These guidelines identify specific criteria that should trigger a phone call by a fellow to the attending physician to inform the attending of a change inpatient condition.
Policy
Expected communication practices when there is a critical change in the patient’s condition are that the attending will be notified, generally within 1 hour following evaluation.
These include:
- Unexpected neurologic or hemodynamic deterioration of a patient
- Unplanned intubation, or ventilator support (e.g., BiPAP or C-PAP)
- Unexpected cardiovascular support (e.g., addition of pressors)
- Cardiac arrest or Code called
- Development of significant neurological changes (suspected CVA, seizure, new onset paralysis)
- Opioid overdose or neurotoxicity suspected from opioids
- Iatrogenic event: serious complications from medical interventions
- Unexpected blood transfusion without prior attending knowledge or instruction
- Development of any clinical problem that requires an invasive procedure/operation for treatment
- Initiation of restraints
- Signing out against medical advice (AMA)
- Suicide attempt
- Death
- At patient or family request
NOTE: This protocol is designed to ensure communication, but should not preclude communication for any issue short of the above criteria. Any member of the team should feel comfortable to contact the attending of record at any time for questions of clinical management.
***Inability to reach the attending should NOT impede needed or emergent clinical care***