Radiation Therapy Inpatient Consultation Note (Urgent/Palliative)

Date/Time of Encounter: [Date and time]

Location (unit/room): [Inpatient unit and room]

Urgency Category: [STAT / Urgent/same-day / Expedited/24-48h]

Referring Service/Clinician: [Service and clinician name]

Method of Encounter: [bedside / telehealth / chart review with collateral / combined]

Reason for Consult

[Consult question in one sentence]. [Urgency-driving symptom or complication]. [Suspected lesion or anatomic site if known].

Actionable Summary

• Patient context: [Primary diagnosis, metastatic status, baseline performance status in one line]
• Immediate stabilization: [Actions done or recommended: steroids, transfusion, imaging, airway support] (Include only items explicitly performed or recommended; specify who will order.)
• RT recommendation: [recommended now / recommended after workup / not recommended] — [Brief reasoning]
• Proposed RT approach: [Target site/region], [intent], [anticipated fractionation], [timing window]
• Key logistics: [Transport needs, positioning tolerance, oxygen, anticoagulation, isolation/precautions, implanted devices] (List only items impacting feasibility.)
• Team coordination: [Who was contacted, what was agreed, pending items] (Include names and roles.)

History of Present Illness

[Consult-triggering symptom(s): onset, tempo, severity (e.g., pain 0–10), and functional impact (ambulation, ADLs)]. [Why RT is considered now: refractory symptoms, rapid progression, imminent risk]. [Anatomic localization if relevant]. [Prior interventions and responses: analgesics, steroids, procedures, systemic therapy]. (Format as 1–2 concise paragraphs focused on urgency and palliative indications.)

(Include indication-specific details only if applicable:) [For spinal cord/cauda equina compression: ambulatory status vs baseline, time course of weakness, sensory changes, saddle anesthesia, bowel/bladder function, back/radicular pain pattern]. [For brain metastases: headache pattern, nausea/vomiting, seizures, focal deficits, confusion, steroid response]. [For bleeding: source, hemodynamic stability, transfusion requirements, anticoagulation status]. [For airway compromise/SVC syndrome: stridor, dyspnea, orthopnea, facial/upper extremity swelling, oxygen needs].

Cancer History

• [Primary cancer type, histology, key molecular markers if relevant to radiosensitivity]
• [Stage at diagnosis and current metastatic sites]
• [Recent disease trajectory and systemic therapy status: recent lines, response or progression]
• [Prior surgery relevant to target site]
• [Reason for current admission and any treatment limitations]

Prior Radiation Therapy

• [Previously treated sites] — [Dates] — [Total dose and fractions] — [Technique if known]
• [Prior RT toxicities relevant to retreatment risk]
• (If prior RT suspected but records unavailable, state explicitly and document plan to obtain records and account for cumulative dose.)

Relevant Medical History and Medications

• [Anticoagulants/antiplatelets with indication and coagulation status if relevant]
• [Current steroid dose and schedule]
• [Pain regimen and bowel regimen]
• [Implanted devices: cardiac devices, pumps, stimulators]
• [Relevant allergies: contrast, adhesives]
• [Other comorbidities materially affecting RT feasibility or safety] (Omit unrelated conditions.)

Functional Status and Prognosis

• Performance status: [ECOG or KPS], baseline [prior performance status], trajectory [stable / declining / improving] during hospitalization
• Prognosis estimate: [days–weeks / weeks–months / months or longer] (Include only when it materially affects fractionation or treatment recommendation. Avoid false precision.)

Goals of Care

• Code status: [Full code / DNR / DNI / DNR-DNI / comfort measures] — verified [date]
• Decision-maker: [Patient with capacity / surrogate name and relationship] — [contact info if surrogate]
• Patient priorities: [Patient's stated goals in brief, direct quotes when feasible]
• Hospice status: [considering / enrolled / not considering / unknown]
• Treatment burden acceptability: [Transport frequency, immobilization, multiple fractions, anticipated side effects] (Document explicitly or label as unknown.)

Physical Examination

• General: [Appearance, distress level, ability to participate in decision-making]
• Vitals: [Hemodynamic status, temperature, oxygen requirement] (Include only if pertinent.)
• Functional: [ECOG/KPS if not already documented], [ability to lie flat and remain still], [pain with positioning]
• Neurologic: [Strength by major muscle groups, sensation, reflexes, gait if safe, cranial nerves if brain involvement suspected] (Include for neurologic indications.)
• Spine: [Focal tenderness, deformity] (Include for spine indications.)
• Airway/respiratory: [Work of breathing, stridor, voice changes] (Include for airway/SVC indications.)
• Bleeding/tumor: [Visible bleeding, tumor appearance, signs of anemia] (Include for bleeding indications.)
• Pain assessment: [Location, quality, intensity, associated symptoms, response to analgesics, functional impact] (Include when pain is a primary indication.)

