When doctors don't return calls..... - page 3

by TheCommuter Asst. Admin

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... Read More


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    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.
    Zookeeper3 likes this.
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    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 < 50 recheck in 30-60 min, or tylenol + cultures x 2 if not done, and colace. Our rapid response nurses have the intensivists' cell numbers and home numbers in their reference book.
    Altra likes this.
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    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!
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    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 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.
    Altra likes this.
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    i guess in this case (which i unfortunately have also been a part of) the pt would have to be sent to an ER, or 911 has to be called.
    never sent the cops out to try and find a doctor before. i have never heard of anyone ever doing this either....

    sometimes the pt will also have consult dr.s, who, if absolutely necessary, can give an order to send them out.
    i had to do that once, and a pulmonologist was called and the pt was sent out.

    i am oh-so-thankful that we have an in-house doctor at nights where i work, because some doctors are pretty much cease to exist between the hours of 11pm and 6am!

    Quote from TheCommuter
    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."
  6. 0
    Quote from TheCommuter
    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."
    I see...and yes, that left you in a very difficult situation.

    I'm not sure if you are into volunteering, but you could volunteer to write a policy on it.

    Otherwise, if you can't get ahold of the physician, then call 911 and have the patient taken to the ER.

    That is all you can do if there is no Plan B and the Medical Director won't return calls.

    It also covers your behind.

    PS: If the MD says anything, just say, "I tried to call you and you didn't answer....and just like you, I have to protect MY license as well."
  7. 0
    I'm in LTC too. We are lucky, the on-call asnwers back within 15 minutes, it maybe a PA or NP but in a crunch I'll take anyone! On the rare occasions they do not call back I recall the service and let them know this is call #2 and I need a call back 15 minutes ago its urgent. The service will hunt them down & hound them at that point.

    If for some really strange reason they still do not call back in 15 mins, I ship to the ER, then consolidate notes into a huge documentation feast! Dr's don't like having it in offical records that they didn't bother to call back.
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    First of all, document each time you try to contact that physician. After you have tried a couple of times, you should contact your charge nurse or nursing supervisor. You don't say what type of facility that you work in. If this is LTC, then I would call EMS. If I were in a hospital, I would insist that the chief of staff or the administrator on call be called. I would also enlist the help of the ICU charge nurse. Most hospital are required now to have in place a rapid response team that can be called any time you feel that a patient is sick and someone needs to see them immediately. It does not matter if the doctor gets mad. He/she needs to answer their phone.
    rnlately likes this.
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    i work agency, so it can be even stickier. Had a patient with a lower GI bleed, the doctor involved was infamous for being rude/arguementive, put a page out, no call back...think I tried twice. That was my limit, at this point patient was sitting in a puddle of blood. Sent patient out to ED. Doc calls back well after the patient was gone. I was prepared for an ear full. All I got was, "well I know we have been having trouble with the service, and sometimes you just have to do what you have to do".
    Altra and netglow like this.


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