Bad Consult:
Consulting renal, patient had diabetes, ckd, cabg 4 years ago, chf exacerbation, diuresed him gave lasix, irregular rhythms, amiodarone, became short of breath, got CT angiogram showing bilateral PEs, DVTs on heparin drip, bridged to coumadin. patient had high creatinine this morning. wondering if you could help us out.
What consultants have to pull out of consulter: (SAMPLE)
Mr john smith, 10w, bed 2, MRN number 2675555, what specifically is the question for consult: high creatinine, baseline creatinine of 1.8, 2.2 in january, last year 2.2, 2.3 range it is today 2.5 starting to get scared. what are the other electrolytes phosph 4.2, calcium 8.8, albumin 3.1, BUN 35, potassium 4.1, sodium 138. not sure why medicine needs a consult, creatinine rise after contrast
Important things in a consult: name/team of caller, pager/phone number, patient name, MRN, location, brief HPI, clear question, urgency of consult, polite deamanor, whole patient history, initial workup
When it comes to consultations, there are several important components to include in order to ensure effective communication and collaboration between healthcare professionals. Here are the key components:
Name/Team of the caller: Clearly state the name and, if applicable, the healthcare team or department of the person placing the consult. This helps establish proper communication and ensures accountability.
Pager/Phone number: Provide a pager or phone number where the consulting physician can reach the caller for any necessary follow-up or additional information. This enables efficient communication and facilitates the exchange of pertinent details.
Patient name: Clearly state the full name of the patient for whom the consultation is being requested. This helps avoid confusion, especially in busy healthcare settings where multiple patients may require attention simultaneously.
Medical Record Number (MRN): Include the patient's unique medical record number, if available. The MRN assists in locating the patient's comprehensive medical information, test results, and previous medical history.
Location: Specify the patient's current location within the healthcare facility, such as the ward, room number, or department. This ensures that the consulting physician can easily locate the patient if an in-person evaluation is necessary.
Brief History of Present Illness (HPI): Provide a concise summary of the patient's current symptoms, relevant medical history, recent interventions or treatments, and any noteworthy changes in their condition. The HPI should focus on the key clinical details related to the reason for the consultation.
Clear question: Clearly articulate the specific question or concern that needs to be addressed through the consultation. This helps the consulting physician understand the purpose of the consult and provide targeted recommendations or guidance.
Urgency of consult: Indicate the level of urgency for the consultation, whether it is an immediate or urgent matter requiring prompt attention or a non-urgent issue that can be addressed within a reasonable timeframe. This information assists the consulting physician in prioritizing their response and action.
Polite demeanor: Maintain a professional and respectful tone throughout the consult request. Being polite and courteous fosters a collaborative and cooperative atmosphere among healthcare professionals.
Relevant patient history and initial workup: Include pertinent details from the patient's medical history, such as previous diagnoses, relevant test results, imaging studies, medications, allergies, and any ongoing treatments or interventions. Additionally, mention the initial workup or interventions that have already been performed, if applicable, to avoid repetition and guide the consulting physician's assessment.
By including these important components in a consultation request, healthcare professionals can ensure clear and effective communication, leading to comprehensive and targeted recommendations or guidance for the patient's care.
Here's an expanded list of components that should be included in consultation results:
- Date and time of the consultation request.
- Patient's age.
- Patient's medical record number (MRN) and current location within the healthcare facility.
- Name of the consulted service and the name of the requested consultant, if specified.
- A clear and concise narrative statement summarizing the patient's problem and the reason for the consultation.
- Patient's past medical history, including relevant comorbidities, previous surgeries, and significant medical events.
- Pertinent laboratory results, diagnostic data, and imaging findings that are relevant to the consultation.
- Current diagnosis or working diagnosis, if available.
- Medications the patient is currently taking, including dosages and frequencies.
- Indication of when the consultation request was made (date and time).
- Name, printed and signed, of the requesting physician or healthcare professional.
- The level or title of the requesting physician or healthcare professional.
- Dictation code, if applicable, for proper documentation purposes.
Here are the seven steps of a courteous consult using the mnemonic CONSULT:
Contact the consultant courteously, Orient, narrow question, story, urgency, later, thank you
Contact the consultant courteously: Initiate contact with the consultant in a polite and respectful manner. Clearly introduce yourself, state your role, and express your request for a consultation.
Caller's name, training level, team
EXAMPLE: Hello my name is _______ (first name), and I am a ______ (training level) on the _______ (team) service. I am calling to request a consult from your service please.
Orient: Provide a brief orientation by giving relevant patient details, such as the patient's name, age, medical record number, and current location. This helps the consultant quickly identify the patient and access their medical information.
