Neurology Adult Residency Department of Neurology, Columbia University
Supervision Trigger Protocol 8.01.16
The Neurology Adult Residency Program at Columbia University Medical Center has adopted attending notification guidelines, known as “trigger protocols,” which were developed by the Housestaff Quality Council at New York Presbyterian Hospital.
These guidelines identify specific criteria that should trigger a direct phone call by a resident to the attending neurologist of record to communicate a critical change in a patient’s condition. It is expected that communication between resident and attending neurologist will generally occur within one hour following the resident’s evaluation of the patient.
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Unplanned transfer to the ICU or more monitored setting (eg., Step Down Unit)
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Unplanned intubation, or ventilator support (eg, BiPAP or C-PAP)
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Unexpected requirement for cardiovascular support
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Cardiac arrest, Code, or Rapid Response Team call
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Development of an unexpected, new, significant neurological change or emergency (ie, stroke or status epilepticus)
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Serious iatrogenic event, ie., a serious complications from medical interventions
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Unexpected blood transfusion without prior attending knowledge or instruction
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Development of any new clinical problem that requires an invasive procedure/operation for
treatment
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Initiation of restraints
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Signing out against medical advice (AMA)
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Suicide attempt
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Death
This notification trigger protocol is designed to ensure communication for serious clinical issues, but should not preclude communication for any clinical issues that do not meet the above criteria. Any member of the team should feel comfortable to contact the attending neurologist at any time for questions of clinical management. If the attending neurologist is not available, the on-call covering attending neurologist or the Chief of Service should be contacted.
Further, the inability to reach the attending neurologist should not impede necessary or emergent clinical care.