When the doctor doesn't respond to their page...

  1. I work in a small hospital, we have hospitalists, and we also have a few general practitioners who admit their own patients, and are usually easily accessible. However, last week, one of the practitioners admitted a patient through the ED and after I assessed her, I realized she was having severe exacerbation of CHF. I paged him SIX times, and he never called back. There was no diuretic ordered. Her bp was through the roof because she hadn't taken her ACE inhibitor that morning, none was ordered. The admitting doc does not have any partners, the hospitalists aren't allowed to write orders for his patients, I was stuck just trying to get her O2 saturation above 82 (the ED sent her up WITHOUT O2!) and her BP down. What do you do in this situation? I gave report to the oncoming nurse (this all started about an hour prior to shift change), documented every page I sent, and clocked out. I did call back the next day to check on the patient, and I informed my charge of every step, but it was infuriating. WWYD?
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    About kate4rn, ADN, BSN, CNA

    Joined: Mar '13; Posts: 15; Likes: 5
    Specialty: 4 year(s) of experience in ER, Telemetry, cardiac, trauma


  3. by   nurse2033
    Why didn't the ER get her under control? She should have gotten a diuretic in the ER. I realize that's a moot point. I would bring it up with risk management, or at least pass it on to your boss. The MD accepted the patient, then basically abandoned them. Ideally the hospital should put this MD's admitting privileges under scrutiny. You did everything right, you tried and tried, then documented your efforts. There is nothing else you could do.
  4. by   amoLucia
    When you started hitting a couple of NO CALL BACKS, did you try the house nsg supervisor? There may be some type of house protocol for her to contact the Medical Director. That would be my one extra step.

    Just know that even in LTC, we often don't get call backs in timely fashion. So a call to the supervisor and the Medical Director is usually our SOP.
  5. by   jadelpn
    I would have notified charge RN, asked if she wanted to or should I call the nursing supervisor. Also notify risk managment.
  6. by   eatmysoxRN
    Is the only thing you had a pager number? Call around to see if you can find another number. The doc should have answered.
  7. by   kate4rn
    I called his office, had the operator connect me with his cell, where I left a voice message, in addition to the pages. I feel like I followed procedure for the most part, I don't think there is a lot of precedent for this. But ultimately, as my patient's advocate, I felt helpless. As far as the ER goes, I called them out on the lack of O2, they blamed radiology, so I asked my patient. She said she wasn't wearing O2 when she was taken to C-T. It was a perfect storm, and no one would take any responsibility.
  8. by   DidiRN
    Something very similar happened to me many many years ago when I worked at a tiny rural hospital. What I was told to do my supervisor was call the police to his house for a "check on his well-being," Yes, very unconventional and not something I would do at the drop of a hat, but it worked (and boy, was he mad). Never had an issue with him doing this again.
  9. by   Aurora77
    Does your facility have a rapid response team? We can RR anyone--not just those being cared for by hospitalists. If you don't think things are bad enough to warrant that, get the house supervisor involved. There's no excuse for a provider not to be available when they have a patient admitted. Yes, they have lives too, but surely 6 pages should get their attention.
  10. by   KelRN215
    There has to be SOMEONE who can take control of the situation. I agree with calling RR, if they come there will be an MD who will take over at least for the time being and give you the orders you need.
  11. by   Altra
    A patient in respiratory distress which is not improving after administration of O2 certainly warrants a rapid response call. And after two pages -- to any physician or anyone -- it's time to go up the chain of command.
  12. by   salvadordolly
    Had a doc that used to do this all the time. We would call the nursing sup and the medical director. He eventually lost his privledges, then his lisence a few years later.
  13. by   kate4rn
    RT are the first responders in my facility's rapid response. I called them, he assessed the patient and asked if she was being diuresed. That prompted my first page to the MD. The patient's weight was 10 k more than it had been a month prior, second call to the md. BP meds weren't ordered, had the operator connect me to his cell; voicemail. I asked my charge what to do, the pt. was stabilizing, sats increasing, I gave a PRN Beta Blocker PO, so bp was coming down. The charge said "keep paging him." So that's what I did. I documented everything. At this point in the day, all administration has gone home. I emailed my nurse manager today, and her boss, she is going to send it u to the admins. I feel bad if I get the physician in hot water, but I feel worse for my patient who went through all of that.
  14. by   kate4rn
    Also, thank you all for your thoughtful replies. I'm a relatively new nurse, and feel like I did the best I could in the situation. Nurses rock!