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Discussion

Advice for calling consults

For all you inpatient NPs/PAs--do you have any sound advice on techniques for requesting specialist consults on your patients? I do this on a pretty regular basis, generally under the instruction of my chief resident or the attending. I would say that 50% of the time I am initially denied, and 90% of the time I am told they will "see the patient tomorrow"--until I say "look, the attending is asking for this and wants it to happen today. I'm just the middle-man here". At which point, they get annoyed, a tense conversation follows, until they eventually agree to see the patient.

Does anyone else have this problem? Has anyone had this problem in the past but have since found a solution? And, most importantly, do any of you receive requests for pt consultation and have certain pet peeves about how these requests are made?

Really appreciate any advice, thanks!

-Kan

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    I wouldn't say this hasn't happened to me but I don't come across the issue frequently enough to become a matter of concern for our service. There could be some internal issues within your organization that you are not aware of (i.e., past history of stat consults not really being stat, lack of personnel coverage for the services you are consulting to who can immediately see stat consults on off hours).

    I guess if ever this issue comes up, I would try my best to explain the rationale behind the stat consult (i.e., what's acutely going on with the patient) and the concern that a delay in the consult could result in adverse outcome for the patient. This, at the same time, maintaining a diplomatic tone or stance with the person on the other line. If it didn't work, there's no shame in invoking the chain of command in such as situation. Luckily, I've always had assurance from our fellows and attendings that if a consult service is giving me grief, I can always turf the issue to them and they will deal with the problem.

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    Yeah, I've turfed a couple. Hated doing it--feels "failury". But it's about getting the patient seen, so ultimately it's just my ego and the senior's schedule that get burned. The thing is, these are not "stat" consults--they're just same day. It's hard to convince ID that my cellulitis admission with multiple sketchy abx allergies (don't sound like true allergies) needs to be managed by a specialist. Today. When he may actually be occupied with more concerning issues. I think if our service wasn't so busy and we'd actually been able to have a conversation about our admission, we may have determined that a consult wasn't necessary. But alas, I'm on the floor, I have my instructions, and everyone is in the OR. I think this particular attempt at getting a consult kind of black-balled me from ID.

    I appreciate your advice. I do try to present a clear and concise clinical picture, but I'm still met with resistance. I think I just need to keep trying and adapting as I learn all the ways I am annoying. :-P

    Thank you again :-)

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    Well, you learn from these little service-specific nuances. We don't typically call ID for issues like this as we have a great Pharmacy service that can decipher allergies and recommend antibiotic choices. In our institution, I can see ID maybe getting a little ticked off for a consult like this especially if the patient is a fresh admit with no cultures/sensitivities to go by. But hey, you're team is requesting the consult so the least they can do is offer their recommendations so I would try my best not to let it bother me as much.

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    Yup, I think you are totally spot on. And really, at the end of the day, the biggest problem I'm having is that I am "letting it bother me". None of it is personal in the hospital. Or rather, even when it IS personal, it's not personal. Ya know? :)

    -Kan

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    Hi! I am starting NP school this Fall so I don't have experience with calling consults. But, my boyfriend is a cardiology fellow and I hear him vent about this all the time. The consult service rotation is one of the worse for him- he just gets burnt out and admits to being short with people because of the constant calls for consults regarding patients with physiological bradycardia or to read ECGs. At the hospital, consults can't be refused as well. He has said when people call, some things that really bother him is when the other service calls requesting an ECHO or other type of cardiac procedure- they are not trained to make that decision but ordering it is up to the cardiologist or when the person calling doesn't seem to know much about about the patient or "isn't thinking it through." If he's short with someone he says that it's not because of them usually just the situation- so don't take it personal. Don't know if this helps at all

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