WORKING PLACES:
There are 17 beds belonging to the hematology clinic. 6 beds are in hematology-oncology service and 12 beds are in general service. There is 1 2-bed and 1 single room in the hematology-oncology clinic (F block 4th floor) (3 beds). There are 4 single and 4 double rooms in the general service (12 beds). We do not have an intensive care bed belonging to our clinic. However, in case of need, we have the opportunity to transfer patients to internal medicine, neurology and anesthesia intensive care services. In addition, stem cell transplantation (autologous peripheral stem cell transplant) is performed. 4 single rooms in the general service are used for this purpose. These rooms are made of hepafil and can be converted into intensive care beds if needed. Autologous transplantation is currently performed. Allogeneic transplantation is also planned for this year. Our center has license for autologous and allogeneic stem cell transplantation. A total of 50 patients have been autologously transplanted so far.
Hematology Outpatient Clinic : We have 4 outpatient clinics, Hematology-1, Hematology-2 in the central building , Mevki building Hematology outpatient clinic and Bone marrow transplant (KIT) polyclinic. The first applicant and benign hematology patients are examined in hematology-1. In hematology-2, patients with follow-up files or malignant hematology are examined. General hematology patients and healthcare board patients are cared for in the Mevki building Hematology polyclinic. In addition, patients who are transplanted or applied for transplant at the KIT outpatient clinic are cared for. Examination appointments can be made online for the hematology clinic. The total number of hematology outpatient clinic patients in 2018 is 32.739 and the average number of outpatient clinic patients per day is 142.
Hematology Laboratory: There are 2 laboratory staff in the hematology laboratory. In the hematology laboratory, operations such as peripheral smear and staining, staining bone marrow preparations, immunohistochemical dyes (such as PAS, MPO) and BOS staining are performed.
Apheresis Unit: Apheresis unit works under hematology clinic. Donor platelet apheresis, therapeutic apheresis procedures (such as plasmapheresis, leukapheresis, lipid apheresis, therapeutic platelet apheresis) and stem cell collection procedures are performed in the unit.
Responsible doctor : Assoc. Dr. Murat Albayrak
Technical Officer: Biolog Meral Tiryaki
Nurse: Derya Öztürk (responsible nurse), Maide Dölek, Şenay Gürbüz
1 secretary and 1 staff (Birgül İbiş) are on duty.
Hematology Treatment Unit: There is an outpatient treatment unit belonging to the hematology clinic. There are 2 nurses working here. This unit serves the hematology clinic of our hospital and is located on the 2nd floor in the oncology building. In this unit, procedures such as intravenous iron therapy, blood product transfusions (such as Plasma, platelets, erythrocytes), other drug infusions and phlebotomy can be performed for outpatients.
STATISTICAL ANALYSIS REPORT OF HEMATOLOGY CLINIC (2018):
Hematology service and polyclinic data for 2018:
Number of hematology polyclinics: 32,739
Average number of outpatients per day: 142
Number of inpatients: 487
Bed occupancy rate: 81.1%
Average length of hospital stay: 11.6 days
Previously, there was one hematology outpatient clinic in our hospital. Currently there are 3 hematology and 1 KIT outpatient clinic. As of now, the number of patients examined daily is around 150, excluding the control patients. In addition, while the number of beds was 10 at the beginning of 2012, now our number of beds is 17. The number of inpatients is increasing. In our service, patients with hematological malignancies such as Leukemia, Lymphoma, Multiple myeloma and patients with occasional advanced examination are hospitalized.
Therapeutic Apheresis Unit 2018 data:
Plasmapheresis: 156
Photopheresis: 10
Leukapheresis: 17
Lipid apheresis: 118
Stem cell apheresis: 21
Therapeutic platelet apheresis: 0
In 2018, a total of 322 transactions were made, and the number and workload of these transactions are gradually increasing. In 2019, twice the number of this number is expected to be processed. Donor platelet apheresis is now under certain conditions and it is predicted that the charge of the apheresis unit will increase after the allogeneic transplant begins.
