ARERO PRIMARY HOSPITAL

INTERDEPARTMENTAL
CONSULTATION
PROTOCOL
BY DR FIRAOL. MD,QFP
Table of Contents page no

Services Provided by APH............................................................................................................................2

Mission & Vision of APH..............................................................................................................................3
Core Values of APH......................................................................................................................................4
Health Care Quality.....................................................................................................................................4
INTERDEPARTMENTAL CONSULTATION......................................................................................................6
2. General Rules...........................................................................................................................................6
Guidelines for Consultation Requesting Health Care Providers...................................................................8
Guidelines for Physicians/Providers Responding for Consultations...........................................................10
IMPLEMENTATION OF THE PROTOCOL......................................................................................................13

Services Provided by APH

1. General OPD services

2. Emergency Adult Medical services

3. Emergency Pediatric Services

4. Inpatient Services

5. OBS/GYN services

6. General Surgical Services

7. Psychiatric service

8. TB & DRTB services

9. ART services

10. Radiology & Imaging services

11. Laboratory service

12. MNCH services

13. NICU services

14. Nutritional rehabilitative service

15. Ultrasound services

16. Major & minor Operation services

17. Emergency & Elective Operation Services

Mission & Vision of APH

1. Mission:- To reduce Morbidity, Mortality, Disability & Improve health status of the
Community through Provision of Preventive, Curative & Rehabilitative health Services.

2. Vision:-Aspire to be Preferable Hospital to Community with the aim to see healthy,

Productive & Prosperous Community.
Core Values of APH

1. Community First

2. Collaboration

3. Commitment

4 . Change

5. Trust

6. Continues Professional Development

Health Care Quality

The degree to which health services for individuals and populations increase the likelihood of
desired health outcomes and are consistent with current professional knowledge OR

Comprehensive and integrated care that is measurably safe, effective, people-centered, and
uniformly delivered in a timely way that is affordable to the Ethiopian population and
appropriately utilizes resources and services efficiently.”

1. The Service is said to have Quality if it is :

1. Safe: Avoiding injuries to patients from Care that is intended to help them. Patient Safety
is the prevention of errors & adverse effects to patients associated with the health care.

2. Effective : providing services based on Scientific knowledge to all who could benefit &
refraining from providing services to those not likely to be benefited.
.

3. Timely: reducing Waits & harmful delays for both who receive & those who give care.

4. Efficient: avoiding waste including waste of Equipment, Supplies, ideas & Energy.

5. Equitable: Providing care that does not vary in quality because of personal characteristics
such as Gender, Ethnicity, Geographic Location & Socio economic status.

6. Patient Centered: Providing care that is respectful & responsive to individual patient
preferences, needs & Values ensuring that patient values guide all clinical decisions

7. Integration: Comprehensive care is provided in a coordinated way across the continuum of

care.
INTERDEPARTMENTAL CONSULTATION
1. Introduction

In simple terms a consult is a request made from one physician or provider to another
physician or provider to give an opinion or advice on a specific patient. A consultation is
usually sought when a physician or provider with primary responsibility for a patient
recognizes conditions or situations that are beyond his or her training or expertise. An
effective consult should always be performed with the patient's best interest in a positive
impact on the patient's Care. Open communication between the referring physician or
provider and the consult provider is essential for effective consultation.

2. General Rules
2.1. Interdepartmental Consultations should be made by at least General Practitioner &
above; but IESO can make consultation when General Practitioners & Seniors aren’t available.

2.2. All Interdepartmental Consultation response should be made by Senior specialist

physicians; in situations when senior specialists aren’t available the most senior clinician from
the department should respond to the consultation request.
2.3. All Consulting physicians/providers should document patient’s pertinent History &
physical examination findings on patient’s chart

2.4. All Consulting physicians/providers should request consultation using Consultation

request form prepared for Interdepartmental Consultation

2.5. All pertinent History & pertinent Physical examination findings should appear on
Consultation request form

2.6. Consulting physicians/providers should document Date & Time of Consultation clearly
with local calendar & time

2.7. Consulting physicians/providers should write their Name, Profession & Sign

2.8. Consultants should document their Date & Time of arrival clearly with local calendar &
time

2.9. Consultants should document their patients’ findings note & their decision &
recommendation clearly & write their Name, Profession & Sign.

