Consult Resident

The consult resident is responsible for all consults at SLUH and CGCH from 7:30AM – 5PM, Monday through Friday.  Second and third year residents rotate on this service.  The consult resident evaluates each consultation patient, and a full note is placed on the chart the day the consult is completed.  All consults are then to be discussed with the responsible faculty attending. Dr. Burkemper is the faculty attending for SLUH and CGCH consults Monday-Thursday unless she is out of the office. Friday consult coverage rotates among the other attendings.  Consult kodachrome rounds occur monthly on the third Thursday of the month and are led by the consult resident (these may include consults at both SLUH and Cardinal Glennon Children’s Hospital).

During his/her month of consults, the resident does not participate in Tuesday morning senior resident clinic or Thursday afternoon continuity clinics.  During certain times (for example when second and third year residents are at the Academy meeting), first year residents will cover consults.  At times, the consult resident may also need to see acute patients in the clinics.  After hours consults are handled by the on-call resident.  Only truly emergent consults will supersede any clinical or educational activity the consult resident is otherwise involved in.  Saint Louis University Hospital and Cardinal Glennon Children’s Hospital Emergency Rooms have a 30 minute consult policy and this should be respected whenever possible; however, if the consult resident is actively engaged in clinical activity they should courteously explain the situation to the Emergency Room and inquire as to whether waiting until the clinical activity is completed to see the consult would be feasible.

The consult resident will see all consults called in promptly between the hours of 8am and 5pm that day.  Consults are never to be delayed until the next day. When a resident or attending from another service calls a consult the consult resident will see the patient without resistance or argument regardless of the complexity of the problem. When a resident or attending from another service calls with any question or confusion about a dermatologic issue regarding an inpatient this will be considered a consult and the patient must be subsequently evaluated and a formal consult placed in the chart that day. When recommendations are given over the phone by the consult resident this will be considered a consult and the patient must be subsequently evaluated and a formal consult placed in the chart.  In addition, the consult resident should monitor the Dermatology Consults on the EPIC System Lists and patients listed there must be subsequently evaluated and a formal consult placed in the chart.  Consult patients should be placed on the Epic handoff template to ensure safe and accurate transitions of care (see Appendix G) If a department clinic patient is admitted and the consult resident is called, the consult resident will go see that patient and it will be considered a consult. “Curbside” consults do not exist. Being re-consulted on a patient should be approached in the same manner as an initial consult.

A consult bag with supplies is kept either in the resident room at the SAP building or in the resident locker at CSM clinic. The consult bag is to be carried with you so that you have supplies ready at bedside when you get a consult. The consult bag CANNOT be left in the Central Distribution room. Again, it is to be carried with you during consult hours and stored in resident room or locker after hours. It is the consult resident’s responsibility to monitor the bag for supply and order refills from central supply. It takes approximately 2-3 days for new supplies (ie biopsy kits, suture, etc) to come in. Supply refills will be left in the Central Distribution room at the Lower Level of SLU Hospital (at the corner of Exceptional and Presence Street) for the consult resident to pick up. It is the consult resident’s responsibility to pick up supply refills as soon as they come in and restock the consult bag. It is imperative that the consult resident pick up the supply the SAME day it is delivered and take it back to the resident room to restock. Extra supplies can be kept in the resident room.

All consults will include a complete cutaneous exam, work up including proper lab tests (i.e. Tzanck etc.), biopsy, recommendations, and a formal written consultation.  Appropriate “time out” protocols must be followed for inpatient biopsies.  Procedure notes must be placed in the chart for all biopsies and are included in the consult note—a separate note is not created for the procedure. All consults will be staffed within 24 hours by the consult attending.  Until a determination is made to sign off on a patient, a daily note by the consult resident is expected—these should be progress notes, not “plan of care” notes. If the patient is critically ill the consult attending is to be called immediately after the resident evaluates the patient.

Please do not tell another service that a consult cannot be staffed within a reasonable amount of time by the consult attending.

If photos are taken of consult patients, these photos must be taken using Haiku, and uploaded to both the patient’s chart as well as the “Consult Pictures” folder on the Teams site.  Photos sent to attending physicians must be sent via SLU e-mail or Haiku and not by text message.

If a follow-up appointment is needed for hospital consults (Emergency Room or inpatient) these can be scheduled in Dr. Burkemper’s hospital follow up appointment slots (Mondays and Tuesdays at 11:30 and 12:50 and 11:30 on Wednesdays). The consult resident should schedule these appointments directly in Epic.

On Friday afternoons and afternoons prior to holidays, the consult resident should email the on-call team (including the consult and call attending physicians) with a list of current patients and things that need to be followed up on over the weekend. See Appendix G for handoff procedure.

In addition to inpatient and Emergency Department consults, the consult resident will answer calls from the SSM Access/Transfer Centers. See Appendix G for the Access/Transfer Center protocol.

See Appendix G for Consult protocols and procedures.