consults

[sweet sunshine]

I work evenings at a hospital, often times when we call the hospitalist about a concern they won't come to see the pt. but will order a consult with a specialist md. this could be after hours and specialist has gone home.

What to do in this situation? Hospitalist who ordered knows its after hours.

How to other hospitals handle this matter?

pt. has a problem but hospitalist doesn't want to deal with it so they consult another md to see pt. but can't see pt. until next day.

So frustrating!

[psu_213, BSN, RN]

I work evenings at a hospital, often times when we call the hospitalist about a concern they won't come to see the pt. but will order a consult with a specialist md. this could be after hours and specialist has gone home.

What to do in this situation? Hospitalist who ordered knows its after hours.

How to other hospitals handle this matter?

pt. has a problem but hospitalist doesn't want to deal with it so they consult another md to see pt. but can't see pt. until next day.

So frustrating!

A couple of different senarios of how our hospital would handle it on nights:

1. Pt goes into A fib. Call attending (hospitalist). They order a 'stat' consult to cardiology. Call cardiologist, they order dilt. gtt. (or IV lopressor, etc.). If pt is hemodynaically stable, they will see pt in the AM--If not stable, call rapid response (or however it is phrased in your facility).

2. Pt's labs come back at an odd time (i.e. midnight). High TSH. Call hospitalist. 'Routine' consult for endocrinologist. Call service--MD will see pt in AM. Although, sometimes endocrine will call you back right away to order more labs and get the ball rolling.

3. Pt has chest pain late in evening/at night. Do EKG, give SL NTG (if pressure OK), call hospitalist if no cardiology consult. This is where our floor's protocol orders would have taken over--if CP not relived by nitro, call RRT.

Now those are some senarios from my (previous) job, and the are facility specific...not sure how your facility handles them or what you hospital protocols are. Either way, if the hospitalist consults someone but the hospitlist won't come to the floor--document that you called the hospitalist, document their response, document that they said they didn't need to come see the pt, call the consult, speak with that doctor, document that you spoke with that doctor, document what they said, and document if they felt no doctor needed to see that pt at that time. (as you can see, documenting is key!)

[LouisVRN, RN]

We have a policy where we have to call the consults as soon as we get them. 2am and patients lab work came back as MRSA, and you want an ID consult. Time to wake the ID doctor up to see if he agrees with the Vanco the pt is already on. Usually our consults will call back so you can at least explain the situation and that will determine whether or not they will come in to see the pt.

[classicdame, MSN, EdD]

if you believe the patient is not being provided safe care then initiate chain of command.

[rkitty198, BSN, RN]

At my facility the doc ordering the consult has to call the consulting doc.

[jmqphd]

We have a policy where we have to call the consults as soon as we get them. 2am and patients lab work came back as MRSA, and you want an ID consult. Time to wake the ID doctor up to see if he agrees with the Vanco the pt is already on. Usually our consults will call back so you can at least explain the situation and that will determine whether or not they will come in to see the pt.

That is one dumb policy.