOP clinic with the same primary medical and nursing teams caring for them.
As a result of these changes in our hematologic malignancy and hematology programs, many patients spend less time in an inpatient bed. We strongly believe that patients and their families benefit from the opportunity to remain an outpatient for much of their stay and appreciate the enhanced continuity of care provided by this unique program.
Our hematologic malignancy and hematology patients have access to some of the most innovative and advanced therapies in the world. Because Kimmel Cancer Center research scientists and clinicians closely work together, new drugs and treatments developed in the research laboratory are quickly transferred to the clinical setting, offering patients constantly improved therapeutic options and the chance to participate in innovative clinical trials. We are currently managing more than 20 clinical trials in addition to standard of care therapies for leukemia patients.
* Case managers – coordinate and manage the care of patients to achieve quality, cost-effective outcomes
* Social workers -- help give advice to patients and their families about how to deal with cancer, and find resources to help
* Financial counselors – can help families work out payment plans for any expenses not covered by insurance
* Nutrition counselors – can help patients and their families maximize their nutrition while battling cancer
* Pain managers – can help keep patients comfortable during their treatments
* Family involvement – with Johns Hopkins’ philosophy of patient-family centered care, care revolves around the preferences and needs of each patient, families are viewed as a source of strength, and patients and family members are included in treatment discussions
* Housing arrangements – There are several temporary housing options available to cancer patients and their families while at the Kimmel Cancer Center for treatment. Some are located within walking distance to the hospital and others are located nearby in downtown Baltimore and the surrounding area.
* Patient education resources -- patients and their families are taught how to actively participate in their care. Every new patient receives a Patient Handbook; a customized binder, complete with handouts for that individual patient's needs, including information on the disease, treatment, coping with side effects and the psychological impact of cancer, nutrition, exercise and what to do when treatment is over.