When doctors don't return calls.....

Doza · Jul 13, 2010

We have had the nursing supervisor send the cops to their house on occasion.

Oh come on! You can't leave us hanging! What happened after?

From your post you said it was indeed urgent. But I am really curious how the doctor reacted and how your nurse manager talked to the doctor if ever he confronted him/her :)

Batman25 · Jul 13, 2010

You guys actually call the cops? Thats ridiculous. What the heck are they going to do? Arrest them for not answering pages? Absurd. Cops have a lot more important work to be doing rather than chasing down lazy docs who wont answer their phones. I'm surprised the police would actually agree to do that kind of work.

Of course they don't arrest them. That's not why they are sent. They check to be sure the doctor is okay and then make sure they get to the hospital because there is a patient in dire need. I have only heard of it happening a few times but the police were very helpful and were happy to lend a hand.

cardiacmadeline, RN · Jul 13, 2010

Oh come on! You can't leave us hanging! What happened after?
From your post you said it was indeed urgent. But I am really curious how the doctor reacted and how your nurse manager talked to the doctor if ever he confronted him/her :)

I don't remember actual situations on why we needed to send the cops, the example in my post is just a hypothetical. And I honestly don't know how they reacted when the cops showed up at their house, but I don't think they made a big deal of it. I don't recall them being rude or upset to the nurses on the phone when they finally contacted us. And I really think the surgeons I work with would not confront the nurse managers of the units involved, because if they are on call and not answering their phones, it is 100% their fault the cops are at their front door. And if they did, my nurse manager would totally stick up for us in a situation like that.

I would also like to point out that the only docs we have issues getting a hold of sometimes are the cardiac surgeons, is this true of other places? Usually, it is because their phone was on silent or turned off, or so they say. I have never had this happen with any of the other MD's.

SolaireSolstice, BSN, RN · Jul 13, 2010

We had a doctor who didn't answer a page on a patient of his (he was the primary) who crashed and a code was called. The primary MD wasn't a critical care doctor, so it was more of a "heads up" type of call, and a hope that the patient could be made DNR. One of the MDs who responded to the code was able to get a DNR order from the next of kin, and 2 hours later the primary MD wandered up to the floor wanting to know what we needed him for because his pager had run out of batteries. I changed the battery in his pager myself. I believe his answering service finally tracked him down based on previous pages received to a hospital down the street and had him overhead paged there. The answering service can be an invaluable service sometimes, and based on their records can often track down where the doctor is.

jwsiii · Jul 13, 2010

I work in a hospital, if the doctor does not respond in one hour you can call his partner that covers or the head Dr of the hopital.

When I am getting an admission that is one of the first things I look at is the Dr, it makes a huge difference who it is, some are great about getting a hold of them others are not. :nurse:

BabyLady, BSN, RN · Jul 13, 2010

I cannot provide specific details, but I did have a terrible shift last night. Not only did I page a doctor multiple times regarding a patient who was deteriorating, but I also telephoned the same doctor's answering service numerous times. In addition, I called his personal cell phone number several times, which went straight to voice mail each and every time that I called. My next step was to report it to my nurse manager, but her phone number was not listed in the contact book because she is a newer employee.
What do you guys do when doctors don't return repeated phone calls and pages? Do your workplaces have established protocols?

You need to get the procedure rectified ASAP, because physicians that cannot be reached fall under protocol in most facilities.

In our facility, you first call the resident on call. If the call isn't returned in 10 minutes, you page again.

If that phone call isn't returned you call ONCE to the physician in charge of that patient.

If your third call isn't returned, you call the Medical Director.

If the Medical Director cannot be reached, we call the House Supervisor who finds another physician in the hospital to make a decision.

Seriously, that would actually have come back on you because the patient cannot just lay there forever with no one responding...so you need to find out what the chain is...a Nurse Manager needs to be informed, but they CANNOT write an order for care.

TheCommuter, BSN, RN · Jul 13, 2010

Seriously, that would actually have come back on you because the patient cannot just lay there forever with no one responding...so you need to find out what the chain is...a Nurse Manager needs to be informed, but they CANNOT write an order for care.

I'm cognizant that this could come back on me, which is why I am asking.

