Since the amalgamation of the entire trauma service at Royal University Hospital many of the consultations to GIM come from Orthopedics. For this reason there have been meetings between the Divisions to come to an understanding of our roles.
The expectations are as follows:
Consultations to GIM from Orthopedics
- For otherwise healthy patients, an Internal Medicine consultation is not routinely required. Age alone is not a criterion for consultation.
- New Consults: between 0800h and 1700h call the General Internal Medicine Consult Service. Include an estimate of when the patient will likely be going to the OR.
- New Consults: between 1700h and 0800h. If there are problems that don’t need immediate managing save the consult until the next day when the Consult Service will be notified (see below). If there are problems that do need immediate managing, call the Senior Internal Medicine Resident on call.
- Consults being followed on the ward: the Consult Service will write an order in the patient’s chart when there are conditions they are managing for which they wish to be called directly by the nurses. All other calls will first go to the Orthopedic Resident.
- Communication with the Internal Medicine Consult Team: Ward rounds will be made by the Surgeon, Residents and Nurse Coordinator 0750-0900h MondayThursday. Due to teaching rounds Friday ward rounds will be made without the residents. At 0900h there will be contact between the Orthopedics and the GIM teams. The purpose of this meeting will be to inform the Consult Service of any problems they will need to see, including any new consults that came in since 1700h the previous evening. To facilitate timing of workups an estimate of when the patient will going to the OR should be given as well.
Consultations to GIM from Orthopedics:
- New Consults: It is recommended that patients with hip fractures should go to the OR as soon as medically possible and preferably within 24 hours. It is part of your learning to develop a way to triage consults – and try to meet these goals of assisting orthopedics in getting their patients to the OR in a safe and timely manner but at the same time ensuring all patients on the consultation service are seen in a timely and safe manner.
- Consults being followed on the ward: As above, clearly indicate which problems should go to you and which to the primary service. This of course does not mean jeopardizing patient safety for “protocols” sake but is done for patient safety reason to ensure that in all circumstances the nurses know who to contact with problems.
- Discharge of patients from Orthopedics: Any patient you are no longer following should be clearly signed off in the chart to prevent gaps in care when each service presumes the other is managing things. If you have made changes from an internal medicine perspective in terms of medications, investigations, echocardiogram results it is suggested that the GIM service takes primary responsibility to forward this information to the family physician via letter (which can be dictated in the GIM office or addition to the dear doctor letter done by orthopedics. If we are actively following patient’s orthopedics has been affording us the courtesy of letting us know when the patient will go home/be transferred. If there is anything to attend to from an internal medicine perspective please attend to in a timely fashion.
- Communication with the Internal Medicine Consult Team: As above, once orthopedics rounds are done someone should contact the most senior member of the GIM team – if you have not heard from them it is highly advised to contact them to allow for efficient planning of your day.
- Collaboration – If an absolutely vital part of ongoing practice for patient safety and your own sanity – for these reasons if there is any problems with the above please let us know and we will continue to work together to resolve any issues!