The Value of Communication

I work at a large academic medical center.  To officially consult a service, you have to place an order into our EMR.  A lot of times, teams will put the consult order into the computer, but they won't call to discuss their consult.  For example, when I was doing ortho, I would get a call from a ward secretary to inform me of a consult that was placed 30 minutes ago:  'rule out nec fasc' or 'rule out compartment syndrome.' 

Nec fasc is shorthand for necrotizing fasciitis, more commonly known as flesh eating bacteria.  This is not a diagnosis that should be taken lightly, nor should it wait 30 minutes to be seen!  If the patient really has necrotizing fasciitis, and you leave them for another 30 minutes, they could lose a limb, or worse, their life.  Compartment syndrome is the same sort of situation.  These are examples of orthopaedic emergencies, situations when a consultant should drop what they are doing and go see the patient immediately.  Granted, the yield for these consults is somewhat low, but if you're concerned enough to worry about something that is considered an emergency, you should call and talk to the person who will be doing the consult directly.  Imagine if I placed a computer consult to the cardiologist that said 'rule out ST elevation MI,' and then allowed the patient to lay in their bed for the next 20-30 minutes waiting for the ward secretary to notice the order on the printer and call the consult!

It's not just emergent consults, however.  If another service wants me to come and see a patient, I'm always happy to.  I'll never refuse a consult.  I do, however, appreciate a phone call to hear the story first hand.  Not only do I like to hear the story, it's always easier to understand the question when you can ask questions back.  If imaging needs to be ordered, I can make sure I have everything I need to take appropriate care of the patient.

Communication, however, is a two way street.  Common sense would say that when you are finished with a consult, you should call the consulting service and discuss your recommendations.  Sure, the recommendations are scribbled on the chart or dictated and won't be available to read for another 6-8 hours.  Calling gives the consultant the ability to explain their plan and the thought process behind that plan.  It provides an opportunity for the person who placed the consult to ask questions.  Most importantly, it makes sure everyone is on the same page.

Too many times, especially in a large medical center, the plan gets confused.  One hand doesn't know what the other is doing.  Each individual team is making recommendations that contradict the other.  In the end, the patient and their family becomes confused and frustrated, and that is a recipe for disaster.