Patient name, MRN, Floor and bed. Provide more identifiers than one to make sure they have right patient
EXAMPLE: The patient is Mr/s _____, MRN is _____, located on _____ (floor) in bed _____.
Narrow question: Clearly define the specific question or issue for which you are seeking consultation. Be precise and concise to ensure the consultant understands the exact information or guidance you need.
REASON for CONSULT;
- ask a focused question regarding the diagnosis (workup, procedures) and/or management (treatments, procedures, escalation, pre-op)
- consultations necessary: diagnosis obscure, therapeutics in question
EXAMPLE: our question for you is: "how should we continue the workup for this patient's _____ (problem: i.e acute renal failure, fever, abdominal pain, etc.) and what is your opinion on the diagnosis?
Therapy example: Can you help us in the management of our patient's _____ (problem: i.e heart failure, uncontrolled blood sugars, small bowel obstruction, severe sepsis, etc)?
Story: Provide a brief but comprehensive narrative or summary of the patient's history, including the relevant medical history, presenting symptoms, pertinent findings, and any previous interventions. Present the information in a logical and organized manner to facilitate the consultant's understanding of the patient's situation.
HPI pertinent: patient age, gender, pertinent history (hpi), hospital course, relevant labs, radiology, anticipated plan
Example: Briefly, Mr. _____ is a _____ (age) year old ) _____ (gender) with ____ (list only pertinent medical problems) admitted with _______ (main problem or diagnosis). During his hospital stay, he has developed _________ (be brief and relevant!). His labs showed ________ (relevant labs only) and films showed _________ (relevant radiology only). We think he may have _______ and would like to do _______ (workup and/or management plan).
Urgency: Clearly communicate the level of urgency for the consultation. Specify if it is an urgent or emergent situation that requires immediate attention, or if it is a non-urgent matter that can be addressed within a reasonable timeframe. This helps the consultant prioritize their response.
How soon does the patient need to be seen?
- 30min-1hour (emergent)
- 2-3 hours (very urgent)
- today -8 hours (urgent)
- 24 hours (routine)
EXAMPLE: this patient can be seen routinely, needs to be seen emergently.
Emergency consultation: patient's life, limbs, vital organs are at significant risk
- direct communication
- one (1) hour from the time of request, 30 minutes if from ED
Urgent Consultation
- acutely ill patients
- prompt workup and assessment
- specialty procedures or management
- significantly affect continued hospital stay
- not exceed eight (8) hours
- within two (2) hours if from the ED
elective consultation (routine)
- neither emergent or needed to proceed with treatment
- no more than 24 hours following request
- if LOS not affected may be extended over weekends and holidays
- may be completed after discharge and not delay hospital discharge or other planned procedures
uncontrolled diabetes (not main problem, endocrine consult may expedite discharge)
Later: If there are additional details, test results, or any other information that will be available later, inform the consultant about it. This ensures that they are aware of any pending information that may affect their recommendations or decisions.
make a follow-up plan with consultant (how and by when?) give your pager / cell number. phone conversation, note may happen later in the evening
phone call allows for discourse and questions to be asked
EXAMPLE: Can you page me ______ (later today / tomorrow) at )_____ (pager / cell phone number) to let me know what you think after you have evaluated the patient."
Thank you: Express gratitude to the consultant for their time and expertise. A simple "thank you" at the end of the consult conveys appreciation and professionalism.
Be courteous and polite (even if they are not!)
avoid calling a consult just to be "on board" with no particular question for that service to address
for diagnostic questions, have a differential in mind and have begun initial workup
for therapeutic questions have an anticipated management plan
have pertinent information available (either written or open on EPIC)
follow up with consultants to ask questions and discuss the outcomes of the case (it's your time to learn!)
Better consult:
What goes well how it is different
SAMPLE:
hi renal fellow, andrew, medicine intern, wondering if ask a consult, gentleman mr. John smith MRN 2765555, he is located in 10w 102b. specifically ask for help in the diagnosis and treatment of acute kidney injury. 72 year old gentleman, CKD 2-3 baseline 1.5, diabetes, CHF came in originally with CHF exacerbation, diuresis aggressively with lasix, yesterday became short of breath, CT angiogram showing PE started on heparin drip, labs in morning showed Cr from 1.5 to 2.5. Have you checked urine electrolytes or FE urea, yes those have been sent. What do you think has happened for AKI? Think about overdiuresis and contrast induced nephropathy. I was wondering if you would be able to see the gentleman today? yes, could you please page me later today. Yes I will give you update after I see the patient and talk to attending?
Comments
Post a Comment