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Consult Guidelines

Page history last edited by Patrick 9 years, 3 months ago

Consult Expectations and Guidelines:


Basic Guidelines:

  • Consults are expected to be performed as soon as possible and must be performed on the same day.
  • Exceptions to this, is the rare "emergency" consult in which the consult is expected to be performed within 4 hours.
  • Consults that will be followed on a daily basis will count toward team cap
  • Night time consults will be staffed with the day call attending and count toward day call team cap. If an urgent question arises during the night, the resident will call the night call attending.
  • Pre-Op eval consults should be followed before and after surgery. i.e. there should not be a "one time consult for surgery patients."
  • All consults should be put on the 'Internal Medicine CareTeam' Powerchart list
  • All consults should be checked out to the OCD for overnight coverage


Who performs the consult:

  • Calls from 7am to 5pm will be taken by the "day-of-night-call" resident (that resident whose team is on for call that same night) and deferred to the appropriate subspecialty as determined by that resident.  Call the Chief resident with any questions or concerns
  • Consult from 5pm to 7pm, the resident will obtain the information to be passed on to the OCD resident to perform
  • Consults from inpatient services 7pm to 6am will be performed by OCD, ER Consults will be done by night float resident.
  • Consults from 6-7am, OCD resident will obtain information to be passed on to the incoming night call resident
  • Family Practice performs all consults (including Otho pre-op eval) on their patients according to the admission guidelines.


Glycemic Control Consult

If resident team receives a consult that is primarily glycemic control before 1PM M-F, call the glycemic control NP listed on amion to do the consult

  1. If they receive a consult after 1PM or on weekends, do the initial consult, then contact Ann by pager and she will continue to follow the patient while in house
  2. Ann will staff these consults with the Gold attending, and on the weekends Gold will leave notes on patients that need to be followed (these will count towards weekend gold cap for overflow etc.)
  3. If a patient has multiple medical issues to be consulted on including glycemic control, the ward team will continue to follow these patients themselves


Consult Issues to be discussed

Draft Consultative Guidelines

MHC Consults mangament

Ortho pre-op consults that request a consult within  a short time frame, i.e the next 2 hours - unreasonable?

ER pre-op eval consults requiring stress test - does the patient need to be admitted, if so to who? or should the patient stay in ED until test completed?


Minutes for Consult Task Force Meetings


Can MHC consults with outpatient concerns (i.e. elevated TSH, mild hypertension) be handled over the phone?

Optimal if MHC consults are performed during the day.

Consults between 7-noon should be staffed by night call resident

Ortho requests for stat pre-op evals in order to fit into OR schedule are not to be placed a higher priority then normal.



Consult Curriculum:

All Resident (and hospitalists) should complete the Johns Hopkins Essentials of Consultative Medicine Modules


Johns Hopkins Consultative Medicine Modules

Recommended Modules:

The Role of the Medical Consultant

Perioperative Cardiac Risk Assessment

Pulmonary Risk Management in the Perioperative Setting


Other Useful Modules:

Venous Thromboembolism Prophylaxis

Diagnosis And Management of Acute Mental Status Changes: Delirium

Perioperative Cardiac Risk Management

Management of Hip Fractures


The Other Modules:

1.     Perioperative Medication Management

2.     Medical and Perioperative Management of the Pregnant Patient

3.     The Role of the Medical Consultant

4.     Perioperative Cardiac Risk Management

5.     Perioperative Cardiac Risk Assessment

6.     Perioperative Infections and Fever

7.     Diagnosis and Management of Acute Mental Status Changes: Delirium

8.     Perioperative Acute Renal Failure: Diagnosis and Management

9.     Pulmonary Risk Management in the Perioperative Setting

10.   Management of Hip Fractures

11.   Prevention and Treatment of Surgical Site Infections

12.   Perioperative Management of Anticoagulation (to be updated this month)

13.   Venous Thromboembolism Prophylaxis

14.   Management of Uncontrolled Pain



Cleveland Clinic Journal of Medicine Perioperative Medicine Articles

Recommended Articles:

How to write a useful preoperative consult

Cardiac Risk Stratification for noncardiac surgery

Perioperative management of diabetes


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