Classical Hematology 2.0

Nearly half of practicing hematologists report a shortage of specialists in the field, often resulting in patients waiting months for an appointment. The Classical Hematology department at Cleveland Clinic is working to optimize many practices to help patients get to the right specialist much faster.

“Our goal is to improve access and speed up the process of getting patients to the right place,” says Director of Classical Hematology Bethany T. Samuelson Bannow, MD. “For example, we often receive undifferentiated referrals where a patient had an abnormal cell count and the busy primary care provider isn’t able to address it as closely as they’d ideally like to. If the labs are slightly elevated, this could just be due to allergies or a recent illness, yet patients are often referred to a hematologist in the Cancer Institute, which is scary for them. We were looking for ways to get these patients seen sooner and to reassure them.”

Making more efficient use of the classical hematology specialty

To help alleviate wait times for patients with abnormal cell counts and certain other labs, the Classical Hematology team collaborated with their colleagues in the Primary Care Institute to create clinics to handle common referrals such as anemia and thrombocytopenia. Often, these patients can be diagnosed and treated for issues like iron or B12 deficiency much faster right in the primary care setting, without having to wait to see a classical hematologist. This also frees up the hematology team to handle cases who are more likely to need specialized care

Hematology Diagnosis Clinic

Patients with certain abnormal cell counts will be able to be seen in the new APP-led Hematology Diagnosis Clinic for a first-line evaluation. APPs will initiate the workup, and in many cases, prescribe treatment. For many patients with high red cell counts, the issue can often be resolved by addressing underlying causes such as sleep apnea or smoking. In these instances, the APP is able to set the patient’s mind at ease that there isn’t an underlying cancer.

In the rare instance that these patients have a more concerning issue, the hematologist is able to make much more efficient use of the first visit because common causes have been ruled out. “Patients get in to see us faster and we can leave the appointment with a plan of treatment because the diagnostic work has already been done,” explains Dr. Samuelson Bannow.

Supporting pre-surgical patients

The Classical Hematology team is also working to bring together existing programs across Cleveland Clinic to support patients prior to surgery. Patients who’ve had deep vein thrombosis in the past, for instance, will now be routed to the Pre-Anesthesia Care Clinic (PACC) instead of waiting for a hematology appointment. PACC is a one-stop shop for patients who need pre-surgical support.

The clinic also assesses cardiology, nephrology and other specialty-specific risk factors. This way, patients don’t have to wait for long periods to meet with various specialists. They go straight to PACC to see a surgical perioperative management specialist.

“There are some cases such as with bleeding disorders when we want patients to come right to us in classical hematology, but a lot of other patients don’t have to,” explains Dr. Samuelson Bannow. “Many patients are better served in PACC or by our Blood Management team because they have systems and protocols in place to support those specific needs. Routing patients this way doesn’t just improve access for that one individual patient – who can now have one appointment instead of five - it means five other patients get in sooner because they’re not going to separate specialty clinics.”

“The national shortage of classical hematologists is getting worse so making the most efficient use of these resources is becoming increasingly important,” explains Dr. Samuelson Bannow. Her team is actively recruiting new trainees and experienced practitioners, an associate program director, a director of adult sickle cell care as well as a director of classical hematology research.

Upcoming research endeavors

The Classical Hematology team is expanding its research program, with planned study protocols in immune thrombocytopenia, autoimmune hemolytic anemia, heavy menstrual bleeding and Von Willebrand disease. Inspired by Dr. Adjei’s vision to improve clinical trial access, Dr. Samuelson Bannow and her colleagues are working to make their clinical trial opportunities available through the central “hub” of main campus as well as Cleveland Clinic satellite sites. This hub-and-spoke model of clinical research will enable patients to participate in clinical trials much closer to home.