Department of Medicine Transfer of Care Policy

Transcription

1 CARDIOLOGY From 7am to 5pm on weekdays, the cardiology fellow is contacted by the emergency rooms for admissions to the service. The cardiology fellow will evaluate all these patients for acuity to ensure appropriate level of care after discussion with the attending. Each patient will be seen by the housestaff and the attending physician the same day for non-emergent care. Transfers from outside facilities are coordinated through the attending physician. After hour and weekend service is provided by the on call attending and fellow. A listing of call schedule is available on the Cardiology web site with daily updating. All patients admitted after hours to the CCU will be seen by the cardiology fellow who will write an admission note and contact the on call attending physician for review. At approximately 10 pm the on call fellow and the on call attending physician will establish contact to review status of the inpatient service. In the event of a patient needing prompt mechanical intervention for STEMI, the on call fellow will contact the on call invasive cardiology attending and mobilize the cath lab. For situations where need for immediate intervention is less certain, the on call fellow should contact the noninvasive on call attending. The noninvasive attending will be notified of urgent interventions for STEMI. TRANSFER OF CARE At 5 pm on weekdays the on call fellow will meet with the inpatient fellow and if there are patients on cath service or EP consultative/outpatient service these respective fellows will also participate in handoff. If there is ongoing activity in the cath lab or EP lab, the on call fellow should ascertain status of patients in procedures and ensure that the labs do not require their support prior to leaving the hospital while on call. The inpatient attending will contact the on call attending by telephone for handoff. After hours, the on call cardiology fellow is contacted by ER for admissions to the cardiology service. For admissions through ECC, the cardiology attending is contacted for transfer. At 7 am, the on call attending will contact the service attending for handoff and the on call fellow will contact the service fellow for handoff. For weekends there is one on call attending for Friday, Saturday and Sunday and handoffs between attendings will occur at 5pm on Friday and 7am on Monday. There is a primary and secondary fellow for weekends and on Friday pm, handoff procedure would be similar to other weekdays. Page 1 of 7

2 Cardiology notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of care. NOTE: The majority of cardiology inpatients and 23 hour observation patients are assigned to the cardiology inpatient service which consists of an attending physician, a cardiology fellow, 2 internal medicine residents, 2 or 3 interns and 2 or 3 medical students. When a cap of 20 patients is exceeded, the overflow patients are assigned to the cardiology consult attending and fellow. There are a small number of both 23 hour observation patients and in-patients who are managed by the fellow assigned to the cath lab or EP lab with invasive cardiology or electrophysiology faculty as attending physician respectively. DERMATOLOGY (NA) CONSULT SERVICE available via proxy to all faculty and residents. This forms the basis for transition of care. Since Dermatology notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of patient care ENDOCRINOLOGY (NA) CONSULT SERVICE Fellows: Transfer of care between the endocrine fellows occurs by telephone and/or in person the day before and/or the day of the transition of care. Attending physicians: Endocrine attending physicians typically attend on and are on call for the endocrine consult service ~2 weeks at a time (excluding some holidays meetings, etc.). Page 2 of 7

3 endocrinology notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of patient care GASTROENTEROLOGY (NA) CONSULT SERVICE For transfer of care of patients on the GI/Hepatology Inpatient Consult services, faculty and fellows on the Consult Service, and On Call at MCG/GHSU and Charlie Norwood VAMC, attending to attending transitions of care (TOC) will ideally take place face to face involving a (S-BAR format). This TOC between attendings may be done in person and/or telephonically depending upon circumstances. Gastroenterology notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of patient care. Procedurally, this entails: 1. The GHSU and VA consult fellows will sign out the patients on the consult service to the on call weekend fellow verbally prior to leaving the hospital for the day. In addition, the consult fellows will forward a list of the consult patients to the on call fellow. This should optimally be done between 5-6pm. The list will include patient information, location, problem list, pending studies, treatment plan. The same format will be followed for holiday (long weekend) call. 2. A GI consult in-patient group list will be created and maintained daily by the inpatient Consult or On call fellow, and will be used and shared daily between the fellows and faculty to facilitate hand off of patients on the consult service during evenings and weekends. All GI faculty and fellows will have access to this list. This list will be created in Cerner Power Chart and updated daily by the inpatient consult fellow at MCG/GHSU. All GI faculty and fellows will be trained on the use and location of this list 3. At the conclusion of the on call fellow s call, he/she will sign out verbally to the MCG/GHSU and VA consult fellows no later than 8:00 am on the morning that the GHSU and VA consult fellows take over. An updated consult list will also be sent to the GHSU and VA consult fellows by 8:00 am. 4. The faculty on the inpatient consult service at MCG or VA will sign out either verbally to the on call faculty staff, using the list. Any unstable and challenging problem cases that require definite follow up and attention over the weekend/holiday period, at either hospital. Likewise, the On Call faculty will sign out either verbally or via any particular problem Page 3 of 7

