The Burden of Inpatient Classical Hematology Referrals at a 700-Bed University Hospital: Opportunities for Growth

Background: Classical hematology (CH) represents a significant proportion of hematology/oncology-related referrals in the outpatient setting. Hematologists also must contend with a high demand for CH referrals in the inpatient setting, and the combination of this high demand with an overall CH-workforce shortage puts immense strain on the referral systems and quality of CH-related care. It also affects the career satisfaction of hematologists and the decision-making of trainees interested in a hematology/oncology career. The objective of this study was to conduct an analysis of CH inpatient referrals in order to inform strategy on addressing the CH-workforce shortage and handling hematology inpatient referral demand.

Methods: Providers submit documentation of inpatient hematology referrals at our university hospital (UH), including the reason for referral, into our electronic medical record. To capture all referrals (including informal curbside referrals that resulted in formal consultation), new patient referrals were reviewed daily. Documented inpatient hematology referrals from September 14, 2023 to July 22, 2024 were categorized by reason for referral given by referring provider by one of the authors (C.V.W) and demographic information on referred patients was collected.

Results: A total of 261 CH referrals were documented in the 9 month period. Of these, 134 (51%) were female and 130 (49%) were male with median age 52 (range: 18 - 92 yrs). During the study period, there were 121 malignant hematology referrals, making CH referrals 69% of all hematology referrals during the study period. The most common reason for referral was anemia (40, 16%), followed by thrombocytopenia (40, 15%).

Conclusions: CH referrals make up the majority of inpatient hematology referrals at the CC. Hematologist-developed workup and treatment algorithms may help alleviate the need for CH consultation for more routine hematologic problems. This study demonstrates the heavy demand for inpatient hematology consultation and the need for an increase in CH-focused faculty. This demand suggests a need to expand CH-focused training and education at the UH and nationally.

Butler:GSK: Ended employment in the past 24 months. Kaur:Eli Lily: Ended employment in the past 24 months. Bowhay-Carnes:Alnylam: Speakers Bureau; Rigel: Speakers Bureau. Perepu:Bayer: Ended employment in the past 24 months.