Specific Events that Mandate a Call to the Attending Physician
Our GME Priorities
- Our GME priorities remain focused on your Safety, your Wellbeing & your Education
- Incidents of bias or mistreatment directed towards patients, learners, or others should be reported immediately to your PD or GME leadership
- Reach out to your PD or GME leadership with any concerns not otherwise reflected
Specific Events that Mandate a Call to the Attending Physician
MUST CALL
- Timely notification following patient admission or consult
- Significant hemodynamic instability requiring intervention or code
- Upgrade in level of care (i.e. floor to icu; heightened level of patient monitoring)
- Unplanned surgery or invasive procedure (i.e. intubation. central line placement)
- New onset neurologic finding
- Unanticipated change in code status or unexpected death
- Change in condition that would result in procedure cancellation within 8 hrs
- Patient planning to leave AMA or refusal of treatment that could lead to harm
- Medication or treatment errors
- Patient or caretaker request
Clinical Precepting Best Practices
MUST PRESENT
In addition to standard presentation elements, residents MUST PRESENT and highlight these elements verbally to the preceptor:
- All vital signs, including fetal heart tones/rate in OB, or chart open during presentation
- Abnormal physical exam findings or new abnormal diagnostic findings (ECG, rads, etc.)
- High risk conditions or high-risk medications – i.e., anticoagulation, active immunosuppression, complex cardiac history, HIV, congenital anomalies or failure to thrive in peds, concern for self or other harm
Reflect with every patient encounter:
- Are there any red flags?
- Has the worst case been ruled out?
- What doesn’t fit?
- What serious diagnosis could be missed?
Clinical Precepting Best Practices
MUST SEE
After precepting, the supervising attending physician MUST personally SEE and evaluate the patient if:
- Considering admission, transfer to a higher level of care, or procedure cancellation within next 24 hrs
- AMA or declining to go to ER or higher level of care
- Patient with high risk conditions for which there is still an uncertain diagnosis after presentation
- Any resident request for in-person attending evaluation (in setting of primary care exception)
Reflect with every patient encounter:
- Are there any red flags?
- Has the worst case been ruled out?
- What doesn’t fit?
- What serious diagnosis could be missed?