2.10. Nurses/Midwives/Providers should document Identifications of patients for whom

Consultation was made, Date & time at which consultation was made & Date & Time at which
Consultants arrived on Consultation Registration log book prepared for this purpose.
Guidelines for Consultation Requesting Health Care Providers
1. Ask a clear and specific question.
1. Don't make the consultant guess what your question is. A vague
question Will likely result in a vague response.
2. Consulting physicians/providers are encouraged to contact the
consultant directly to clarity the question to be addressed.
3. If the Consulting physicians/providers are interested in arranging a
procedure (endoscopy, bronchoscopy, etc), he or she should make that
request clear to the consultant.
4. A request for a consult should be placed documented on
Interdepartmental Consultation request form, dated with local time
mentioned, named & signed.

2. Establish the degree of urgency.

1. The Consulting physician/provider must decide if the consult should be seen
emergently (immediately), urgently (same day) or routinely. Underestimating the
urgency of the consultation may negatively impact patient care; repeatedly
overstating the urgency may annoy the consultant.
3. Call the consult early.
2. Call early in the day to allow the consultant the best opportunity to see the patient
the same le day;
 3. Call early in the week, especially if attempting to schedule specialized procedures or
diagnostic studies not routinely performed on weekends;
4. Call early in the hospital course; calling a consult on the day the patient is scheduled
for discharge reflects poor planning and may not allow the consultant to make
effective intervention
4. Physician-to-physician/provider communication is critical!
5. Don't delegate the responsibility of calling a consult to anyone who is not fully
familiar with all details or the patient's case;
6. If the Consulting physician/provider calls the consultant directly, the consultant is
much more likely to return the favor after the patient been evaluated.
5. Provide essential medical information.
7. In all but emergent circumstances the consultant Should reasonably expect to find a
complete admission history and physical examination for the patient entered in the
medical record
8. In particular, the Consulting physician/provider should provide critical details that
may not be immediately available to the consultant (e.g., information from outside
hospitals).
6. Notify the patient to expect a visit from the consultant.
9. The Consulting physician/provider should always discuss plans for consultation
with the patient (to be sure that the patient is in agreement and to avoid any
misunderstandings.
7. Acknowledge the recommendations provided by the consultant.
10. The Consulting physician/provider has the option to accept or reject the
consults recommendations. However, if the Consulting physician/provider elects
not to implement the consultant's recommendations, he/ she should, at least,
acknowledge in the medical record that the consultant's recommendations have
been and reviewed.
8. Avoid "curbside" consultation except for simple, straight-forward problems.
11. "Curbside" consultation is best suited for questions with a factual answer
that can be looked-up quickly in a reference source (e.g., drug dose, lab test
 interpretation. etc.). For more complex questions, a request for formal consultation
is more appropriate;
12. Be willing to request formal consultation if that is suggested by the
consultant.
13. "Curbside" questions ideally be discussed between attending
physician/provider
14. Without involvement or trainees or other personnel.
1. If co-management of the patient is desired, the Consulting physician/provider
should discuss that directly with the consulting physician/provider.
2. The patient's attending physician remains in charge of the patient's overall care, but
can delegate specific aspects or management to the consultant, if mutually
agreeable.
3. Co-management should not be assumed or presumed by either party. If the
referring physician and consultant agree on Co-management, the boundaries should
be carefully defined and entered into the medical by the referring physician.
10. Discuss the consultant's findings and recommendations with the patient.

