MEDICAL CONSULT SERVICE ORIENTATION WELCOME!!! U P DAT E D : A P R I L 2 0 1 8 MIREK OTREMBA, MD OUTLINE Structure of the service Schedule & Call Teaching & Feedback Clinics Misc. University Health Network

STRUCTURE OF THE SERVICE Hospitals covered TWH 2 residents max UNIV AVENUE = TGH (+PMH, TRI), MSH 2-4 residents Discuss where elective students/residents will spend time Inpatient consultations Services requesting consults Surgery, Psychiatry, Gyne, OB (after 5/weekends) - Discuss Common reasons for consultations Clinics Pre-op clinics 3 sites

OB clinic OPG site 700 University University Health Network YOUR SPACE There is a room designated for med consult residents/students Room 431 at MSH (Dr. Otrembas office) Sign out entry key from Patricia in room 431 and return at end of rotation Computer & phone available there Water/Fridge/Microwave/etc.

available there University Health Network INSERT TITLE HERE REQUESTS FOR TRANSFER OF CARE & PESU AT TWH At times, we will be asked to see patients on surgical services with the request for transfer to medicine

TWH: For medical issues in psychiatry patients in ED, psychiatry will call med consults first 85, M-F and CTU team after hours and weekends/holidays Med consults will see and decide: A) Patient can remain under original service with our service following B) Patient benefits from GIM admission/transfer: discuss with MC staff and then GIM on call resident/staff and pass on information University Health Network

SCHEDULE Review the on-call schedule HOME call 8am-5pm designated resident at UNIV and TWH RESIDENT RECEIVING CALLS ROTATES WEEKLY 5pm 8am ONE ON-CALL RESIDENT COVERS ALL SITES Weekends: 8am 8am ONE ON-CALL RESIDENT COVERS ALL SITES Round only on sick patients (update signout list on FRIDAY with TO SEE) Review the clinic schedule

AM CLINICS all UNIV AVE residents attend Huddle in AM & decide if all stay in clinic or cover ward/consults PM CLINICS/OB one TWH resident attends University Health Network OBSTETRICS - MSH Dr. Shital Gandhi Pager 416 380 5557 Office 17-4857 OB medicine covers consults Mon-Fri 8AM5PM Weekend/Evening coverage

By med consults OB hands over any acute issues UNIV ave med consult staff reviews new consults/issues Hand over to OB medicine next AM Wednesday OB clinic (1-5pm) OPG 3rd floor - 700 University Ave R3 level clinic attendance required! University Health Network TEACHING ROUNDS SCHEDULE CANMEDS 2005 ROLES MEDICAL EXPERT; SCHOLAR

Monday 8 AM Harvey Rounds TWH 8th floor New East Wing Cecilia Miller Conference Room Tuesday 8 AM Evidence based rounds ASSIGNMENTS) ( REVIEW RESIDENT MSH PAU classroom Wednesday 8 AM Staff teaches rounds MSH PAU classroom

Wednesday 12 noon Grand Rounds Thursday 8AM OB Medicine Rounds 60 Murray St. 3rd floor Seminar room 4 Friday 8:30 AM Bedside Physical examination Location rotates based on patient availability Friday noon once/month - OB medicine rounds OPG 3rd floor classroom A see monthly consult schedule for details University Health Network FEEDBACK Please seek out Feedback from staff on an on-going

basis UNIV AVE Staff with the UNIV AVE residents TWH Staff with the TWH residents Competency by design - Seek assessments during your rotation 1 per week End of rotation evaluation at the end of the month with input from all staff University Health Network SIGN OUT CANMEDS 2005 ROLES: COMMUNICATOR

Sign out website Accessible through the med consult website (under Useful Links) Sign out login Use your Cerner/Powerchart credentials Secondary password: consult Med consult website UN: consult PW: consult University Health Network

