Cmnctn
Consultation
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Consultation
, Referral and Consultation
Approach
Relationship
Maintain a friendly, collegial relationship with consultants and hospitalists
Approach as a longterm relationship
Socially converse when time and situations allow
Follow-up on shared patients
Learn from their expertise
Treat as partners working for the best interest of the patients (as opposed to adversarial relationships)
Assist consultants when they need help from the emergency department or other consulting services
Assist with order placement, procedure set-up, consent process
Connect them with nursing staff or technicians who can assist them
Acknowledge when "dumping on admitting or consulting services"
Thank them for their help in particularly difficult situations
Approach
Consultation (example)
Introduction
Introduce yourself
Write down their name and the time of the phone call
Thank the consultant for their involvement
Frame the Consultation (brief overview)
Subjective
65 year old female with a history of diabetes and coronary disease
Presents with a 5 day history of progressive exertional
Chest Pain
Assessment
I suspect
Unstable Angina
and
Plan
I would like to transfer this patient to you for further evaluation
Details (pertinent)
Subjective
Anterior, substernal
Chest Pain
with radiation to both arms, jaw
Associated
Shortness of Breath
and
Nausea
. resolved prior to presentation
History
S/p
PTCA
with DES x2 to LAD in 2012, last echo 1/2013 with 45% EF, no WMA
On
Metoprolol
,
Aspirin
,
Plavix
,
Atorvastatin
Objective
Last BP 110/60, HR 95,
O2 Sat
s 93% RA and unremarkable exam
Normal
Troponin
, unchanged ekg,
Chest XRay
Plan
Given
Aspirin
325, oxygen, nitro-paste and
Heparin
Listen, clarify history and answer questions
Ask specific questions when seeking consultant advice
Summarize your understanding of next steps
We will await RN report and will then obtain
Ambulance
transport to your facility
I estimate one hour from that time to arrival at your facility
Are there any other measures you recommend prior to transport
Closing
Thank you for your assistance with this patient's care
Precautions
Tribalism (or the specialty clique)
Avoid using team cohesiveness (e.g. Emergency providers) to isolate other groups or consultants
Avoid labeling other specialties with negative characteristics
Encourage collaboration and mutual respect
Lin and Brazil in Herbert (2015) EM:Rap 15(12): 6-7
References
Sacchetti and Herbert in Majoewsky (2013) EM: Rap 13(9): 4
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