Data Reviewed

• Imaging: [Modality and date/time] — [Key findings: lesion location/level, epidural extension, cord compression, fracture/instability, brain lesion size/edema/mass effect, bleeding source]
• Pathology: [Histology and key markers impacting radiosensitivity or urgency] (If tissue diagnosis absent or uncertain, state explicitly.)
• Labs: [Hgb, platelets, coagulation studies if relevant, other labs affecting safe delivery]
• Other records: [Pertinent external notes, operative reports, prior RT records with dates]

Assessment

1. [Problem 1: Clinical problem/indication — e.g., malignant spinal cord compression, symptomatic brain metastases, tumor bleeding]

   [Supporting evidence: key symptoms, exam findings, imaging]. [Goal of RT: pain relief / hemostasis / neurologic preservation / local control]. [Alternatives considered: surgery, systemic therapy, interventional radiology, supportive care]. [Feasibility constraints]. [Why treatment is needed now and why inpatient].

2. [Problem 2: Clinical problem/indication]

   [Assessment details as above]

   (Include additional problems only if relevant; order by decreasing urgency.)
3. Goals of care alignment

   [How patient goals, prognosis, and code status inform plan selection and fractionation]

   (Include as distinct item when it materially drives decision-making.)

Plan

[Problem 1]: Radiation Plan

• Intent: [urgent palliative / palliative / bridge to systemic therapy]
• Target: [Imaging-defined site, levels, or volumes]
• Dose/fractionation: [Specific regimen or range, e.g., 8 Gy × 1, 20 Gy in 5, 30 Gy in 10]
• Technique: [conventional external beam / IMRT / SRS / WBRT / other]
• Timing: [Simulation goal/date], [planned start date], [inpatient vs outpatient completion]
• Re-irradiation considerations: [Prior RT data needed and plan to obtain] (Include only if applicable.)

(If RT is not recommended: state reason — [prognosis too limited / symptoms not attributable to radiatable lesion / cannot tolerate positioning / safer alternative available] — and document recommended alternative with responsible service.)

[Problem 2]: Radiation Plan

(Include only if additional problems require distinct RT plans.)

Inpatient Logistics

• Transport: [Bed vs chair, required staffing/monitoring, isolation/precautions]
• Positioning: [Supine/prone tolerance, mask feasibility, arms up, immobilization needs]
• Premedication: [Anxiolysis or analgesia needs and who will order]
• Oxygen: [Requirements during transport, simulation, and treatment]
• Setup considerations: [Lines, drains, wounds impacting setup]
• Scheduling: [Constraints, machine availability, inpatient slot coordination]
• Implanted devices: [Pacemaker/ICD status, clearance status] (Include if applicable.)
• Prior RT records: [Retrieval status and responsible party]

Supportive Care Recommendations

• [Steroids for neurologic compromise: dose, taper plan, responsible service]
• [GI prophylaxis if on steroids]
• [Pain regimen optimization and bowel regimen]
• [Antiemetics if indicated]
• [Transfusion targets if bleeding/anemia]
• [Anticoagulation management if bleeding risk or procedures expected]

(Include only relevant items.)

Coordination

• Consults: [Placed or recommended: neurosurgery, orthopedic spine, interventional radiology, palliative care, medical oncology]
• Orders: [Who will place imaging and medication orders, by when]
• Escalation triggers: [Conditions prompting urgent notification and who to contact, e.g., worsening weakness → call neurosurgery and radiation oncology]

Informed Consent

• Capacity: [Patient has capacity / surrogate consenting — name and relationship]
• Benefits discussed: [Expected symptom relief, likelihood, and timeframe]
• Risks discussed: [Common and serious risks, site-specific]
• Alternatives discussed: [Surgery, systemic therapy, interventional options, no RT/best supportive care]
• Interpreter: [Language and interpreter ID if used]
• Emergency consent exception: [If applicable: why immediate treatment necessary, why consent unobtainable, plan to obtain when feasible]

Communication with Primary Team

• Contact: [Date/time] via [phone / secure message / in-person rounds]
• Individuals: [Names and roles contacted]
• Recommendations relayed: [Key urgent actions and treatment plan communicated]
• Shared plan: [Acknowledgement received and any outstanding items]

Follow-Up Plan

• Inpatient monitoring: [On-treatment visit frequency, response and toxicity monitoring, responsible team]
• Outpatient handoff: [Clinic, provider, and timeframe for follow-up]
• Treatment summary: [Plan for summary completion and communication to primary team and oncologist]

(Use precise language for data status: "unknown" = clinically relevant but not currently available; "not assessed" = not evaluated; "denies" = explicitly asked and patient denies. Document retrieval plans for essential missing information. Omit non-relevant sections rather than leaving empty.)