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

[TheCommuter]

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?

[mykrosphere]

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!

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."

[BabyLady, BSN, RN]

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."

[gentlegiver, ASN, LPN, RN]

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.

[diane227, LPN, RN]

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.

[morte, LPN, LVN]

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".