First Hill Campus
Policy on Trigger Protocols for Urgent Attending Physician Notification
TRIGGER PROTOCOLS
Attending notification guidelines, known as “trigger protocols”, identify specific criteria that should trigger a phone call by a resident to an attending physician to inform the attending of a change in patient condition. Expected communication practices when there is a critical change in the patient’s condition are that the attending will be notified following evaluation. These include:
1. Unplanned transfer to the ICU or more monitored setting (eg: IMCU)
2. Unplanned intubation, or ventilatory support (eg: BiPAP or C-PAP)
3. Unexpected cardiovascular support (eg: addition of pressors)
4. Cardiac arrest, Code, or Rapid Response Team called
5. Development of significant neurological changes (suspected CVA, seizure, new onset paralysis)
6. Iatrogenic event: serious complications from medical interventions
7. Unexpected blood transfusion without prior attending knowledge or instruction
8. Development of any clinical problem that requires an invasive procedure/operation for treatment or need for more expensive scanning (ie CT, MRI)
9. Concern on the part of the resident for potential need for initial operative intervention
10. Possible question/s that might require a return to surgery
11. Signing out against medical advice (AMA)
12 Suicide attempt
13. Death unless expected or discussed with attending prior to occurrence that there is no need to contact them at the time of the death
NOTE: This protocol is designed to ensure communication, but should not preclude communication for any issue short of the above criteria. Any member of the team should feel comfortable to contact the attending of record at any time for questions of clinical management.
**Inability to reach the attending should NOT impede needed or emergent clinical care.**
S:\SurgResFHC\WorkGroups\MedEdSurg\Program Files as of 2009\Policies\Trigger_protocols (01).doc updated 11/9/11