fmc.wiki - Spring Creek

Spring Creek Pager

Prior to 2021, the upper level hospital resident carried the "Spring Creek Pager," affectionately named for a facility where Dr. Roger Bermingham was previously the medical director. While on-call messages are now received via an Opt-In Group in Epic Secure Chat and come from a variety of sources, they continue to be called "Spring Creek pages."

30 MINUTES TO RESPOND

- confirm patient is ours
- create new or open previous telephone encounter
- read recent notes
- we do not fill controlled substances after hours

don’t ever tell someone not to go to the ED

Criteria for having (most) patients come to ER/BC

- Trouble breathing, chest pain
- Infants < 3 months with a fever or other problem
- Can't feel baby move
- Bleeding
- All chest pain, seizures, stroke symptoms need transportation by ambulance

Urgent Care Facilities

FMC Walk-In Clinic 970.495.8980

FCYC Peds Urgent Care 970.494.2626

AFM Horsetooth 970.204.0300

AFM at CSU 970.237.8200

24 hour services

Harmony ED - lab & pharmacy

Fort Collins Police Department

Also for Welfare Checks

970.419.FCPD (3273)

NOTIFY ED/BC IF PATIENT EN ROUTE

go see patient with ED doc if it’s a good learning opportunity

Basics

Exacerbation of a chronic problem: what's different, what has helped, recent treatment?

If unsure, designate a time to call back to check in.

Never hesitate to use your attending.

If still unsure, err on side of caution and have them come in (even patients with anxiety get sick).

Common pediatrics questions:

If c/o fever, ask about temperature: Has it been taken? What is it? How was it taken? Get specifics
Ask about drinking, eating, peeing, and pooping. Again, repeat the question to get numbers, such as how many wet diapers today?
Ask if throwing up, trouble breathing, color, eating differently
can it wait until morning?
should child be seen now?

Strategies for challenging situations:

Validate/acknowledge the patient’s problem
Suggest a plan (What’s the main thing bothering you? Try something and ask pt to call back in 3-4 hours if not better)
Abd pain—get as many specifics as possible
Controlled substances - draw the line, be consistent, FMC policy is to not prescribe narcotics after hours

Obstetric patients

Most patients will need triaged to the OB deck for evaluation

bleeding (how much, recent intercourse, recent exam, infections?)
abdominal pain
decreased fetal movement (>23 weeks)—do fetal kick counts x 1 hour (5/hr), call back in no better
leaking (how much for how long?)
contractions –(term or preterm? <10/hour)

Notify OB deck—(tell patient to go through ED entrance if at night).

Other Urgents

You will get critical lab values after hours—assess whether patient needs to come in or whether it can wait until morning; police can do safety check if you are unable to reach the patient

Suicidal patients—refer to CAC in the ED; if patient refuses to come in, call police to go to patients home for safety check.

Call 911 for acute problems

When a patient is coming in, communicate and do some proactive triage with the intern.

Nursing Homes Notes

First things first

Do they have a no transfer order/MOST form?
Consider calling family/POA prior to transfer.
Keep Megan and Rita in the loop- route the task, specify if patient should be seen
If you get called that an established NH patient has run out of a controlled substance over the weekend, you do not have to fill it.

Is the call clinical? Calls for clinical issues are appropriate. But…you are not meant to manage daytime NH issues. Those kinds of calls should be deferred.

Is the call just informational? Nursing homes are required to notify you of certain events. Falls are a common issue. If FYI, document and ensure staff has what they need.

Is it a lab follow up call?

Blood Sugars: SNF required to report high and low. Ask about trend, recent meals, need for new orders.
INRs: new start or change in therapeutic level? Who normally manages? See guidelines
Urine results/cultures. Why was it ordered and is that symptom still present?

New or changing clinical situation

Things to find out first:

Confirm MOST/Do Not hospitalize orders.
When can you next get labs/Xray at the facility?
Can you treat with something they have: most common oral antibiotics, IM/IV ceftriaxone. Can you start an IV? (limited by staffing availability), normal saline.

What does the nurse calling you need?

Use closed loop communication to ensure a shared understanding
your options are: transfer to ER (NHs get dinged for too many of these), try an intervention with or without follow up later in the shift
Ask for brief feedback on your plan. “How does that sound to you?”
If you are going to call the nurse back, get a second number and/or ask the nurse to call you at a certain point if you haven't connected.

Special situations

Nurse error. Listen and be empathetic
Order verification: New pts, often ones we just discharged. Often the nurse just needs to "verify" the orders they received for medications. They do this by reading the medication list to the provider. Please listen and confirm that the orders are correct. The discharge orders can be found in the After Visit Summary in Epic, so pull that up during the phone call to confirm the new patient orders.
Hospice patients: Did they call hospice first? Some families may want to rescind hospice or do not hospitalize orders in special situations (Hip fracture with severe pain)
You can always text Dr. Gause if there is a question after hours. No guarantees in a timely response, and the on-call hospital attending is also a great source of knowledge!
Dr. Gause/Rita admit pts for short term rehab that belong to other docs (we only accept discharges from MCR and PVH). We get calls about their care, but if they have to be admitted to PVH/MCR they go to the hospitalist. Dr. Gause will typically be listed as PCP. If Good Sam says FMC is PCP, we ARE the PCP! Trust them.
Narcs: if the patient recently discharged, and there was an error with meds ordered at time of transfer, okay to correct. Don't feel compelled to refill a chronic medication that got overlooked during the week, unless you feel the patient may withdrawal without it.

Megan Gause's

Skilled Nursing Facilities (SNFs)

"skilled" (ie short-term) and Long-Term Care

Updated June '24

Good Samaritan - Long Term Care and Skilled (aka short term rehab)

Common Pages

Required to report: someone fell...
...treat it like a patient called in from home
Required to report: patient is refusing schedule medication.. thank them for the information and notify Dr. Gause/Rita by forwarding the triage encounter.
Can I give a prn medication?.. yes if you feel it's appropriate!
When admitted to SNF (either as skilled or long-term), medication reconciliation - just need to confirm Epic med list and what nursing home received (as noted above under order verification).

Page updated

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