Page 4 - Registrar Orientation Manual 2016

POLICY
Senior Medical Officer (SMO) and Resident Medical Officers (RMOs) Responsibilities and the Limits of Delegation of Responsibilities to RMOs
The following must always be documented in the clinical notes by the referring team:
 the name of the SMO making the referral
 the expectations that the referring SMO/team have of the SMO/team referred to,
 a summary of the clinical details, and
 the contact details of the referring doctor.
The team who respond must clearly document their opinion and answer any specific questions.
Any urgent action that is required must be communicated verbally to the referring SMO or team.
Disagreements between SMOs must be escalated immediately to their Clinical Directors (CD) and, if necessary, the Clinical Unit Leader (CUL), Service Head or Chief Medical Advisor (CMA).
5. Complex cases requiring input from multiple specialities
 Early SMO to SMO communication should be established to delineate the responsibilities and expectations of the different services involved in patient care. This cannot be delegated to RMOs.
 For ICU cases, the responsible ICU SMO will coordinate care.
 While a patient is in the ED Resuscitation, the ED SMO will coordinate care until there is an agreed
designated team who will take primary responsibility. This should be agreed in a timely way.
 For trauma cases, the Trauma Director will coordinate care (see the Trauma Protocol).
 In non-trauma cases, it must be agreed which SMO and team will take primary responsibility and for what. The responsibilities of the other services should be agreed and understood.
 The SMO with the primary responsibility may change over time but must always be clear.
 If there is any disagreement over the most appropriate service and SMO to take primary
responsibility, there should be a SMO to SMO discussion, if necessary escalated as noted above.
 For patients in the HDU, the SMO identified as the primary SMO responsible for the patient’s care is responsible for coordinating all care provided to that patient.
 The SMO primarily responsible for patient care should be documented in the patient’s clinical notes. This SMO is also responsible for coordinating all care provided to that patient.
6. Patients in the Emergency Department and Emergency Department referrals
Refer to the Speciality Referral Guidelines which outlines the responsibilities of RMOs referred patients by the ED and the need to immediately escalate issues to their SMO to deal with at the SMO to SMO level and if needed at a CD to CD, or CUL to CUL level or to the CMA.
7. Audit Indicators
Compliance with this Policy will be monitored by incident reporting and mortality reviews.
8. Associated Documents
Waikato DHB Specialty Referral Guidelines (5295) Waikato DHB Trauma Protocol (1538)
Waikato DHB Electronic Results Acknowledgement: The responsibility of the Senior Medical Officer and the delegation of the responsibly to Resident Medical Officer (1452)
Waikato DHB Clinical Records Management (0182)
Waikato DHB Deceased (Care of) policy (0133)
Waikato DHB Admission, Discharge and Transfer (1848) Resuscitation Policy
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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