When doctors don't return calls.....

[TheCommuter, BSN, RN]

I cannot provide specific details, but I did have a terrible shift last night. Not only did I page a doctor multiple times regarding a patient who was deteriorating, but I also telephoned the same doctor's answering service numerous times. In addition, I called his personal cell phone number several times, which went straight to voice mail each and every time that I called. My next step was to report it to my nurse manager, but her phone number was not listed in the contact book because she is a newer employee.

What do you guys do when doctors don't return repeated phone calls and pages? Do your workplaces have established protocols?

[nyteshade, BSN]

When I worked LTC, if the resident's doc did not call back within the hour, we could then call the medical director, if the doc was the director, we had a list of docs that came thru the facilty, and called them in the order listed. If the patient truly needed to be sent out, I called fire rescue to take em out.

[healthstar, BSN, RN]

Great question. I always wanted to know what one would do in this kind of situation.

[Zookeeper3]

Well my facility is a bit more structured than yours so while I don't have the same dead end you hit, this still is common place with "select MD's".

Next course of action is the charge, then we have a house supervisor. After I've called 3 times, 15 minutes apart... my last call is to the service... "this is a stat call, I've not heard back.. do you have any suggestions or back road to get any doctor from the group to answer the call?" Sometimes the service knows the docs and knows who to call because that particular doc is notorious for that, so just ask.

With no house supervisor to clear your next move, I have called the police to their house to knock on the door. We now require the house soup, but prior to that, I've already put my license on the line, documented my behind off, and dang well going to hunt this golfer, movie goer, function attending orifice down.

So next line of action is to assume that there is either ill will affecting him and call the cops or it must be a medical emergency, and call the cops.

Word spreads in the doctors lounge... "did you know I blew off three calls and the cops showed up at my door?" some crazy nurse called them.

I promise, promise once you get that ok, it won't happen again and the other docs will have you on speed dial.

If your snarky, fill out an incident report to risk management, we've had a select few loose their admitting rights for 30 days. We don't play that game.

[rnlately]

In addition to the above actions, document like crazy.

[cardiacmadeline, RN]

We have had the nursing supervisor send the cops to their house on occasion. If it is one of our surgeons not answering, I may try to call one of the other surgeons even though they are not on call. I would only do this if I desperately needed orders. We once had a situation where we couldn't get hold of a surgeon, so we called the cardiologist on call even though they weren't following the patient. He did give us orders and wasn't upset about it. We also have a rapid response team, so we always have the option to call them.

[Meriwhen, ASN, BSN, MSN, RN]

If it's not emergent, I'll wait 15-30 minutes and try again.

If it's an emergency or I've tried twice with no luck, I'll notify my supervisor (though they would have already been notified that the patient was deteriorating before I started playing Hunt the Doctor), then I'll call the medical doctor and/or the medical director of the facility.

Fortunately, it's rare that I can't reach one of my doctors, even at ungodly hours. It did happen once, and I did have to call the medical director. Neither he nor the patient's doctor were bothered by my doing that.

[ButterflyNurse30]

If we couldn't get the doc to call back where I used to work we would call the hospital to make sure he was really on call...sometimes the doctors would switch the call rotation and we would not be told. If the doc was on call for himself that wasn't calling us back we would then page the medical director or if the situation was serious enough go ahead and send them to ER.

[Flo., BSN, RN]

We have a flow chart of who to call. It depends on the seriousness of the situation, some just direct you to call the medical director while others have you go through resident 1,2,3, attending, working your way up to the medical director. Lucikly my docs are very responsive.

[cookienay]

Yes, my facility does have a policy regarding this. And yes we have had to use it. It basically goes something like this. Attempt to contact for x number of times or x number of minutes. If an emergency, call the Rapid Assess team (which has an intensivist or hospitalist available). If not call the VP of medical services. Oh yeah- an incident report.

Filled out two in the last two months for physicians who feel it is optional to answer their pages. I even documented that one refused to evaluate a patient on an EMTALA form. They love me I tell ya!!

[platon20]

You guys actually call the cops? Thats ridiculous. What the heck are they going to do? Arrest them for not answering pages? Absurd. Cops have a lot more important work to be doing rather than chasing down lazy docs who wont answer their phones. I'm surprised the police would actually agree to do that kind of work.

[cardiacmadeline, RN]

Yes, it is ridiculous to have to call the police and the nursing supervisors have only done it a few times in urgent situations. And this decision is really thought out before calling them and other options talked about. (Is there another doc that could handle the situation?) Usually, we do it if there are a couple of units that can't get a hold of the doc on call and there is an urgent situation that needs a MD's attention ASAP. Let's say you have a patient in the ICU crashing, can't get a hold of the surgeon on call, can't get a hold of the other surgeons that are not on call and this patient needs emergent surgery. What are you going to do? Tell the family "oh sorry, we can't do anything because Dr. So and So won't answer his calls"? Transfer him to another hospital because Dr. So and So won't answer his calls? If it is a life or death situation, darn right we're calling the cops.