4 cases to the inpatient consult staff the following Monday or after weekend/holiday call in order to ensure continuity of care plan and management. GENERAL INTERNAL MEDICINE Internal Medicine faculty take consecutive call while on the inpatient service during weekdays, however, faculty cross-cover on weekends. Internal Medicine notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of patient care. Night admissions: Residents are expected to call attendings at 11 pm and at any time they have admissions to discuss. They are also expected to contact the assigned attending of record at 6-7 am to review admits to the service. The Orange Medicine attending will staff all consults including night consults, when they are on service. The expectation is that the attending will staff non-emergent consults the same day or within 24 hours. HEMATOLOGY/ONCOLOGY There are 3 services in Hem/Onc. 1. Daytime o There are three attendings covering at any given time. General Hem/Onccovered by an attending. Service also has a fellow and 2 Interns. CAp 20 Patients 2. Non-teaching service o Attending, also has a fellow and two extenders. o BMT, has a transplant attending and 2 Extenders 3. After hours o There is an attending on call. First calls are taken by the fellow. Weekends Two call teams 1. One attending and fellow cover General Hem/Onc 2. A second attending and fellow/extender cover BMT and the uncovered service. Page 4 of 7

5 Hem/Onc notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of patient care INFECTIOUS DISEASE Infectious Disease faculty take consecutive call while on the inpatient service during weekdays, however, faculty cross-cover on weekends. All Green Medicine patient admissions are called to and discussed with the Green Medicine faculty physician at or before 11:00 pm. Attending to attending transitions of care (TOC) will ideally take place face to face involving a (S-BAR format). This TOC between attendings may be done in person and/or telephonically depending upon circumstances. For continuity of care on the consult service attending to attending transitions of care (TOC) will ideally take place face to face involving a comprehensive discussion of the patient s medical condition and issues surrounding their care (S-BAR format). This TOC between attendings may be done in person Infectious Disease notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of patient care NEPHROLOGY Medicine Resident/Hospitalists are expected to call the on call fellow with every admission to Yellow, Floor, ICU or change in patient status throughout the night. Attendings are expected to be notified by either the resident or fellow with every admission to Yellow, Floor, ICU or change in patient status throughout the night. Attendings are expected to be notified by either the resident or fellow with every consult to nephrology throughout the night. Page 5 of 7

6 Nephrology notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of patient care PULMONARY Most night call and weekend/holiday call is done by the on call pulmonary attending. These physicians rotate for 7 straight days, nights, and weekends. Night call is from home and weekend call is a full day on Saturday and Sunday and holidays. For transfer of care, it is important that transfer of patient care between the regular MICU attending and the on call attending be as smooth and seamless as possible. Attending to attending transitions of care (TOC) will ideally take place face to face involving a (S-BAR format). A short typed summary of each patient s case history is also incorporated into the handoff. This TOC between attendings may be done in person and/or telephonically depending upon circumstances. The on call physician is listed in the MCGHI OnCall located on the main web page. Pulmonary notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of patient care RHEUMATOLOGY TRANSITION OF CARE Rheumatology faculty and fellows take consecutive call during the week and on weekends. Fellow call schedules are at-home call for nights and weekends and are in full compliance with ACGME duty hours requirements. Transitions of care are direct hand-off from fellow to fellow with cases then discussed with the appropriate attending. Attending to attending transitions of care (TOC) will ideally take place face to face involving a (S-BAR format). This TOC between attendings may be done in person and/or telephonically depending upon circumstances. notes/consults are written within the EMR, this information is electronically available at the bedside or remotely at the time of the transition of patient care. The Rheumatology Service does not have an inpatient service. Page 6 of 7

7 CONSULT COVERAGE The Rheumatology Service provides outpatient and inpatient rheumatology consultative services but do not attend on general medicines services at GHSU. Rheumatology outpatient and inpatient consultative coverage is divided up among the three faculty (approximately 10 days per month per attending) with the fellows serving as the consult fellow on a rotating basis. All new cases are discussed with the attending by the fellow and seen by the consult attending within 24 hours. Follow-up inpatient and/or outpatient care is provided by the assigned consult fellow and the consult attending. Note: The Rheumatology Fellowship operates under the guidance of and fully supports the GMEC endorsed Georgia Health Sciences University House Staff Policy and Procedure: HS 24.0 Transition of Care Policy Page 7 of 7