The Washington Manual Internship Survival Guide Read Online Free Page A

  Must obtain consent of parents or legal guardians for minors.
    •   Minors can consent for themselves if being treated for chemical dependency, STDs, or pregnancy (excepting elective abortion in some states).
    •   It is also important to document informed refusal of a treatment/procedure.

Triage
    9
    BEFORE ACCEPTING ADMISSIONS
1.   Obtain demographic information: name, date of birth, medical record number, current location, and attending physician.
2.   Why does the patient need to be admitted? What is the admitting physician’s assessment?
3.   Is the patient competent, and does he or she want to be admitted?
4.   What are the patient’s chief complaints, comorbidities, relevant past medical history, and brief current history?
5.   When was the last previous admission? Obtain old medical records (inpatient and outpatient). If the patient is coming in transfer, be sure to acquire all radiographs and lab results.
6.   Obtain most recent vital signs, pertinent examination including mental status, key lab data, CXR, ECG, and code status. Review as many lab results and films in the ED as you can.
7.   Confirm IV access.
8.   Inquire about major interventions performed, medications given, and consultations pending.
9.   What follow-up is necessary (i.e., lab tests that are pending, consults that need to be called, blood transfusions, antibiotics)?
    10.   Find out who the primary physician is and if this person has been notified.
    11.   Do family members need to be called?
    OTHER IMPORTANT QUESTIONS TO CONSIDER
    •   Is this an appropriate admission for your service (i.e., Is there something you can do for the patient that no one else can do? Does a different service make more sense?)?
    •   Can this patient be managed as an outpatient? If yes, social services may need to be involved. In addition, arranging follow-up is crucial.
    •   Is the patient stable enough for the floor or for transfer from an outside hospital? Are any more treatments needed before transfer (i.e., nebulizer treatments or blood transfusions)?
    •   Can your staff adequately handle this patient?
    •   What specific interventions does this patient need that other institutions cannot provide (in the case of a hospital-to-hospital transfer)?
    •   Obtain collateral information from family, nursing homes, or other caregivers. Always collect and hold onto important phone contacts.

Admissions
    10
    GENERAL POINTS
1.   When called with a new admission, it is critical to review old records. However, if the patient is accessible, always see the patient first and check vital signs before digging through his or her chart. With that said, old records are invaluable . Most systems have old lab results, discharge summaries, and H&Ps stored as electronic versions; use these extensively, but always confirm with your own eyes and ears.
2.   After assessment of the patient and examination, admission orders should be completed as soon as possible . This will help the nursing staff and will enable you to get appropriate lab results in a timely manner. If you need stat labs, always inform the nursing staff directly. It is also helpful to inform the nurses when your orders are complete. Telemetry orders should also be completed as soon as possible, if needed.
3.   Taking a history and performing the physical examination should be well engrained by now. It is often helpful to type or dictate the H&P right after evaluating the patient before moving on to your next admission . If you decide to dictate, you must ensure a signed copy of the dictation makes it into the medical record chart. A short handwritten holding note of the current admission problems and short assessment should also be entered in the chart while awaiting the dictated H&P. Lab results can be added to the dictation as an addendum.
4.   If the patient has a private primary care physician, he or she should be notified as soon as possible regarding the