SIGN-OUT ETIQUETTE For ON-CALL - please indicate only MUST-DOs for known patients with issue overnight/weekend needing follow-up For new patients seen but NOT reviewed with staff add: NEW PATIENT - STAFF TO SEE For patient seen in clinic and needs follow-up add patient and location as PRE-ADMIT and date of planned surgery New consults to be seen following morning add patient to list as NEW CONSULT PLEASE SEE Patients signed off but possible re-consult in future change location to SIGNED-OFF University Health Network

COMPUTER ACCESS & DICTATION Computer access & training required UHN EPR (416 340 5091) MSH PowerChart (416 586 4800 x 2100) Dictation UHN (416 340 4800 x 6000) OR via email MSH (416 586 4800 x 2649) University Health Network SUGGEST ORDERS At MSH suggestions should be placed

electronically: Decide with the consulting service if you can order direct or as suggestions Suggest Orders Medical Consult order allows you to enter suggestions to be activated later by the primary team Urgent/emergent orders should be placed directly so they are active without primary team needing to be contacted University Health Network SUGGEST ORDERS/COMMUNICATION University Health Network

MSH SUGGEST ORDERS University Health Network INSERT TITLE HERE COMPUTER CPOE TGH/PMH/TWH Leave your suggestions on paper orders Most patient care orders still on paper only Urgent orders to be placed directly into EPR University Health Network

HALF DAYS, LIEU DAYS, AWAY TIME CANMEDS 2005 ROLES PHYSICIAN AS A MANAGER Half-day Coverage Covered by another resident at the site or staff Academic sessions Staff/resident colleague covers Lieu days Arrange time with your colleagues/staff Doctors appointments & other

away time Arrange coverage with your colleagues University Health Network REVIEW CONTACT INFORMATION Staff contact information Ensure accuracy of resident contact information Elective student/resident contact information Admin - Patricia Davison 17-3823 [email protected] Director - Mirek Otremba 17-3016 [email protected]

University Health Network OPTIONAL INFORMATION Role of the consultant Problems in consultation medicine University Health Network ROLE OF THE CONSULTANT THE 10 COMMANDMENTS (1/4) 1. Determine your customer Ask the requesting physician how you

can best help them, if a specific question is not obvious They may want co-management 2. Establish urgency Emergent, urgent, elective University Health Network ROLE OF THE CONSULTANT (2/4) 3. Look for yourself 4. Be as brief as appropriate Need not repeat in full detail data that were already recorded

5. Be specific, thorough, and descend from thy ivory tower to help when requested Do they need help order writing/entry University Health Network ROLE OF THE CONSULTANT (3/4) 6. Provide contingency plans and discuss their execution 7. Thou may negotiate joint title to thy neighbours turf

Frank discussion defining which specialty is responsible for what aspects of patient care is needed 8. Teach with tact and pragmatism Judgement on leaving references should be tailored to level of training and service University Health Network ROLE OF THE CONSULTANT (4/4)

9. Talk is essential There is no substitute for direct personal contact with primary physician 10. Follow-up daily Daily written follow-up is desirable When patients problems are not active, consultant should discuss signing-off with the requesting physician beforehand University Health Network PROBLEMS IN CONSULTATION MEDICINE (1/3)

Based on Detskys article in your book Reasons for requesting Consultation Knee jerk/reflex reaction to a clinical entity Threat of litigation after an adverse event occurred Supervisor requests consultation even though residents do not feel it is indicated Resident or medical student requests consultation without knowledge of the attending staff University Health Network PROBLEMS IN CONSULTATION MEDICINE

(2/3) Failure to Request consultation when help is needed Strategy during the consultation process Too many consultations the Double Whammy Poor communication Holding the patient hostage University Health Network PROBLEMS IN CONSULTATION MEDICINE (3/3)

Problems of Ego, Pride, and Embarrassment Consultee is embarrassed because of criticism contained in consultants note Consultants advice is not taken Consultant is told to mind his/her own business Request for help is viewed as a sign of weakness University Health Network

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