Contacting Tox Regarding Patients

[EM2BE]

I have done a toxicology rotation for my residency requirements. I found some pet peeves when working on the service. Part of the service was to answer phone calls and give advice to hospitals. The other part was to do inpatient treatment when patients were admitted or transferred to the service. The phone call part is what I am hoping to start a discussion about.

I found some hospitals have their triage nurses call, some the nurse caring for the patient, and some the physician/resident/PA/NP caring for the patient. Trying to figure out what the advantage is of the nurses calling in other than time constraint. I found on the toxicology side, it was difficult to answer questions with very minimal information. Some would call without vital signs even being done yet. Some call without any labs (sometimes I do understand this is appropriate, but most of the time it can wait). Some are really nice and call with everything. Unfortunately, when nurses call, getting the neuro exam over the phone was quite challenging.

Maybe the situation is different than other places, but at this place, it was always a resident answering the phone. It is not the poison control center that patients/families call.

Question here is: What is typically done at your shop? And if you typically have nurses call, is there a specific reason?

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[Nervous Ned]

At UMass, we (the residents) are the ones who make the call. I'm not sure how typical our setup is, but we have a tox consult service and no poison control center. So when we call, we either get the second year resident doing their tox rotation, a tox fellow, or on occasion a tox attending. Plus, we have a large tox division with 11 faculty, so a lot of times, we wind up working with one of the tox attendings in the ED anyway.

I never realized that nurses make those calls at some hospitals, and I don't understand why that would be either, except to try to expedite care, as you said.

 

[BADMD]

I never realized that nurses make those calls at some hospitals, and I don't understand why that would be either, except to try to expedite care, as you said.

At lots of places, the doctors can't be bothered to come to the phone...unless the patient is sick, in which case they are pissed that it took me "so long" to come to the phone. Other places have the nurse/clerk call so that they can check off "called Poison Control Center" to their paperwork.

I can't speak for others, but I greatly appreciate hearing from the physician. Nurses rarely have the information/correct information. It is usually impossible to give good advice without talking to a physician. It is even worse on the floors of community hospitals...the doctors aren't even around and the nurses have to call the physician, based on what we have told them, to get orders. It is the worst game of telephone ever.

 

[ToxicChic]

Agree with the telephone comment- its an issue at my shop in Columbus.
To answer the orig question, we have the poison specialists answer all initial calls and the residents follow up on admitted patients via telephone after AM table rounds. We used to have the residents answering the phones for initial calls but there were too many issues with that (orienting them every month on how to create toxicall charts, and having them dispense advice while they are supposed to be spending most of their time learning the med/tox subject matter).
After AM rounds and a few callbacks we go over to the hospital and see inpt consults as a group. The residents don't end up writing consults/progress notes bc fellows write them, but they follow along and discuss the consult with us.
Residents don't get the *privilege* of tox clinic

 

[Daiphon]

At lots of places, the doctors can't be bothered to come to the phone...unless the patient is sick, in which case they are pissed that it took me "so long" to come to the phone. Other places have the nurse/clerk call so that they can check off "called Poison Control Center" to their paperwork.

I can't speak for others, but I greatly appreciate hearing from the physician. Nurses rarely have the information/correct information. It is usually impossible to give good advice without talking to a physician. It is even worse on the floors of community hospitals...the doctors aren't even around and the nurses have to call the physician, based on what we have told them, to get orders. It is the worst game of telephone ever.

Agree with the above... it's always best to speak with the treating physician; there are nuances involved with the sicker patients, and I want to ensure that the essentials of therapy are the focus (e.g. get fomepizole & HD going in lieu of spending time mobilizing vitamin therapy for ToxOH).

My home base has a service, so it's easier there; but the community shops can be frustrating... part of the job though. Just keep plugging & trying to advocate for the patient, and do your best.

 

[EM2BE]

Glad to see the consensus is that it should be a physician-physician conversation. Maybe I should start asking/insisting to speak with the physician instead of working with incomplete information. Thanks all!

 

[Nervous Ned]

Glad to see the consensus is that it should be a physician-physician conversation. Maybe I should start asking/insisting to speak with the physician instead of working with incomplete information. Thanks all!

What makes sense to me is that whoever is the LIP caring for the patient should be the one to contact the tox service. So it would be reasonable for an NP working as a provider in the ED to make the call, but not a regular nurse.