Acceptance of Inpatients from Winnipeg Community Hospitals for Subspecialty Evaluation

From U of M Internal Medicine Wiki
Policies
Policy: Acceptance of Inpatients from Winnipeg Community Hospitals for Subspecialty Evaluation
Policy Nr: Sec 03 - 08
Target Review Date: 2019-09-12
Main Stakeholder:

Introduction

The Department of Medicine provides the majority of subspecialty consultation in the Winnipeg Regional Health Authority. Most internal medicine subspecialties are available at the tertiary sites, however availability of on-site consultation at the four community hospitals is varied, with some consultation provided by department of medicine physicians and some by private subspecialists with no formal arrangement with the hospital. This policy will guide triaging which patient requires transfer to a tertiary site for assessment and the process to complete the transfer.

This policy is not meant to replace other specific subspecialty assessment and transfer policies.

This will only apply to subspecialties who do not have their own policy in place. Every effort should be made by the subspecialist to see the patient in their community hospital where possible.

Aims

The intention of the policy is to provide community hospital inpatients with timely and safe access to appropriate subspecialty diagnostic services.

Attending physicians of community hospital inpatients are free to consult any licensed qualified physician. In many cases these individuals have relationships with subspecialists who can and will make themselves available to a specific site in a timely manner and who will render the appropriate assessment. The following policy is intended to deal with the alternate circumstance.

Procedure

  1. If an attending physician determines that a tertiary subspecialty consultation is warranted, the first step is to consult the general internal medicine physician on call for the site. This does not apply to patients who are already admitted under a general internist.
  2. The internist on call for the site will assess the patient and determine if a subspecialty consultation is required.
  3. If the internist agrees that the patient requires a subspecialty assessment, the internist will call the subspecialist and discuss the case. If a disagreement between the general internist and the attending physician occurs regarding need for consultation, then the attending physician may exercise their prerogative to call the subspecialists on call directly.
  4. If physician resource will result in delay of assessment at the community site, then the subspecialist will contact the internal medicine Bed Doctor to arrange for transfer to the tertiary site.
  5. If the patient requires assessment by the subspecialty and will likely return back to the community site, then the Bed Doctor will inform the subspecialist where in the hospital the patient will be transferred to. The subspecialist in that case will be the physician of record and responsible for the assessment, continuing care and ultimate disposition of the patient.
  6. If the patient requires assessment by the subspecialty, has what appears to be a single system problem within the scope of the subspecialist, and will likely require admission to the tertiary site, then the Bed Doctor will inform the subspecialist where the patient will be transferred to. The subspecialist in that case will be the physician of record and responsible for the initial assessment, decision for admission, and for calling the appropriate admission attending to transition to formal admission. Admitting orders will be the responsibility of the subspecialty service.
  7. If the patient requires assessment by the subspecialty, has what appears to be multiple system problems that are active and not within the scope of the subspecialist, and will likely require admission to the tertiary site, then the Bed Doctor will inform the subspecialist that the patient will be considered a direct referral for internal medicine assessment. Admitting orders will be the responsibility of the internal medicine service.
  8. All transferred patients will be assessed within time frames set out by WRHA regional policy.
  9. If a patient is being transferred from a community site and will likely require admission to the tertiary site, and the tertiary site is beyond level one over capacity as per the regional overcapacity protocol, then the community site will be required to accept an appropriate patient from the tertiary center emergency room for transfer to an inpatient bed. This transfer will take precedence regardless of the ER situation at the community site.
  10. Assuming normal operating procedure, with minimal bed capacity pressures, the community sites will access subspecialty service according to the following distribution:
    • Grace Hospital and Seven Oaks will contact Health Sciences Center first
    • Victoria Hospital and Concordia Hospital will contact St. Boniface first
    • Exception: Dialysis patients at Seven Oaks will be transferred to St. Boniface
    • Exception: Patients who have an established relationship with a certain tertiary center (bed capacity permitting)

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