Afternoon consults and admissions (inpatient)

[nexus73]

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For inpatient doctors, what's your experience when consults get requested after 3pm or so. Or the ED has an admission or a boarded patient to be seen, 3pm or later. Are you seeing these, or common to roll to the next day?

 

[jbomba]

For inpatient doctors, what's your experience when consults get requested after 3pm or so. Or the ED has an admission or a boarded patient to be seen, 3pm or later. Are you seeing these, or common to role to the next day?

330 is cut off for our academic hospital consult team

 

[clausewitz2]

330 is cut off for our academic hospital consult team

At our shop when I was rotating through c&l, they would see literally any consult placed before 5 pm. It was pretty terrible.

 

[Old&InTheWay]

The CL team at my institution usually defers non-urgent consults that come in after 3 pm or so until the next day. But there are attendings in the ED until 8pm most days and a resident is on overnight, so perhaps it's easier for the consulting teams as they know there is someone available if the situation becomes more urgent.

 

[Wheatbread]

3pm, then gets rolled to next day. We have 24hrs to see the patient. If I’m on the floor after 3pm it’s at my discretion if I see it.

 

[Celexa]

Agree, the consult gets triaged and done the next day unless there's a real good reason they need to be seen right then.

 

[Jules A]

I avoid starting consults after 3:00pm unless it is a doc who I especially like or an unusual/urgent situation.

 

[psych_0]

If you mean do I see inpatient admissions on my inpatient until at 3pm, then absolutely not. Any admission that hits the floor after 12pm gets seen the next day. Now on days when I am on home call until 11pm, I will sometimes see admissions via telepsych until ~3pm if I am bored. But seeing those admissions takes away from the wRVU pool for my colleagues the next day, so I don't do it often. Usually just a judgement call.

If you mean inpatient consults in the hospital, it would vary by institution. In residency, we would see any and every consult that came across before 5pm. I still get flashbacks of the consult on the other side of the hospital that came across at 4:57pm for "Patient yelling. Wants to talk to psych." At my community hospital now, it is completely up to the discretion of the physician on the consult service. Mon-Fri the consult attending will see any consult that comes in and usually lives at the hospital 7:30am-7pm most days. On the rare weekends I cover the consult service, I see 10 consults then cap it until the next day. Whatever doesn't get seen Sunday rolls into Monday. Weekends can be very busy though, up to 18-20 consults per day at times.

 

[Jules A]

If you mean do I see inpatient admissions on my inpatient until at 3pm, then absolutely not. Any admission that hits the floor after 12pm gets seen the next day. Now on days when I am on home call until 11pm, I will sometimes see admissions via telepsych until ~3pm if I am bored. But seeing those admissions takes away from the wRVU pool for my colleagues the next day, so I don't do it often. Usually just a judgement call.

If you mean inpatient consults in the hospital, it would vary by institution. In residency, we would see any and every consult that came across before 5pm. I still get flashbacks of the consult on the other side of the hospital that came across at 4:57pm for "Patient yelling. Wants to talk to psych." At my community hospital now, it is completely up to the discretion of the physician on the consult service. Mon-Fri the consult attending will see any consult that comes in and usually lives at the hospital 7:30am-7pm most days. On the rare weekends I cover the consult service, I see 10 consults then cap it until the next day. Whatever doesn't get seen Sunday rolls into Monday. Weekends can be very busy though, up to 18-20 consults per day at times.

Wow, that is a lot of consults. How big is your hospital?

 

[comp1]

From a service line perspective, it helps if you can vary the shifts. For example, we have some MDs working 4-10's with 7 AM to 5:30 PM schedules and some who just do the normal 8-4:30. Some alternate regular days off and work like 8-4:30. This gives a bit more berth to the ED. Because here's the thing...psych consults tend to pile up in the late afternoon/early evening when not a lot of consultants are looking to work. There's not a lot at 3 AM and weirdly there's not a lot at 12 PM either. If you can take some pressure off those later afternoon consults, it helps the ED and the med floors a lot. Personally, I can whip out a quick consult in 30 minutes and definitely in 45 minutes. So I'll try to see any that come in before that time period. If it's a truly extreme situation, we can request comp time if we have to stay later.

 

[nexus73]

From a service line perspective, it helps if you can vary the shifts. For example, we have some MDs working 4-10's with 7 AM to 5:30 PM schedules and some who just do the normal 8-4:30. Some alternate regular days off and work like 8-4:30. This gives a bit more berth to the ED. Because here's the thing...psych consults tend to pile up in the late afternoon/early evening when not a lot of consultants are looking to work. There's not a lot at 3 AM and weirdly there's not a lot at 12 PM either. If you can take some pressure off those later afternoon consults, it helps the ED and the med floors a lot. Personally, I can whip out a quick consult in 30 minutes and definitely in 45 minutes. So I'll try to see any that come in before that time period. If it's a truly extreme situation, we can request comp time if we have to stay later.

For us it's tough. We're a community hospital with psych unit and the docs cover consults and ED as part of the job. I'm a broken record complaining but our admin seems to want the inpatient docs to run the consults and ED as if those services were separately staffed, when they have their own census of psych inpatients to cover as well.