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Lindee Abe, APRN
Consulting another healthcare professional was not taught in school when I went to school for my FNP. It was something that I learned during clinical rotations and later in clinical practice. Since this topic is not routinely covered in any textbook, it is a great topic to address in this forum. I’m happy to share what I have learned in my practice.
Be Focused
There are consults, and there is a giving report. First, when giving a report on a patient, usually because you are leaving at the end of your shift, this requires a different conversation than a consult. All clinicians should be familiar with a SOAP (i.e., subjective, objective, assessment, plan) note format of documentation. It helps to follow a similar format when giving a report, although you may abbreviate the information only to include the pertinent data. We have all received a patient report comprising every detail about their history. As we all know, it takes a lot of work to focus on the most critical data.
The receiving clinician doesn’t need to know if the patient had their wisdom teeth removed at 15 when they are there for pyelonephritis. This is especially common with students and is something that you can help students work through if you precept students to prepare them for practice.
Consulting with BLUF
The biggest thing I have learned when calling consults is the BLUF (i.e., bottom line up front). This applies to giving reports and case presentations, but even more so with consults. This is so important to ensure that you are communicating the most important information and to tell the consultant what the phone call will be about. The BLUF should include the age and gender of a patient. This can be a factor when determining if the consultant you call is even the correct person to talk to for this patient.
One example would be pediatric orthopedics. Orthopedics generally doesn’t see pediatric patients, but that will depend on the patient’s age and the type of consult needed. Suppose the pediatric patient needs surgical repair for a fracture. In that case, there may not be an anesthesiologist who is comfortable with a pediatric patient. There may not be a pediatric unit if the patient needs to be admitted. This also highlights another point of emphasis – make sure you are calling the right consultant.
Know Who to Consult
Most hospitals usually have a list of who is on call for each service. Make sure that you are looking at the correct dates and services. I made the mistake of looking at the wrong dates and called the physician who was on call the following week. It did not go over well with that physician, and I will not repeat that mistake. Make sure that the service you are calling is the one that sees the patient you want to consult. In some hospitals, OB/GYN is grouped together, but in other larger hospitals, OB and GYN may be two separate services. Another example would be cardiology and interventional cardiology. If in doubt, ask a coworker if one is available before calling a service.
Every hospital has its own system and staff services differently. This can take some time to get used to the system used when you first start. You must know what services are in-house when on call and at home. Some services may also be able to look at imaging or EKGs at home, and others may not. It helps to know if the provider is upstairs or 30 minutes away if it is an emergent consult. This may come with time and questioning of the staff to better understand how different services operate. The staff can also usually tell you who is more likely to come in almost immediately because they live 5 minutes away from the hospital. They also know who typically takes the whole 30 minutes to get there.
Have a Plan in Mind
Another important tip is to know why you are calling the consultant. It only took me a few times to go through a very extended case presentation when I first started working, and the consultant interrupted me halfway through to ask why I was calling. I don’t blame them one bit for it, either, because the reality is that their time is important and they need to know what the point of the call is.
Are you calling because you want them to evaluate the patient and possibly admit them to their service? Do you want to know if it is appropriate for them to follow up in the clinic later that week? Are you calling because you have done a typical diagnostic workup, but you still can’t reasonably determine what is causing the patient’s symptoms and want to know their recommendation for diagnostics?
These questions are all asking different things. If you aren’t clear about what you are asking for, you likely won’t get the answer you need. They may assume you want them to be seen in the clinic for a fracture, but the reality is that it is displaced, and you can’t reduce it and are requesting them to see the patient. If you aren’t clear about what is needed, the consultant won’t know. You are the only one that is looking at the patient.
Do the Right Thing!
This leads me to my next point. Some consultants will come in to see a patient more easily than others. Some consultants may try to second guess if the patient needs to be evaluated in person. That is an appropriate conversation, but stand your ground if you think the patient should not go home. If you believe a patient should be admitted and are the only one who has physically assessed the patient, don’t back down. I’m not saying to admit everyone, but fight for admissions if you feel they are necessary. If the service being consulted doesn’t want to admit the patient, that’s fine. However, they should (as professionals) come to the department to evaluate the patient. They can discharge the patient from there with an appropriate follow-up plan if that’s their expert opinion.
Group Consults on One Call
Another tip I learned is that if a consult in the department is needed, consider if any of your current patients or patients in the lobby may also need a consult with that service. It is much easier to get the service to consult on a patient when they are already there than to call them 15 minutes after they leave to come back.
Consulting different services is a skill that comes with practice. When I first started, I would write down the main points of the BLUF, why I was calling, and pertinent facts. If the consultant wants additional information regarding the patient, they can ask, and you can provide the information, but you don’t have to tell them every last detail. Just know that you will make mistakes and learn from them when you first start. You will also get better as you learn different preferences and personalities. Stick to the basics and utilize the lessons I learned to improve yourself when calling for the next consult.
