Component First major axis-component or analyte Property Second major axis-property observed e. The current classifications are listed in Table
It can take time for new information and recommendations to reach all clinicians even within a single specialty. Moreover, important information, such as on the perioperative use of beta-blockers and statins, is not necessarily published in the anesthesiology literature. It is critical to relay information such as the recent recommendation not to withdraw statins prior to surgery, as the current editions of most anesthesiology textbooks have incorrect information suggesting discontinuation.
Thus, consultants should include pertinent recent data and guideline recommendations, especially if they go against previous dogma. Rare diseases, blood disorders, other special cases As outlined in Table 1advice on perioperative management is appreciated for patients with rare diseases, coagulation disorders or other blood disorders, and brittle diabetes and other endocrine disorders, as most anesthesiologists are not intimately familiar with these conditions.
Anesthesiologists also need, but often do not get, basic details on coronary stents and other implanted devices see Table 1as well as guidance on the latest anticoagulation recommendations, with which it is difficult to keep up to date. A sensitivity to audience and context It is always appropriate to ask the surgeon requesting a consult—and the anesthesiologist assigned to the case, if known—what he or she wants to know from the consult.
If guidance on specific cases is impractical, it is appropriate to ask the chair of the anesthesiology department, or several anesthesiologists collectively, for general guidance on what they look for from preoperative consults. Anesthesiologists, like consultants, comprise a broad range of people, and it is always important to be sensitive to context.
Generalists who work mainly on healthy patients or in a community setting may have forgotten some of their training in acute medicine and are more likely to appreciate advice on intraoperative care.
On the other hand, an anesthesiologist who trained in a cardiothoracic subspecialty fellowship, who routinely deals with issues such as left ventricular assist devices and heart transplants, would not benefit from such advice.
A consult is an opportunity for the medical consultant to provide helpful management suggestions to the operative team. The consult is an important contributing factor to this decision, but it should never be the mechanism of the decision. The following case illustrates a typical scenario for a cardiac consult request and presents examples of good and bad notes requesting consults and good and bad consults written in response.
The case A year-old man is scheduled for femoral-popliteal bypass surgery. His medical history is significant for diabetes, a myocardial infarction MI 3 years ago followed by placement of a stent, and a limited ability to assess exercise tolerance.
Evidence of an anteroseptal MI is present on lead electrocardiography.
His medications include metoprolol 25 mg twice daily and an oral hypoglycemic agent. For this complex surgery with significant fluid requirements, a much better consult request would include several specific requests and questions and might read as follows: Is further therapy required to optimize CAD treatment?
If so, can this be done postoperatively? Is an echo indicated? Example of a bad consult A poorly written consult in a case like this may: Moreover, there are no proven major outcome differences related to the type of anesthetic chosen.
State that the patient be sent to the ICU following surgery. Mandating an ICU stay in advance makes no sense unless the operation itself demands ICU care, which is the call of the surgeon and anesthesiologist anyway. Example of a good consult In contrast, a good consult for this case would involve: A detailed history examining the potential for silent ischemia associated with the diabetes, as well as the relationship of the hypertension and beta-blocker therapy to episodes of ischemia.
The level of ischemia should be clearly categorized.3) The medicine consult residents will write a note on all requested transfers/admissions 4) The medicine consult residents will discuss all requests for transfer/admissions to .
MR Form S Page 1 This form is for use with hospital patients only.
E/M Level Patient Identification DEPARTMENT OF MEDICINE PULMONARY/ICU PROGRESS NOTE. Pulmonary Consult Resident Rotation. This rotation is designed to provide the resident with a practical background in Pulmonary Medicine.
The resident(s) on the service will complete pulmonary consultations on hospitalized patients with respiratory problems and staff them with the Pulmonary Consult Team. — Pulm timberdesignmag.com Hosp Consult note Name: Pulmonary Medical student Hospital Consult note System: Hospital. Pulmonary Consult Resident Rotation.
This rotation is designed to provide the resident with a practical background in Pulmonary Medicine. The resident(s) on the service will complete pulmonary consultations on hospitalized patients with respiratory problems and staff them with the Pulmonary Consult Team.
Format of Dictated Consult Notes. Patient Identification Physician Requesting Consult. Reason for Consultation.
Impressions. Recommendations. .