Hematology Treatment Unit 2018 data
Phlebotomy: 1031
Drug infusion (Ferinject etc.): 775
Erythrocyte transfusion: 580
Platelet and TDP transfusion: 177
A total of 2565 transactions per year (2018) have been carried out in the treatment unit, and this number is growing steadily. Thus, patients are provided with higher quality service. At the same time, the workload of the emergency room and clinics is reduced.
Hematology Laboratory 2018 data:
Bone marrow staining procedure: 427 patients had bone marrow staining.
CSF staining: 74 patients.
Pleural fluid: 5
Peripheral smear: 23,963
CLINICAL WORK FLOW PROCESS:
Patient entries begin at 06:30 in the morning by the secretary. Patients can log in and get a queue number from 06:30 in the morning. Polyclinics open at 07:30 and cleaning control is carried out by the responsible nurse. Material and tool checks are made and deficiencies are completed. Outpatient services are provided between 08.00-17.00. The examination of the applicant patients is carried out by the attending doctor. The requested examinations are evaluated by the doctor and the patient is offered hospitalization, consultation and / or follow-up according to their results. The hospitalized patients, vital functions are monitored, the vascular access is opened, the nurse pre-assessment form is filled and the file is edited. The examinations to be made are requested by the doctor from the hospital database system. The examinations are taken by the nurse and sent to the relevant laboratory. Where necessary and indicated, bone marrow aspiration and biopsy are performed by the attending doctor. In the clinical council, the patient is evaluated and if chemotherapy is planned, the doses and scheme are prepared. Medicines to be applied are requested from the patient database. Chemotherapy treatment is prepared in the chemotherapy unit and applied to the patient by the nurse (under the supervision of a doctor). Written consent of relatives and patients is obtained before giving chemotherapy. Patients who are given an invasive procedure decision (such as bone marrow aspiration and biopsy, lumbar puncture and intrathecal treatment) are informed by the doctor. The consent of the patient and his wife is taken into consent forms. The procedure is carried out by the doctor. The received material is taken to the relevant laboratory by the staff. The nurse provides the follow-up and control of the materials of invasive procedures. When a consultation decision is made regarding the patient, the consultation request is sent from the hospital database to the relevant unit. The patient whose discharge is decided is informed by the doctor. The procedures are completed by the secretary. The nurse gives the patient discharge training and form (Control time, prescription, matters to be considered at home, etc.). The hematology clinical visit starts at 09:15. The visit is made with the participation of the training assistant, specialist doctors, assistant doctors and related nurses. In the visits, assistant training is done for at least 30 minutes daily. The nurse applies the follow-up and treatment of the patients with the knowledge and directive of the doctor. An evening visit is held at 16:00 in the evening. The distribution of food in the unit is done under the control of a dietician. At 08:00 in the morning, the bedding of the service is changed. Dirty laundry is delivered to the laundry. General cleaning of the clinic is done. The responsible nurse checks the tools and materials, and the emergency cabinet. Missing materials are completed. Malfunctions are detected and corrected. The expiration date controls of the drugs are made. The tools used in the service are maintained and calibrated. In addition, the service is checked for waste. Monthly and quarterly statistics are made. It is delivered to the relevant units.
GOALS OF OUR CLINIC:
1. To start allogeneic stem cell transplantation as soon as possible after optimizing the infrastructure
2. To increase the number of beds of hematology to at least 25
3. To turn all the beds of the hematology service into a single room
4. To set up the appropriate infrastructure for current flow cytometric examination in our hospital with service procurement and to perform this examination in our hospital.
