Telephone Consults

Here are some important steps I recommend taking when making a telephone consult to a specialist or hospitalist. You can use these tips to provide an organized and concise review of your patient’s case for a consultant.

We all know the ER is a very busy environment. Nurse Practitioners and other providers are constantly being pulled from one task to another problem throughout a shift. It’s amazing if you really think about how our minds jump quickly from one task to the next in the ER in order to provide emergent and excellent care for all our patients. In emergency medicine, we are constantly being interrupted. Multitasking is definetly part of our job description. It’s a skill we all must have to survive a shift. From a nurse asking a question while we are trying to read a CT scan report, to a patient ringing the call bell asking for more pain medication, to a baby screaming at the top of it’s lungs, to EMS bursting through the ambulance bay doors with a patient in distress, to the psychiatric patient hallucinating and being combative with staff, to the elderly patient in the hospital gown walking down the hallway “mooning” everyone in sight (yes this really happens)…needless to say we are constantly being interrupted. And during these chaotic moments, the phone inevitably rings. It’s the specialist who was paged calling back to discuss the patient’s case with you.

I think it has happened to all of us at some point during our emergency medicine careers. We answer the phone and then briefly blank on the topic we wanted to discuss with the consultant. I am sure some of the specialist have thought “why the heck is she paging me if she is not ready to talk with me?” But the specialist can’t see what is happening on the other side of the phone. Haha! I can be pure craziness sometimes!

When I first graduated from NP school, I would get anxious when I had to make a telephone consult, especially when paging a surgeon. Over the years and with experience, I have developed a particular routine for myself which I almost always complete BEFORE paging for a consult. I take a moment to get my thoughts organized. I jotted down pertinent information I wanted to share during the conversation (yes…I will actually physical write a few notes). This decreases my stress level because I feel more prepared and ready to discuss the case. It definitely takes time and practice to figure out what is going to work best for you!

Get Prepared!

  1. Have your notes about the patient’s case ready to go. I usually will keep these in my pocket after I have made the page. I hate having to run across the department to get back to my computer because I don’t have the patient’s information.
  2. Know the patient’s name and age.
  3. Have the MRN (medical record number) and DOB (date of birth) available in case it is requested by the specialist.
  4. Know the results of the labs and studies that have been completed on your patient.
  5. Have a copy of your abnormal imaging results ready. I will usually have this pulled up on my computer screen or have a printed copy available if it is a complicated case.
  6. Know the abnormal lab values. I will usually have these written down on my “notes about the patient” so I can mention them to the consultant.
  7. Know the patient’s most recent vital signs.
  8. Know the patient’s weight (especially for pediatric patients).
  9. Know the patient’s pertinent medical history and past surgeries.
  10. Review the patient’s case with your attending physician, especially if the patient’s case is complicated. Sometimes my attending physician will ask me questions about the case I haven’t thought about and/or need to investigate further before speaking to the specialist. With some particular cases, I also like having my attending physician confirm and agree that a consult is indicated. This is especially helpful to do ahead of time in case the specialist gives any push back on admitting or seeing the patient in the ER.
  11. Know how long the patient has been NPO (especially for surgical patients).
  12. Know the patient’s Rh type in pregnant patients needing an OBGYN consult.
  13. Know what medications have been given to the patient while in the ER.
  14. Always review the patient’s home medications. Mention to the consultant any pertinent home medications. For example, it may be important to know whether or not your patient is taking a blood thinner.
  15. Know how to look up the patient’s insurance information if needed. Sometimes this information is needed to assist with scheduling outpatient follow up. Having the patient’s correct phone number can also helpful!
  16. Before you place a page, make sure you are paging the correct provider or medical group in regards to your specific patient. Does the patient have a primary care provider, surgeon, or previous specialist they have seen in the past?

Be prepared to be specific as to why you think the patient should be evaluated or admitted by the specialist/hospitalist.

Before you Hang Up:

  1. Make sure all your questions have been answered by the consultant. Have a list of questions you want answered written down and ready to be asked before placing the initial page. Sometimes I will start talking about the patient’s case and then hang up the phone, forgetting to ask a particular question. I absolutely hate having to re-page to ask another question. Ugh! Especially the times a surgeon is in the OR.
  2. Always write down the consultant’s name and time of when they called back BEFORE you start discussing the patient’s case. Otherwise, you may hang up and have forgotten the name consultant you were speaking with on the phone. You need this information for accurate charting as well as for providing appropriate outpatient follow up for your patient.

The most important thing to do when it comes to telephone consults is to develop a routine that works best for you!

About Lauren

I am so happy you have found my "Emergency Medicine & Mom Blog."

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