General Duties & Workflow
Pick up or reassign the Medicine Consults pager to yourself at 6:45 AM.
If scheduled to Sinai Community Care, sign out the consult pager to the CCU resident at 12 PM.
When doing a Consult…
Add each patient to the “Medicine Consult” list on CORES.
The type for each note is “Medical Consult Note”
Title each note “Medicine Consult Note”.
If the patient may be better suited under the Medicine service, this can be suggested to the primary team.
Staffing Consults…
During the week: non call team attendings [Baltazar/Himelfarb or Tabatznik/Kassel], equally distributed.
During nights: staff with the nocturnist. Triage the consult with the nocturnist prior.
During the week...
Check your list on a daily basis.
See new consults, but reassess the current list as well.
For patients seen for pre-operative evaluation, if they are stable and do not have active medical issues on post-op day 1, you can sign off with attending physician approval.
If you write on the note that “We will follow along with you,” please make sure you are reassessing periodically if a patient needs the medicine consult service or you can sign off.
If a patient has been transferred to Medicine, you can take the patient off the list.
Daily at 4PM, the pager and sign-out should be forwarded to the Lead Physician. Text the Lead Physician to let them know the pager is reassigned to them. Try to avoid passing on any pending consults.
If there are important issues to follow up on the weekend, please sign out to the consults attending.
During night float…
At 6:45PM, the NF Admitting (MAO) resident is to transfer the Medicine Consult pager to the RR2 pager and the NF Admitting resident will see Medicine Consults until 6:00AM.
If consults are requested after 6:00AM, please return the page and obtain all of the pertinent information and add it to the sign-out.
Verbal sign-out must be given to the daytime Medicine Consult resident.
Add completed or pending consults to the sign-out.
On weekends…
Consults are covered by the: non call team attendings [Baltazar/Himelfarb or Tabatznik/Kassel], equally distributed. Ensure that the Medicine Consult Pager is reassigned prior to leaving on Friday afternoons, as this can be arranged ahead of time.
Curbside Consults….
This is frequently asked for by other services. If there is any doubt or concern, always do a formal consult and staff with the appropriate attending.
Declining Consults…
If there is an inappropriate consult placed for Medicine, discuss with the consult attending and then refuse the consult if deemed necessary.
Inappropriate Consults…
If there is an issue on the Medicine Consult service, inform the chief residents immediately so this can be escalated.
Who to Discuss Consults with:
During the week - Non-call teams’ attendings [Baltazar/Himelfarb or Tabatznik/Kassel], equally distributed.
During the night - Nocturnist holding the Gatekeeper phone.
Ground Rules
Medicine Consult resident(s) should be available from 6:45AM to 4PM Monday to Friday.
Holidays and weekends are off for the residents of the Medicine Consult Service. Sign-out should be completed and sent to the covering attending physician. All Medicine consults need to be staffed with an attending. Do not sign off until discussed with an attending.
If a patient goes to the ICU postoperatively, unless the primary team is requesting a medical consultation, the postoperative evaluation can be deferred until the patient leaves the ICU.
Attend Morning Report, Board Review, Noon Conference, Grand Rounds.
If called to “transfer to medicine” clear any bias and evaluate the patient objectively for need for transfer. Do what is in the patient’s best interest and never attempt to “block.”
When there are two residents, alternate new consults during the day or alternate consult days. Alternating consult days means that both residents come to work but one resident could do follow ups and the other should take new consults.
Preoperative Evaluations
Preoperative Evaluations - Review this presentation done by one of our former residents, Dr. Jeremiah Reese, regarding preoperative evaluations. It’s very helpful! Also see Hopkins Module on pre-operative evaluation for more tips!
general surgery —> Medicine
SICU DOWNGRADES TO MEDICINE: If Surgery would like a Medicine team to assume care of a SICU patient once they are transferred out of the ICU, a Medicine consult can be called 24-36 hours before the anticipated transfer occurs or when the transfer order is put in by SICU. If a patient was on Medicine prior to the SICU transfer, a Medicine Consult is required to return to the Medicine service. The patient should be seen and staffed with the attending. Once accepted and a bed is available, SICU should call Gatekeeper with the bed assignment and transfers the admission. The accepting Medicine attending’s name should be listed in Cerner as “Attending” and the Medicine Consult note should be addended to indicate who the accepting attending is.
SURGERY UPGRADES TO MICU: If there is a surgery patient who needs to be evaluated for transfer to higher level of care to MICU, the surgeons can directly request a consult by calling the MICU intensivist phone. There is no need to call a Medicine consult first to decide whether or not a MICU consult is appropriate.