Mercy Hospital  MEMORANDUM
DATE:   September 22, 1999
TO:	DEM STAFF
	CLINICAL COORDINATORS
FROM:   BRUCE A. MacLEOD, MD, F.A.C.E.P.
SUBJ:   NOTIFICATION OF SURGICAL ATTENDINGS

   There is a perception, and sometimes reality, that there is a delay in
completing the surgical consultations in the Department of Emergency Medicine
by the surgical house staff. To improve communications between the two
departments and to improve the flow of surgical patients through the
Department of Emergency Medicine, the Division of General Surgery has agreed
that the general surgery attending should be contacted at the same time that
the surgical consultation is initiated. When we call the surgical officer of
the day, the consulting surgeon should also be contacted and by the attending
DEM physician to alert them of the developing consultation. When this was
discussed at the Division of General Surgery there was not universal agreement
that the surgical house staff were the barriers to efficient patient flow
through the Department of Emergency Medicine. Indeed, many of the surgical
attendings felt that the majority of surgical patients had prolonged stays in
the Department of Emergency Medicine prior to the initiation of the
consultation process. By clarifying when the consultation process is initiated
and documented on the chart that we can better understand where we can improve
the quality of care provided to these patients.
   Just as we are respectful of the Department of Medicine attendings in
regards to how many calls they receive after 11 p.m.,we should also be
respectful of the surgical attending in the application of this initiative.
The general surgery attending should not be contacted after 11 p.m. or before
6 a.m. Since the vast majority of the surgical consultations take place after
6 a.m., and before 11 p.m., I believe that will be ample opportunity to assess
and improve this process.

   If you have any questions, please feel free to contact me. I look forward to
your comments and suggestions regarding this issue.

BAM: kms.794a
C:      Charles Copeland, MD