Guidelines for Physicians/Providers Responding for Consultations

1. Answer the question that was asked.
4. Don’t be distracted by other interesting findings that are outside of the scope of the
original question;
1. If the consultant uncovers other previously-unrecognized clinical problems that
need to be addressed; the consultant should call the Consulting physician to discuss
them further.
2. See the patient in a timely manner.
3. When the consult is called, establish the degree of urgency with the Consulting
physician/provider.
4. As a general rule, all interdepartmental consultation response should be responded
as early as possible & as the nature of consultation
5. All professionals providing consultative services must make arrangements to
provide consults on nights, weekends, and holidays when requested.
6. Make certain that the recommendations are clear and easy for the Consulting
physician/provider to understand.
7. Be concise and succinct; use definitive language;
8. Recommendations offered in a list are easier to understand than
recommendations buried in paragraphs or text
9. When the diagnosis is uncertain, listing every possible differential diagnosis is not
helpful, Otter the top 5 possibilities;
10. Prioritize your recommendations. Make clear which recommendations are critical,
which should ordinarily be 5 or fewer. Other recommendations can go on a "non-
critical" list. Indicate Which (if any) of the recommendations Will be carried out
by the consulting beam
11. Be very specific and offer detailed recommendations. The referring
physician/providers should have expected to have consultants level of expertise.
Clearly drug doses, routes of administration, frequency and duration of dosing,
specific tests to be ordered, etc.
12. For handwritten notes, legibility counts. Recommendations that cannot be
deciphered are not helpful and carry potential for harm.
13. Physician-to-physician/provider communication is critical!
14. A telephone call from the consult attending/providers is usually appropriate and
appreciated referring physician/providers. When consult contains "critical"
recommendations that need to be implemented as soon as possible, direct physician-
to-physician/provider communication is essential;
15. Never leave "critical" recommendations in the medical record without notifying the
Consulting physician/provider;
16. The consultant's note should be professional and respectful in language and tone.
17. An effective note should be informative without being patronizing and should be
helpful without being condescending;
18. A consult note is not an appropriate place to offer criticism of other providers,
services, or Institution.
19. "Chart Wars" are counter-productive and should always be avoided; providers who
disagree on management plans should discuss their differences of opinion directly.
20. The consultant should first discuss his or her findings and conclusions with the
Consulting physician/provider, not with the patient.
21. Remember that the consultant's recommendations may or may not be implemented
by the Consulting physician/provider. Don't confuse the patient;
22. If the consultant suspects a diagnosis with high potential for emotional impact (e.g.,
a new diagnosis or cancer), the consultant and the Consultation physician/provider
should discuss who is in the best position to break this news to the patient.
23. Continue to see the patient as frequently as required until the medical issue has
been satisfactorily resolved.
24. The appropriate frequency of follow-up depends on the severity and of the
problem under evaluation;
25. When further follow-up is no longer necessary, the consultant should enter a formal
"sign Off" note into the medical record
8. Arrange subspecialty outpatient follow-up, when necessary and requested by the
consulting physician/provider.
9. Define parameters for co-management when requested by the consulting
physician/provider.
26. A consultant should never assume a co-management role unless specifically
requested to do so by the consulting physician/provider. If the physician/providers
requests that a consultant take over management of specific aspects of the patient's
care, the parameters Should be carefully defined in a conversation and documented
in the medical record
27. Identify the contact person from the consulting team who will be writing the co-
management orders and enter that information in the medical record.
10. Accept requests for "curbside" consultation only when the issue is simple,
straightforward and clearly within the consultant's area of expertise.
28. For questions where decision making is more complex, the consultant should not
hesitate to suggest formal consultation and offer to Sec the patient;
29. "Curbside" questions arc ideally discussed between attending physicians. Trainees
should not otter "curbside" opinions without first reviewing the question with the
attending consultant.

IMPLEMENTATION OF THE PROTOCOL

1. The protocol will be implemented after orientation is given to relevant stakeholders

for further comments & awareness creation
2. All departments including both Adult & Pediatric EOPDs should avail
Interdepartmental Registration Log book to register all information of patients for
whom consultation was made & date & time of consultation & date & time of respond
to consultation
3. Its implementation will be evaluated by Coordinators & Directors weekly
4. All departments Heads should avail hard copy of Consultation request form to their
wards & monitor the implementation of Interdepartmental Consultation according to
this protocol
5. QIU always audit its implementation status monthly in EBC audit platform
 ARERO PRIMARY HOSPITAL

Inter departmental consultation form

Nature of consultation Urgent Emergency Cold

Patient Name____________________________ Sex _______Age________ MRN __________________

Consulting Department _________________________________________________________________

Consulted Department__________________________________________________________________

Consulting Health Care Professional _______________________________________________________

Consulted Health Care Professional _______________________________________________________

Consultation date & time Date ____________________Time _________________________________

Pertinent History

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_____________________________________________________________

Pertinent Physical Examination Finding

V/S:- BP______________PR_____________RR_________T___________Pain Score________________

___________________________________________________________________________________________
___________________________________________________________________________________________
_________________________________________________________________________

Assessment:-

___________________________________________________________________________________________
_______________________________________________________________________________

Name ________________________ Profession__________________________ Sign _______Date __________

Consultant Arrival Date & Time

Date _____________________________ Time______________________

Decision of Consultant
___________________________________________________________________________________________
_______________________________________________________________________________

Name________________________Profession_____________________________Sign________Date_______