medicine consults

Please arrive to the Medical Service Office on your first day at 8:00 am for orientation from the chief residents. 

 

You will come every morning thereafter at 7:30am to pick up the pager from the post-call medicine resident.  You can leave at 4pm every afternoon. 

 

If you are absent (e.g., become ill or have an unexpected emergency), you must contact the WHC chief residents to provide backup coverage for you during your absence.  Please also notify the VA chiefs and your consult attending as well.

Schedule for the month:
  • New consults will print out in the small printer in the Medical Service copy room. Please check this printer multiple times daily to make sure you do not miss new consults.

  • You should see old consults in the morning.

  • Daily attendance/participation in noon report is required (at orientation, the chief will inform you of the latest schedule as it has changed due to COVID)

    • Monday, Tuesday, Thursday: case based, chief led resident report in the medical conference room

    • Wednesdays and Fridays: Grand Rounds and Life Conference respectively in the Freedom Auditorium across from the medical office

  • In addition to the above educational activities, there is a consult curriculum, which provides a required program of study.  Please see Medicine Consult Curriculum.

VA Consult Pager

9-259-3286

Medicine Team Rooms
  • Team 1: 55027/55028

  • Team 2: 57714/55054

  • Team 3: 57138/57139

  • Team 4: 57036 /56993

  • Team 5: 57037/54179

  • Team 6: 58738

  • Or call Vocera at x58899 and say “Medicine Team 1”

Primary Responsibilities:
  • The consultation service provides problem-oriented guidance to non-medical clinical services at the DC VAMC which desire advice on management of medical issues or pre-operative assessment.

  • You are expected to see Internal Medicine Inpatient Consults from 7:30am – 4:00pm Monday – Friday.  You will carry the VA consult pager (see above for pager #) during this time. 

  • You may receive a consult request by being paged, but you should also look for consult requests on the printer located in the Medical Service Office (copy room). You should check the printer a number of times each day for new consults.

  • After seeing the patient initially, you should discuss the case with the consult attending & write up the consult in the computer, listing the attending as a cosigner.  The attending is expected to see the patient within 24 hours.

  • You should then follow the patient on a daily basis until it is appropriate to sign off after discussion with the attending. 

  • Rounds will generally be at either around 10am or 1pm with the consult attending (depending on their schedule and your clinic schedule), meeting in the Medical Service office.  If an urgent matter develops with a new or old consult or if you think a patient needs to be transferred to another service, do not hesitate to contact them before the designated time.

  • If another service wants to transfer a patient to medicine, they must be seen by the consult resident first.  Review the chart, see the patient, decide if a transfer is appropriate and if they would truly benefit from being transferred to medicine, and discuss with the consult attending.

    • If you are accepting the patient to medicine:

      • Inform the primary service that the patient has been accepted. 

      • Call the admissions office to get a bed x54180 or 57152 and ask for medicine team number assignment. 

      • Once provided with this information, you should call the medicine team to sign out the patient.

      • Please write a brief note describing the patient’s course and need for transfer.  This note will be used to communicate the reason for transfer to the primary team in your absence. You should give a verbal sign out as well to the Medicine team accepting the patient. 

    • If the transfer is not accepted (after discussion with the consult/on-call attending), advise the primary service accordingly, and continue to treat the patient as a consult (give recommendations as appropriate). 

  • Ask the consulting team whether they would prefer for you to leave recommendations only, or would prefer for you to write orders yourself.

  • When you have clinic, you may sign out to the on-call medicine admitting resident at noon. The admitting resident can be reached at VA pager 3822.

  • Your patients are covered during nights, weekends and holidays by the on-call medicine resident. Only urgent consults will be seen during this time period. You are expected to take over the case the following weekday morning.  You will pass off the pager and census sign-out each day at 4:00pm to the long-call resident.  You should retrieve the pager/sign-out from the night float physician in the morning by 7:30am.

  • You are responsible for maintaining an up-to-date census daily on the CPRS Handoff system (see chief residents for instruction)– this census should be printed out every afternoon and passed on to the long-call resident. If a consult needs attention (or tests followed up, etc.) at night or on weekends, emphasize this on the sign out (as well as verbally) to the long-call resident. 

  • You are not responsible for outpatient medicine consults.

 

How to Write Consult Notes:
  • Due to constraints in CPRS, you should use a progress note to complete the consult.  To pull up this note template, go to the “Notes” tab. Under “action” menu, select “New Progress Note.”  Use the “MED <MED: INPATIENT PROGRESS NOTE>” template.  Again, remember to identify the appropriate attending as the “expected cosigner”.

  • If a patient is accepted as a transfer to medical service, after discussion with the attending, a brief consult note can be entered or the consult can be discontinued.

  • Your attending should close the official consult request. 

 

Important reminders:
  • Round and write notes on every patient daily.

  • Always see and evaluate urgent requests immediately.

  • Notify an attending of new/urgent consults, especially pre-operative evaluations, in time for an attending to staff ALL patients prior to going to the OR.

 

Tips:
  • Perform new consultations promptly.

  • Obtain complete history/ROS/exam, appropriate testing, and write a clear analysis of the medical condition with your recommendation.

  • You are not limited to the small amount of space on the consult form – continue on a new progress note if necessary

  • Maintain contact with the requesting MD after the initial consultation and after any significant changes in therapy.  When signing off on a patient, please have a discussion with the consulting service.   

  • There is no such thing as a “bogus consult”.  Keep in mind, you are being asked to help patients on other services, so your approach should be that of professionalism  and collaboration

  • Forming collaborative relations with the housestaff on other services will greatly improve your experience, reduce inappropriate calls, increase your role as a true consultant, and improve patient care

  • Learn the principles and problems of interface medicine, including development of professional and social skills necessary for effective interdisciplinary communication and patient care.

  • Provide problem-oriented, evidence-based recommendations for dealing with medical urgencies in non-medical patients.

  • Refine diagnostic and management skills of medical problems in patients on non-medical wards.

  • Learn the principles of effective pre- and peri-operative risk assessment and differential diagnosis, including preoperative cardiac assessment and DVT prophylaxis; learn the principles and management of post-operative complications.

 

Important Numbers