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Faulkner Hospital

For all critical changes in a patients condition, the attending will be notified 1. promptly (generally within 1 hour following evaluation). These include:

Admission to the hospitalTransfer to the ICUUnplanned intubation or ventilatory supportCardiac arrestHemodynamic instability (from any cause including arrhythmias)CodeDevelopment of significant neurological changes (suspected CVA/seizure/new onset paralysis)Development of septic physiology

For surgical patients: development of major wound complications (infection, dehiscence, evisceration)Medication or treatment errors requiring clinical intervention (invasive procedure(s), increased monitoring, new medications except Narcan)First blood transfusion without prior attending knowledge or instructionDevelopment of any clinical problem requiring an invasive procedure or operation for treatment

Expected communication practices for residents, fellows, and mid-level providers

The following will be discussed 2. with and approved by the attending before they occur:

Discharge from the hospital Discharge from the Emergency DepartmentTransfer out of ICU

The attending should also be 3. contacted if:

Any trainee feels that a situation is more complicated than he or she can manageNursing, physician staff, or the patient request that the attending surgeon be contacted