Figuring out how to contact the physician

[rnmi2004]

I work nights on a med-surg floor, and one of the most frustrating aspects of it is when I have to contact a physician. We have several different physician groups & specialties we deal with, and it seems every one of them has a different policy.

Some groups want you to call the admitting attending. Others use residents. But only for certain cases. You might be able to figure it out by looking at the chart & seeing if you recognize a resident's signature on the progress notes. Some doctor groups have attendings that will use residents; other attendings within the same group will never use residents. Sometimes there is an answering service & they will page whoever is on call. Or maybe you're supposed to call the doc at home. Or page them. Others want to be text paged. One group wants you to page the PA with "minor concerns" but the PA isn't always on at night & may only be on until midnight; and as far as I can tell there is no real way of knowing if the PA is on until you've paged them repeatedly & they don't call back. Sometimes an MD will be in an independent practice that has other doctors take their calls certain nights.

If you're lucky, the rolodex will have notes on how to contact the MD; sometimes the group is listed in the on-call book; sometimes you have to ask other nurses.

It is so frustrating when the "rules" on who to call are different for every patient & every doctor group. And then when you choose wrong, whoever you called or paged yells at you because you woke them up & they're not the one on call, or you were supposed to call the resident, or they resident says you need to call the attending.

Is this common? What goes on in your area & has your hospital come up with ways to easily contact the physician?

[mom23RN]

Boy, that sounds awful!!!! Have you talked to your supervisor about this? How about the docs? I would think having a book with the docs listed would be a great idea. The first contact number for them should be the number that they would like to be contacted through. Whether that be their cell, answering service, etc. They could even put in the residents name as that contact if that's who they would like contacted or even the resident's beeper number or such.

I sure hope you get that straightened out! If not, head:D to ER. At least there we never had to worry about that stuff!!! :roll

[TazziRN, RN]

The last place I worked, we called the answering service and they put us in touch with whoever was on call. The place I'm at now, we're so rural the ER is the answering service.

[Mississippi_RN]

We have a physician book (needs updating though) that lists how each dr wants to be contacted. A form was sent out to each dr asking how to contact them (after 5pm and weekends for example...) for questions about their patients. All of the docs were pretty good about responding, especially since it helps us help them (and leave them the heck alone if they wish)... LOL

[ammason0302]

Hi there!!

Whew!! That sounds like such a mess. It really sounds like an issue that needs to be addressed by management. To make things run smoothly on a med/surg floor, there needs to be a few things that are consistent such as which MD to contact and how to contact them. I would talk to my coworkers and gather several people who would like to see change. Then you can approach your supervisor with ideas of how to fix the problem. Hopefully you have a good supervisor who values your opinion. Good luck!!

[rnmi2004]

Thanks! A few months ago, I read in a newsletter that a plan was being formulated to make it easier for staff to figure out how to contact the physician & how...that was months ago & I haven't heard anything since. So the higher ups know it is a problem--I guess that is a good first step that they're acknowledging the problem?

[HappyNurse2005, RN]

Our operators here handle that. I dont know if they have a list or its intheir computer, but they know. We are a big teaching hospital (many, many residents) with a bazillion specialties available, many local doctors offices, etc.

Since we are primarily a post surgical floor, we do have a note up that tells us the surgeons would rather be called at home after 11pm instead of paged.

[Runningnurse]

I guess it's a bit different for us...we're a pretty big teaching hospital, so there's always an intern on call overnight. During the day, the interns are always your first call.

Our problem is who to call if we have off-service patients. I'm on an oncology floor, but we get a lot of gen meds if those floors are full...and there are nine different gen med teams. So depending on which number team your patient is on, you have to figure out who the intern is that day. But it's all online, and at night the pagers all roll over to the covering intern.

[Antikigirl, ASN, RN]

Oh man! We have a listing that is updated bi monthy that gives all the numbers and preference in calling of all MD's! Docs can choose what number they wish first, second and so on, and an after hours line as well!

We also have a section in our pt assignment sheets of who is who for hospitalists that shift, who is acting for who if someone isn't there..and so on! If you can't figure it out our charge nurse has that information 24/7 so you ask them!

When all else fails, I typically call their answering service and have the MD paged. I see it this way..if I need to call the MD about a patient and don't know where else to turn..it is vital enough to call who is responsible for that patient IE the MD! This includes pain management and sometimes I get slack for that..but hey...pain needs tx!

I would talk to your administration or supervisor...nurses wouldn't be able to do much if they can't get a physician 24/7...so that info must be readily available to someone...have to find out who or where!

[LoraLou]

luckily i work in a teaching hospital in an ICU, so there are intensivists during the day, and when i'm working nights i have the intern that I have to call, who if they have a problem will call the resident over the hospital, who then has to call the on call intensivist, if we have issues with what the intern ordered or anyone else we follow the same chain of command. We also have eicu with attendings there from 6pm to 7 am and can call them with orders. When I float to Open heart recovery we call the surgeon who did the surgery while they're usually jerks at least I know I'm calling the right person.