5. To make genetic tests more comprehensive and faster.
HEART AND VASCULAR SURGERY CLINIC
The main inpatient group of patients in our clinic are atherosclerotic heart diseases, peripheral vascular patients and varicose veins. In addition, advanced cardiovascular surgery procedures can be performed in a limited number of centers such as pediatric and infant patients with congenital heart disease, heart valve repairs and complex aortic surgery (aortic dissection, etc.). Due to the high emergency density of our hospital, the most common trauma and injuries in Ankara are one of the clinics where emergency patients are accepted. After the supply of the C-Arm Digital angiography device, which is planned to be purchased in our clinic, great progress will be made in these services.
Clinical Workflow Process:
Our clinic provides polyclinic service by specialist doctors. Depending on the suitability of the surgery program, our assistant doctors attend the service provided in our center polyclinic as part of their training. Patients registered at 08:00 are taken for examination according to their sequence number. Outpatient services are provided between 08:00 and 17:00. After completing the examinations of the patient who is being examined, the patient is re-applied to the doctor for the result or control, according to the evaluation, the patient is directed according to the decisions of surgery, hospitalization / medical treatment and follow-up.
With the file issued by the clinical secretary of the hospitalized patient, the first welcome and hospitalization forms are filled, the medicines are questioned, and their pre-assessment form is filled in. Service assistant doctor performs hospitalization examination and fills out the relevant forms, informs the service specialist and orders according to his instructions. The drugs requested from the computer are taken by the service nurse and applied in line with the order. Every morning between 08:00 and 09:00 and 17:00 to 18:00 in the evening, general intensive care and service visits are made by the assistant and the specialist, and then by the clinical manager. Every morning, after the visit, the whole team makes a council about the new inpatients and the decisions taken are recorded in the council book. Informed consent forms are prepared by informing patients and their relatives who have taken the decision for surgery and obtaining the consent of the patient and his wife. All necessary laboratory tests and blood-blood products are prepared for the patients, and the lists are included in the daily and weekly surgery lists, these lists are revised daily according to the needs. The patient, who is informed by the anesthesiologist and signed the consent forms, is transferred to the operating room with his staff and service nurse, as his file and an identifying tape on his arm. Here, the operating room staff and the operating nurse meet the patient. Before being taken to the operation room, it is evaluated by the surgical team accompanied by the anesthesiologist for the last time. After confirming the pathology and planned surgery in the patient, the patient is operated. While the appropriate patients are transferred to the service after the operation, the patients in need are kept in the cardiovascular surgery intensive care unit and following the improvement that can go to the service, they are taken to the service by the staff accompanied by an intensive care nurse and transferred to the service nurse. Patients are usually discharged after 1-2 days in intensive care and 5-7 days in the ward.
Our practices and studies that will serve as an example for clinically similar or other clinics
Consultation services are provided on the same day and by specialist doctors.
Our outpatient services are provided by specialist doctors. In the days when the surgery program is mild, an assistant doctor works in our central polyclinic under the supervision of a specialist.
Every day after the intensive care and service visit, the clinic council meets and the angiogram of the patients on the surgery list of that day is monitored and the surgery program and operation team are determined. This contributes to the training of assistants, as each specialist contributes to the decision, as well as to the discussion environment.
In our clinic, laser varicose vein treatments are being carried out with increasing numbers in the last five years. For this purpose, we convey our experience to our Turkish and foreign colleagues who come to our clinic.
In our clinic, life support device (ECMO) applications, which is the highest point in Cardiovascular Surgery, has been made.
Our Clinical Opportunity / Advantages:
Both cardiac and vascular surgery operations can be performed simultaneously in the operating theater within our clinic.
In studies conducted jointly with our clinic and Radiology clinic, cases of ruptured aortic aneurysms and aortic dissection with very high surgical mortality are performed endovascularly (EVAR-TEVAR). Similar complex vascular interventions can be performed by combining with the DSA-enabled C-Arm radiography device in the operating room and surgery, which is planned to be taken to our clinic.
Our clinic has a technological device park reached by Cardiac Surgery and is constantly renewed.