As I assume the position of Chief of Staff at Sarasota Memorial Hospital, I wan to thank you for your trust and confidence in me to represent you to the Board and the Hospital Administration. In preparation to take of my responsibilities, I have reread the Medical Staff Bylaws to review my duties. These are some of the duties I think are important to share with you:
- Act in coordination and cooperation with Hospital management in matters of mutual concern involving the care of patients in the Hospital.
- Receive and interpret the policies of the Board to the Medical Staff and serve as the Medical Staff's representative for clinical performance and maintenance of quality with respect to the delegated responsibility to provide medical care to the patients of the hospital.
- Represent and communicate the views, policies, and needs of, and report on the activities of the Medical Staff to the President and the Board.
In Summary, I will be representing you to the President and the Board, and them to you. Our mutual goal is excellent clinical care delivery to our patients. This is all achieved with proper and regular communication between all parties. In order to facilitate that, I will plan to be in the Doctor's Lounge, lunchtime on Wednesdays. If you prefer a one on one, we can schedule a meeting to discuss your concerns, needs, thoughts, etc.
At the last Board meeting, I shared with the members my gratitute to all involved in the quality improvement and patient safety tasks. Their relentless pursuit of high quality care and safety measures give me a sense of security as a physician and as a potential patient at some point. Please help me maintain our pursuit of excellence as Medical Staff of one of the finest hospitals in Florida, if not the nation.
As part of our ongoing efforts to provide easy and effective communication, I will periodically review with you important sections of the Rules and Regulations document. What follows are the revised guidelines regarding requesting consults. Please read carefully and follow the new guidelines.
Jack Wazen, MD
Chief of Staff
SMH MEDICAL STAFF RULES AND REGULATIONS
- An update of the Rules and Regulations was approved by the Hospital Board 09.21.2020. The full document can be found by visiting SMH.com/For Physicians/Physician Resources/ scroll down the page, Medical Staff Services Section/SMH Rules and Regulations, lin here.
- Article VI defines requesting and responding to Stat, ASAP and Routine Consultations:
Article VI: Consultations:
6.A. Requesting Inpatient Consultations
(1) Requests for consultations shall be ordered in the EMR by a Requesting Practitioner (including Advanced Practice Professional) and in accordance with the following communication guidelines:
• STAT Consults – For STAT consults, the Requesting Practitioner (who must be a physician) will personally speak with the Consulting Practitioner (face-to-face or by telephone) to provide the patient’s clinical history and the specific reason for the emergent consultation.
• ASAP Consults – For ASAP consults (e.g., “urgent,” “today,” or similar terminology), the Requesting Practitioner (who may be a physician or another member of the care team) will personally speak with the Consulting Practitioner (face-to-face or by telephone) to provide the patient’s clinical history and the specific reason for the urgent consultation.
• Routine Consults – In addition to entering the reasons for the consultation request in the EMR, the Requesting Practitioner (who may be a physician or another member of the care team) will make reasonable attempts to personally contact the Consulting Practitioner to discuss all routine consultation requests.
(2) Failure by a Requesting Practitioner to follow the communication guidelines described in this Section may be reviewed through the appropriate Medical Staff policy.
6.B. Responding to Inpatient Consultation Requests
(1) Any member of the Active Staff can be asked for an inpatient consultation within his or her area of expertise. Members who are requested to provide an inpatient consultation will respond to the request either in person, via telephone, or via other technology-enabled direct communication (i.e., VOALTE or other EMR communication). In either case, the Consulting Practitioner is expected to respond in accordance with the following patient care guidelines:
(a) STAT Consults – must be completed within 2 hours of the request, unless the patient’s condition requires that the Consulting Practitioner complete the consultation sooner;
(b) ASAP Consults – must be completed within 12 hours of the request, unless the patient’s condition requires that the Consulting Practitioner complete the consultation sooner;
(c) Routine Consults – must be completed within 24 hours of the request or within a time frame as agreed upon by the Requesting Practitioner and the Consulting Practitioner.
(2) The Consulting Practitioner may ask an Advanced Practice Professional with appropriate clinical privileges to examine the patient, gather data, order tests, and generate other documentation to help facilitate the consultation. However, an evaluation by an Advanced Practice Professional will not relieve the Consulting Practitioner of his or her obligation to personally see the patient.
(3) When providing a consult, the Consulting Practitioner will review the patient’s medical record, brief the patient on his or her role in the patient’s care, and examine the patient in a manner consistent with the requested consult. Any plan of ongoing involvement by the Consulting Practitioner will be directly communicated to Requesting Practitioner.
(4) Failure to respond to a request for a consultation in a timely and appropriate manner will be reviewed under the appropriate Medical Staff policy.
(5) Practitioners who wish to refuse consultation are responsible for finding alternate coverage. If they are unable to do so, then the Chief of Staff or the appropriate Department Chairperson can appoint an alternate consultant.
(6) Once the Consulting Practitioner is involved in the care of the patient, the Requesting Practitioner and Consulting Practitioner are expected to review the patient’s medical record on a regular basis to assure continuity of care until such time as the Consulting Practitioner has signed off on the case or the patient is discharged.
(7) A Requesting Practitioner who believes that an individual has not responded in a timely and appropriate manner to a request for a consultation may discuss the issue with the CMO, the Chief of Staff, or the appropriate Department Chairperson.
6.C. Recommended Consultations
(1) In the ordinary course of events, the practitioner shall decide when consultation is required for a given clinical situation.
(2) Consultation(s) either in an individual case, a certain type of case or for all patients may be mandated during the delineation of clinical privileges of a Medical Staff member.
(3) The Chief of Staff, the CMO, and the appropriate Department Chairperson shall each also have the right to call in a Consulting Practitioner where a consultation is determined to be in the patient’s best interest.
6.D. Mental Health Consultations
A mental health consultation and treatment will be requested for and offered to all observation and inpatients who have engaged in self-destructive behavior (e.g., attempted suicide, chemical overdose) or who are determined to be a potential danger to themselves or others. If psychiatric care is recommended, evidence that such care has at least been offered and/or an appropriate referral made will be documented in the patient’s medical record.
6.E. Surgical Consultations
Whenever a consultation (medical or surgical) is requested prior to surgery, a notation from the Consulting Practitioner including relevant findings and reasons, must appear in the patient’s medical record. If a relevant consultation has not been communicated, surgery and anesthesia will not proceed, unless the surgeon states in writing that an emergency situation exists.
6.F. Critical Care Consultations
A consult with a Critical Care specialist is required at the time of admission to an Adult Critical Care Unit for all patients unless the patient is in a “stepdown” bed status or waiting availability of a non-critical care bed.