Obtaining a consult in the ambulatory care setting can be more challenging than the inpatient venue because of situations like this. The caregiver’s goal, however, is to give the patient safe and good quality care no matter what coverage obstacles may exist.
There are steps that can be taken to bridge the gap between the primary caregiver who is asking for a consult and the physician receiving that request. These actions can be handled in two levels of intensity, depending on the urgency of the consult.
For a routine test, such as a colonoscopy, the physician asking for the test should send:
· A written order for the test
· The reason for the test
· The results of any tests which may be germane to the consultant
· Any patient or patient’s family history which might be germane to the test
· Current medications (including over-the-counter, herbs, vitamins, and other supplements) that the patient is on
· A request for a written report of the test
The request for the test and the information sent are to be documented in the patient’s medical record.
It is clear that it is easier to do this routinely if your office maintains a form which can be used as a check-off sheet, a place to write the information noted above, and a place to attach information such as lab or imaging study reports.
For urgent consults, the same type of sheet and the same items apply, but two more things are added. The form will also have a place for your working diagnosis or impression; and it will have a place for you to indicate the urgency of your request. To make things simple, you can have one form which has all the things for both routine and urgent consults on it.
There is one last and very important thing that you can do to make sure that this urgent consult is given the attention it requires – you must call the consulting physician directly even if you do not know them. Connecting with this doctor will help make an impression about the case and it will also help the two of you exchange ideas and concerns about the patients. The consulting physician should be encouraged to call you as soon as the exam is complete so that you can collaborate on the best plan of treatment for your patient.
All of this, of course, is to be recorded in the chart and followed up in your office. A dropped consult request, whether it is a routine test or an urgent exam, may mean that a patient will suffer a serious illness, treatment which could have been avoided, and/or death. Moreover, you may face a lawsuit.[i]
To improve the consultation process and ensure patient safety, we recommend:
- The use of a standard consultation request form, such as that found in Princeton’s Physician Office Practice Toolkit
- Consistent use of correct terms to promote a clearer understanding of the process
- A system to continually monitor your consult requests to be sure they are being done, that you are receiving results in a timely manner and that you are following up with your patients in a timely manner on both positive and negative findings.
Worsley, Barbara, “Patient Handoff: Not Just for Hospitals”, The SCPIE Companies, page 2.