How to know when to call the doctor

I work for a small hospital, so we don't have a doctor in house during the night. We do have an ER doctor available for emergencies, but he's for emergencies only. So, if you have a patient who "just doesn't look right," we had to set some guidelines for when to call the attending physician.

The following was actually established as part of our rapid response team:

1. Respiratory Status: RR less than 8 or greater than 28, new onset shortness of breath, SpO2 decreased from baseline


2. Change in Heart Rate: Greater than 130 or less than 40, changed by 20% from baseline, change in rythym


3. Change in Level of Consciousness: Lethargic, confused, unresponsive, agitated


4. Change in Blood Pressure: Systolic less than 90 or greater than 170 or changed by 20% from baseline, or undetectable


5. Staff worry: Just doesn't look right, nausea, vomiting, diaphoretic, not sure what is wrong


6. Chest pain: New or recurring


7. Fluid Status: Input is greater than output, Wet lungs, urinary output less than 50cc in 4 hours


8. Temperature: Greater than 104 or less than 96.8, Critical is greater than 106 or less than 91


9. Labs: WBC greater than 12,000 or less than 4,000, Critical WBC is greater than 25,000 or less than 2,500

Of course the above is a guideline only, and is not a replacement for common sense. If you think a breathing treatment is indicated, you don't have to wait for the doctor's permission. Likewise, calling lab, doing an EKG, and ordering any other pertinent test is also allowable.

This policy has been proven effective in preventing the patient from failing. It's being proactive, observing the signs of impending doom, and taking action now.