Here's a little background. This occurred on a weekend night shift in a nursing home with no written policy for this type of situation. No supervisors are in the building during night shift. The doctor that I was attempting to reach also happened to be the medical director of the facility. We do not deal with residents, interns, or an expansive list of doctors. In addition, it is nearly impossible to obtain telephone orders from other physicians who are not servicing the patient because they "do not want to step on the attending doc's toes."

prinsessa · Jul 13, 2010

I'm cognizant that this could come back on me, which is why I am asking.
Here's a little background. This occurred on a weekend night shift in a nursing home with no written policy for this type of situation. No supervisors are in the building during night shift. The doctor that I was attempting to reach also happened to be the medical director of the facility. We do not deal with residents, interns, or an expansive list of doctors. In addition, it is nearly impossible to obtain telephone orders from other physicians who are not servicing the patient because they "do not want to step on the attending doc's toes."

We also have that problem at our facility (LTC). We are shocked if the MDs call back within an hour. Many times we will page the doctor the entire shift and never have them call back.

**RosesrReder, BSN, MSN, RN** · Jul 13, 2010

Our hospital protocol goes something like this: MD has not called back, notify charge nurse, charge nurse notifies house supervisor, house supervisor attempts to contact MD, cannot get locate MD, someone is sent to MD's house to knock on his/her door.

Document, document, document in between.

AggieNurse99, BSN, RN · Jul 13, 2010

Let me get this straight. You, the RN/LVN, have a reason to page the doctor. [i.e. concern about pt status etc - doing your duty to the patient.] The doctor does not call back within a reasonable time, and all you've done is document? If your concern is critical/urgent/deterioration, at a LTC w/o a MD 24/7, then you must call EMS. It doesn't matter if the doc doesn't call, you have to do your duty to the pt. For non-critical/urgent needs, can nursing leadership and the medical staff come up with some standard orders or protocols for certain situations. Send an email to the nurse executive and medical director with "patient safety concerns" in the subject line. Mention common situations, typical solutions/orders, and forming a committee to come up with standard protocols. Keep a copy for yourself to send to the accrediting agency if needed in the future. If you are at a hospital, call your rapid response/medical emergency team. When in doubt and in serious need of a doctor, there's always one in the ED, and easy to reach. Simply activate your code blue system.

I work at a small general hospital and the general consensus is we do the right and safe thing for the pt. If I had to call the medical director or the primary intensivist in the middle of the night b/c someone didn't answer their page, that doc would be in review within the week. In the same respect, the medical director has given us unofficial orders that we can write in his name, like D50 for FSBS

CoffeeRTC, BSN, RN · Jul 13, 2010

I knew this was a LTC issue!!

I've been in this situation before on an off shift/ weekend. I called the DON and ADM and left messages telling them I'm having issues and can't get al hold of a doc. In one situation I sent them to the hospital with approval from the family (that is what they wanted in the first place, but I just needed simple orders to treat at the facility)

I've also let the answering service know that it is an absolute emergecy to get a hold of the doc (they finally figured out a way). I've called other docs in the same practice and asked them either to give me the orders or get that doc to call me back (they gave me some orders and got the doc to call)

In most situations, I'm am the supervisor so the next step is to call the DON but they are normally at home and can't/ won't be of help. Next step is to call the medical director for orders BUT...what happens if that is the one you are trying to reach or that doc has someone else on call and that doc doesn't know this pt from Adam or won't give any orders??? I might get the family involved and they might be going to the hospital for treatment.

Love to hear other LTC nurses on this one!

Zookeeper3 · Jul 13, 2010

This is not simply an LTAC issue, I work in a 30 bed ICU. We have called "any available surgeon to bed... stat" because we couldn't reach the doc. If were lucky and one shows up (almost never happens), the demand to know what doc is on call... tell them the name and a nasty reply is sure to come. Some are notorious.

so NOOOOO we don't call the cops to have them arrested, umn, we need the doctor to respond, that would defeat the purpose:banghead: geeze! When a doc is on call and hasn't answered stat calls for an hour, the cops are dispersed to alert them to the emergency. It IS their role and they are happy to take that call over another. Obviously a dispatcher will not pull away a cop that is needed somewhere else, they are trained to prioritize... crying out loud.

Our medical director does not need to be called, the house soup has the authority with their blessing, because we are not a teaching service and the on call doc must answer all calls in 15 min. Sure they may be on another call, that's why courtesy has us re-page them, or call back the service for a stat.

You simply just don't let a patient die because the cops might be wasting a trip out. :eek: