Page 3 - Registrar Orientation Manual 2016

POLICY
Senior Medical Officer (SMO) and Resident Medical Officers (RMOs) Responsibilities and the Limits of Delegation of Responsibilities to RMOs
3. RMOs must contact the responsible SMO regarding patients they see or admit in the following circumstances and SMOs must ensure that they are available to respond
 Any patient who is seriously ill or sufficiently ill to require admission to the Intensive Care Unit (ICU), or HDU, or the Low Stimulus Area (LSA) in Mental Health.
 Any patient who requires acute transfer to another service or hospital.
 Any acutely ill patient transferred to Waikato Hospital.
 Any patient for whom the diagnosis or management is unclear; and for whom a delay of management until the next ward round would be inappropriate.
 Any patient who deteriorates unexpectedly.
 Any acutely unwell or unstable patient who requires more than a brief stay in the Resuscitation
area in the Emergency Department (ED).
 Before making the decision to take a patient to theatre or for an invasive procedure.
 If requested by the nurse in charge of the ward at the time, or a clinical resource nurse.
 If a patient has a complication following a procedure with which the RMO is unfamiliar.
 To discuss all new admissions, referrals or patients discharged from ED at the end of their duty.
 Any unexpected death.
 Any death that may need to be reported to the coroner, before it is reported.
It is expected that all inpatients are seen each weekday by a RMO, and that the responsible SMO informed of any significant change in the patient’s condition.
On the weekend and out of hours, the on-call SMO is responsible for all inpatients admitted under their speciality or seen by their on-call RMOs. Every patient should have a weekend plan documented in the notes, and the on-call SMO should be informed of any deviation from that plan.
4. Involvement of SMOs in ward referrals
A ward referral is defined in this policy as one clinical team asking another clinical team to assess a patient on a ward and contribute to their inpatient management.
While many phone calls between RMOs regarding inpatients under another team are simply asking for general advice and are not actually referrals, even when providing advice, the RMO is still acting under delegated authority and the SMO should be informed if appropriate.
A RMO of the team receiving the referral should see the patient in a timeframe consistent with the clinical urgency, and then discuss the matter with their supervising SMO.
The SMO should be informed of any opinion their RMO has given, and decide if that is appropriate. The SMO will decide if they need to see the patient themselves.
The SMO initiating the referral should always be informed of the outcomes of the referral. Any urgent action that is required must be communicated verbally to the referring SMO/team.
Only a SMO can make a decision that a ward referral requested by a SMO is inappropriate. In this situation, the SMO of the team receiving the referral request should provide advice to the referring team; this could include an offer of an outpatient clinic appointment or other recommendation.
A direct SMO to SMO discussion is the best way to address any issues or in difficult cases.
Doc ID:
2561
Version:
02
Issue Date:
27 July 2016
Review
26 July 2019
Document Owner:
Dr Paul Reeve
Department:
CDlainteic:al Services
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