St. Jude hospitalists improve processes for better patient care

At 2 a.m., a parent calls to report their child with cancer has a fever. Moments like these demand immediate, expert decision-making. Patients undergoing treatment are often medically complex and at high risk for complications, where even subtle symptoms can signal serious shifts. Families need to know that the care their child receives at 2 a.m. will be just as coordinated and precise as it would be at midday.

At St. Jude, the Hospitalist Medicine Program plays a central role in making that possible. Designed to provide continuous, around-the-clock care, hospitalists help ensure that patients receive consistent evaluation and management, whether they are inpatients or arriving for urgent assessment in the Acute Care Clinic.

What is a hospitalist?

Hospitalists are physicians, including pediatric hematologist-oncologists and pediatricians, who care for patients when their primary doctors are not physically on site, ensuring seamless, around-the-clock support for children with medical needs. Hospitalists serve as an extension of the primary care team, maintaining continuity of care, day or night, weekday or holiday, while coordinating treatment across specialties.

“At St. Jude, our hospitalists care for every patient who comes through our doors,” explained Jeremy Slone, MD, MPH, Hospitalist Medicine Program director, Department of Global Pediatric Medicine associate member. “In a single shift, that might mean treating a brain tumor patient, followed by someone with hemophilia, leukemia or sickle cell disease. Unlike specialists who focus on one area, hospitalist physicians must be ready to manage it all — while aligning with the protocols and practices of each care team to ensure consistency across the institution.”

That level of expertise has become increasingly important as pediatric cancer care has advanced. Treatments that were once experimental are now standard, offering curative options for patients who would not have had access to them a decade ago. But with those advances comes greater complexity, as patients often require more intensive care.

“While therapies have improved, they also require a higher level of monitoring and coordination,” Slone said. “Many of these patients are at increased risk for side effects, which makes timely evaluation and intervention critical.”

To meet those demands, care models have evolved. Hospitalists provide continuous coverage to manage complications as they arise, whether a patient is admitted overnight or develops symptoms while outside the hospital.

Triage transformed

Answering that 2 a.m. call is only the first step. What happens next, and how it happens, depends on the systems behind the care. The Hospitalist Medicine Program’s academic work centers on quality improvement and advancing the understanding of hospitalist medicine within pediatric hematology-oncology.

One of the clearest examples of that focus is the program’s work to standardize patient triage in collaboration with nursing and the Office of Quality and Patient Safety. Early on, Slone and his team identified variability in how patients were triaged. Without a consistent approach, the questions asked often depended on who answered the call, leading to differences in how symptoms were evaluated and, ultimately, in clinical decision-making.

“Without a structured triage process, it can be challenging to gauge urgency in real time,” explained Maria Lopez-Garcia, MD, staff physician in the Hospitalist Medicine Program. “With a standardized approach, we can assess concerns, provide initial guidance when appropriate and escalate urgent issues, ensuring the right care happens at the right time.”

Together, these gaps — triage variability, unclear communication pathways and inconsistent documentation — highlighted the need for a more structured, standardized system.

In a study published in the Journal of Pediatric Hematology/Oncology Nursing, St. Jude investigators describe the adaptation and implementation of a triage pathway to guide how patient concerns are assessed and managed. The study was led by Matt Davis, MD, Department of Oncology assistant member and pediatric hematologist-oncologist with the Hospitalist Medicine Program. It also included Slone and Sherry Johnson, MSN, RN, CPON, NE-BC, and Jonathan Burlison, PhD, from the Office of Quality and Patient Safety. The approach includes structured questions, decision-making algorithms and standardized documentation to ensure consistency across providers. It enables nurses to assess symptoms, provide initial guidance and escalate urgent concerns when needed.

“The impact of implementing this triage system has been very positive,” Slone said. “What started as a tool for nights and weekends has now become our standard triage approach across the institution, used 24/7 in all clinics.”

Shaping the future of hospitalist medicine

What started as a need for after-hours coverage when primary care physicians were not in the clinic has evolved into a range of clinical services and a broader effort to help define the role of hospitalists in pediatric hematology-oncology. Although hospitalist medicine has been established for many years, it remains relatively new within the field of pediatric hematology-oncology. Even the most experienced programs, including the one at St. Jude, are less than 15 years old. As the field continues to take shape, the hospitalist medicine team is helping lead that evolution by developing and evaluating standardized approaches that improve care locally while informing best practices across the field.

“I believe we’re uniquely positioned as an institution to lead in this field. We’ve built the systems and expertise needed to deliver consistent, high-quality care while helping define what hospitalist medicine should look like moving forward,” Slone explained.

This leadership extends beyond the institution and into the broader field. In 2023, St. Jude hosted the first Pediatric Hematology-Oncology Hospitalist Conference, bringing together programs from across the country to share best practices and address common challenges. The conference is set to return in April 2027.

In parallel, the team has contributed to published research defining the role of hospitalists in the specialty, helping to establish a clearer framework for the field moving forward. A multi-institutional report published in Pediatric Blood & Cancer, led by corresponding author Liza-Marie Johnson, MD, Department of Oncology, highlights the important role of pediatric hematology-oncology hospitalists in delivering high-acuity care, improving quality and patient safety, as well as addressing workforce challenges while offering a roadmap to support the field’s continued growth.

“How inpatient care is delivered in pediatric hematology-oncology is evolving, and hospitalist physicians and advanced practice providers are central to that change,” Slone said. “Being part of national discussions on care delivery and workforce development reflects the leadership of St. Jude in the field and its commitment to advancing both science and clinical care to help define hospitalist medicine in this specialty.”

So, when the phone rings at 2 a.m., a parent of a critically ill child is met with clarity and confidence from a team and a system shaped by continuous quality improvement, designed to respond and ensure their child receives expert care at any hour.