Consulting with specialists

Question 1

Presenting to your Supervising Physician or a Specialist in an ER setting.

Answer 1

• More important than you think
• It is not unlike how you would present to any Physician
• Important to recite key points
• Prepare your thoughts
• Organize what you will say.

Question 2

Physician and Physician Assistant Relationship – Vital partnership

Answer 2

• Usually not the same physician everyday
• Different Styles
• Different comfort levels in working with PAs
• Different comfort levels with you specifically

Question 3

To safely discharge a patient:

Answer 3

• Needs a direction
• Ask about Insurance, PCP, ability to follow-up
• Document this in the chart
• PCP if complicated, communicate test results, diagnosis, etc.
• Important for collaborative care.
• Team Discharge

Question 4

Key Points of a Discharge

Answer 4

• Document:
  Final Diagnosis
  “Disposition” – Home, Admitted, Transferred
  Diagnostic Rationale (or called Medical decision making)
  Instructions/Education given
  Procedures performed- step by step
  When to return to the ER
• Condition Specific
  Prescriptions given
  Consultations Obtained
• Contact information for the Specialist
  Reviewed written instructions with the patient

Question 5

When to call a specialist for consultation

Answer 5

• Things outside the scope of a typical ED Provider.
• Get a thumbs up from the specialist

Question 6

Temporary Holding Orders- Maybe

Answer 6

• Considered abbreviated Admit orders
• ED Providers don’t manage people through their hospital stay
• The intent would be to have managing service take over
• Often used for Specialist admissions
• Hospitalists will most often do it themselves- this is preferred

Question 7

AD CAVA DIMPLS - Admission pneumonic

Answer 7

• Admit
• Diagnosis
• Condition
• Activity
• Vital Signs
• Allergies
• Diet
• Interventions
• Medications
• Procedures
• Labs
• Special Instructions

Question 8

Communicating with the admitting Physician or PA

Answer 8

• Call the Hospitalist or specialist
• Be professional
• “Be Prepared”. They may grill you
• Be versed on admission criteria
• Introduce yourself
• Be organized
• ED attending agrees
• HPI, Brief Pertinent Physical Exam Findings
• Diagnostic Results- Labs, Imaging
• Treatments rendered, and response to treatment while in ED

Question 9

Communicating with the admitting Physician or PA

Answer 9

• Who is taking the patient?
• Clear communication
• ED Clinicians don’t manage an admitted patient
• A specialist might request a Hospitalist

Question 10

Communicating with the admitting Physician or PA

Answer 10

• What is the admission criteria?
• Medicare and insurance guidelines come into play
• Become familiar with these guidelines
• You may have to build your case
• Simply a desire by you or the patient will not work
• Don’t create the expectation to the patient that they are going to be admitted