Each night around 8PM, the late Night Hospitalist will start an Epic chat with the 3 night seniors:
Hi night seniors, Drs. *** and I will be night lead hospitalists tonight. Please feel free to message us here in this chat or can page p3989 with anything we can help with.
Just a reminder on the escalation pathway: https://inpatient.careteamapp.com/EscalationPathway
Important types of cases to escalate: new SDU admits, upgrade to SDU/ICU, patients requiring RRT calls, significant HD instability, new/suspected acute emergent condition (ACS, acute abdomen, cord compression etc), unexpected death, procedures, AMAs
Change to a higher level of care (e.g., stepdown or ICU listing)
Unanticipated change in mental status
Significant new laboratory abnormality (e.g., K > 6.0, Na < 120, pH < 7.25, lactate > 4.0, bicarb < 12, hemoglobin drop > 3gm)
Significant new abnormality in vital signs (e.g., BP < 90 or drop of 30mm Hg, HR < 50 or HR > 130, O2 sat decrease to < 90%, O2 > 4 LMP NC)
Death, not expected that day
Procedure requiring consent
Change in Code status
Disagreement with plan of care (with patient, family members, or consultants)
AMA discharge
New admissions in RESUS or requiring stepdown
Any event, preventable or non-preventable, that results in harm to a patient
Any situation in which an intern or resident feels uncomfortable or has a concern.
Escalation to the Attending of record (or Night Hospitalist after 7PM) is expected for all of the following situations:
Upgrade to higher level of care (e.g., stepdown or ICU)**
Unanticipated change in mental status
Any time an RRT is called
Significant new abnormality in vital signs (e.g., sustained BP < 90 or drop by >30mmHg, sustained HR < 50 or HR > 130)
Significant new lab abnormality (e.g., lactate > 4, Hgb drop >3)
New high-flow nasal cannula, nonrebreather, or BiPAP requirement
Any new or suspected acute emergent condition (e.g., cord compression, bowel perforation, acute coronary syndrome)**
Unexpected death*
Procedure requiring consent
Change in code status*
Disagreement regarding plan of care (with patient, family, or consultants)**
AMA discharge*
New admissions in RESUS or requiring stepdown
Any event, preventable or non-preventable, that results in harm to a patient
Any situation in which an intern or resident feels uncomfortable or has a concern**
For patients on the Oncology Teaching service, all of the above situations should be escalated to the Oncology Fellow/Attending during the day, or the Night Hospitalist after 7PM. Select situations should additionally be escalated to the Oncology Fellow On-Call overnight via page/call** or Epic chat/email.*
The following Oncology-specific situations should be escalated directly to the Oncology Fellow On-Call via page/call:
Questions or concerns regarding chemotherapy
Any oncologic emergency (e.g., cord compression, tumor lysis, rapidly increasing WBC)