20. STANFORD DEPARTMENT OF OHNS GUIDELINES FOR CONSULTATIONS

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20. Stanford Department of OHNS Guidelines for Consultations

General guidelines for all consults: ◼ Otolaryngology is a service oriented specialty where relationships with practitioners of other services are established and maintained. ◼ ALL consults should be seen the day they are received unless it is late in the day and the referring provider expressly states that it is fine to see the next day. If the consult is received but not seen on that day, please see the consult yourself on the following day so another resident is not left with your work. ◼ If a consult is received and you think it is truly an inappropriate consult,an OHNS Chief Resident MUST hear about the consult and give permission for the OHNS resident to not see the consult. ◼ Consults take priorityover the OR. ◼ All consults must be staffed with the on call attending the day of the consult. ◼ A consult note must be entered on the day of the consult (including vocal fold consults). This includes any consult you see, even ones that are immediately signed off on. ◼ A full consult note must be entered for every consult patient. It is not OK to only enter a procedure note without a consult note (for example: a full consult note needs to be entered for a patient with possible vocal fold paralysis –not just the laryngoscopy note.) ◼ During the day, the consult note may (and should) be started but not completed (i.e. don’t put the assessment and plan) until the consult has been seen/discussed with the attending. ◼ All outpatient calls should be returned in a timely fashion and have a telephone encounter documented in the appropriate EPIC. ◼ The night float residents should see and document all consults-even ones that are not urgent. ◼ Referring providers should be treated with respect –just as we want to be treated when we call in a consult. Inevitably, we will receive some consults for conditions we think are “silly” or “a waste of time”. Remember that we sometimes call in these types of consults too. A consult is a request for help. BE NICE.

Emergency Department Consultations: ◼ Should be seen within 1 hour of receiving the call (obviously,quicker for urgent consults) ◼ Always check out with the ED physician-don’t leave without talking to them.

Consults at SHC: ◼ The Consult PGY 2 (and occasionally 1) serves as the front-line consult resident. ◼ Consults will be added to the team of the staffing attending (ie a consult staffed by a Scope attending will go to the Scope service.) ◼ Trach consults will go to the service of the staffing attending. ◼ Vocal fold consults go to the Headmirrorservice. ◼ Existing H&N patients with a H&N issue will go to Scalpeleven if not yet staffed with the H&N attending (i.e. laryngeal tumor patient followed by Kaplan in the past but staffed with rhinology fellow will go to H&N) ◼ New H&N patients will go to team of staffing attending unless directed otherwise by the chief (i.e. new tongue SCC consult staffed by FPRS fellow will go to Scope at first.) ◼ If you want a consult to be seen in a fellow/instructor clinic (i.e. mandible fracture to be seen in FPRS clinic) you must email, call or text that attending. A STAFF MESSAGE ALONE IS NOT SUFFICIENT!

Consults at LPCH: Please refer to Peds Service Guidelines provided by the division.