General guidelines on when to call dr. Or transfer pt.

[lizzyberry]

Hello, I was reading another post about when to call the dr. What are general guidelines on when to call the dr. or transfer a patient to ICU or IMCU, for example a patients BP is 70/60 or if a patients O2 sats are low, any tips? Thanks

[Virgo_RN, BSN, RN]

Generally speaking, I would say that any change in patient condition that is not resolved with nursing measures, but requires medical intervention, would buy a phone call to the doc. For example, say you have a postop pt. who is spiking a temp and requires a couple of liters of O2 via NC to sustain a sat >92. My first response would be to encourage intensive TCDB and IS. If the temp and low sats do not respond to those nursing measures within a couple of hours, then I'd be calling the doc. If, on the other hand, I couldn't keep the pt's sats >92 without NRB flush, then yeah, I'd be calling the doc right away and not messing around with nursing interventions. They need medical assistance immediately. If I can't reach the doc immediately, then I'd be calling rapid response AND calling the doc.

A BP of 70/60 is not compatible with perfusion adequate to sustain life. That would require immediate action, again in the form of rapid response if the doc is not immediately available.

Whether any of those situations requires transfer to a higher level of care depends on how the patient responds to the interventions, and what the root cause of their problem is. Some patients just need a little Lasix, a bit of Bipap, or a fluid bolus, and they're fine after that. Others need more than that, and transfer to a higher level of care is appropriate.

The general guideline on the inpatient unit that I used to work on was that any patient who required greater than two hours of Q15 minute monitoring needed to be transferred to the ICU. Also, certain gtts and obviously mechanical ventilation could not be done on the unit.

[CABG patch kid, BSN, RN]

I'd say it depends on your facility, because what one unit can or can't do varies by hospital. For example, on our stepdown/tele floor, we don't do any vasoactive gtts, so if the pt needed Neosynephrine for that BP, he'd have to go to ICU/CCU. You'd have to find out what the unit guidelines are.

Most importantly though, it depends on the pt and disease process. A pt with a really bad cardiomyopathy may live with a BP of 80/50 and in that case you wouldn't want to transfer a pt because of that. You really need to look at what's normal for that pt and what the trend has been.

[Virgo_RN, BSN, RN]

Actually, I just checked, and 70/60 has a MAP of 63.