University Medical Centre St. Radboud Nijmegen has started the project Continuity of Care and Logistics for adult patients with bone tumors in the spring of 2007 (sarcoma chain). This project is focused on the patient group in a multi professional way. Within this project there also has been looked at the information transfer between different, at the patient involved departments on nursing level.

Transfer between the orthopedic outpatient clinic (gateway specialism for this patient category) and the orthopedic ward goes well, because a nursing pre admitting interview takes place at the outpatient clinic. The report of this interview goes to the orthopedic ward together with the medical chart of the patient.

If the patient is diagnosed with osteo sarcoma or Ewing sarcoma the patient is referred to the department of medical oncology for neo-adjuvant chemotherapy. Between department orthopedics and department medical oncology there is no form of information transfer on nursing level.

To guarantee an improvement of continuity of care for this patient group consultations were held with senior nurses linked to these departments.

From this consultation became clear that there was, however, need for better information exchange.

Since the January 1st 2008 patients who are referred to the department medical oncology by means of the orthopedic outpatient clinic are transferred personally and in writing (copy of the pre admitting report and a summary of the hospitalization for the biopsy) to the nurse coordinator of the medical oncology ward. Because this takes place before the first admittance of the patient on the medical oncology ward it is already clear what the (potential) care problems are. It is also clear how the patient has experienced his sickness process up to that moment and if there are psychosocial problems at hand.

Because of this the nurses who are going to take care of this patient can anticipate and improve their care regarding the personal needs of the patient. Until now not many patients have been transferred this way. This because we have many young patients (children) who go to the children’s oncology ward. This department has not participated so far, at nursing level, at this project. Evaluation of this new manner of transfer takes place in March 2009.