w*****s
发帖数: 230 | 1 好心人请回答或PM，多谢。
第一个病人在ICU应该有几个主治大夫？是不是最少两个。一个是医院ICU的， 一个是
病人这个病的。 比如心脏病人住ICU。应该是一个心脏科attending physician, 一个
是ICU的。 对吗？这两个主治医生的职责都是什么，有什么不同？
第二个如果ICU主治大夫不在医院， 比如家里正好出点事情， 得回去一个小时。这时
候是不是其他手下的可以集体商量下一步怎么办。 而因为病情紧急等不到主治大夫回
来。 这个决定是否符合程序。 如果不符合程序，这种情况怎么办？人家主治大夫也是
应该有情况的。
第三个就是如果一个主治大夫需要出去旅游半个月，比如心脏科医生。 大概还有6天回
来的时候医院来了个重症病人。这个病人正好是这个大夫的专科。 所以病人被分配给
这个主治大夫。 而不是其他主治大夫，人虽然在可不是这个专科的。 这样就出问题了
：一个重症病人竟然有6天不能见到主治大夫。就算是别的大夫可以传达， 信息时代可
以一边在海滩晒太阳一边看病历。 可毕竟差别就大了， 这时候是不是就可能把人家耽
误死了。 这个责任怎么算？！
衷心谢谢好心人。
（我也发到dreamer版，说话可以随便点） | A*****a
发帖数: 52743 | 2 认为医生不在造成什么事故，找『不在』和『事故』之间的因果关系
病人和医生的关系不是一对一责任制那么简单
【在 w*****s 的大作中提到】
: 好心人请回答或PM，多谢。
: 第一个病人在ICU应该有几个主治大夫？是不是最少两个。一个是医院ICU的， 一个是
: 病人这个病的。 比如心脏病人住ICU。应该是一个心脏科attending physician, 一个
: 是ICU的。 对吗？这两个主治医生的职责都是什么，有什么不同？
: 第二个如果ICU主治大夫不在医院， 比如家里正好出点事情， 得回去一个小时。这时
: 候是不是其他手下的可以集体商量下一步怎么办。 而因为病情紧急等不到主治大夫回
: 来。 这个决定是否符合程序。 如果不符合程序，这种情况怎么办？人家主治大夫也是
: 应该有情况的。
: 第三个就是如果一个主治大夫需要出去旅游半个月，比如心脏科医生。 大概还有6天回
: 来的时候医院来了个重症病人。这个病人正好是这个大夫的专科。 所以病人被分配给
| t**x
发帖数: 20965 | 3 感觉答非所问。 估计真出了事故人家才这么问，不按照规章制度肯定容易出问题。建
议家里有老人小孩的看看。
我查了一下，估计ICU医生的，感觉很多医生都做不到。
1. Visit and personally evaluate each patient admitted by 5pm on weekdays
and NOON on weekends (Saturday or Sunday) by close of day, and complete
documentation in the EMR within 24 hours of the visit.
2. Visit and personally evaluate each patient admitted after 5pm on weekdays
and NOON on weekends (Saturday or Sunday) by the following morning, and
complete documentation in the EMR within 24 hours of the visit.
3. Visit and personally evaluate each patient on all subsequent days of the
patient’s stay, including day of discharge, and complete documentation in
the EMR as appropriate within 24 hours of the visit/discharge.
4. Use and update of the “white-board” is strongly encouraged during all
rounding encounters to facilitate accurate identification of the lead
attending, and collaboration between with the patient, family, and care team
around daily treatment goals.
5. Provide oversight and supervision to GME trainees and others with
responsibility for directpatient care in accordance with GME Policy No. 12
Graduate Medical Trainee Supervision Policyand the Protocol for
Implementation of GME Policy No. 12 Graduate Medical Trainee Supervision
Policy. With respect to Nurse Practitioners (NPs) and Physician Assistants (
PAs),Attendings shall provide supervision and oversight consistent with the
requirements of individual protocols.
6. Propose to each patient a treatment plan or procedure; the Attending
Physician or his/her designee is also responsible for obtaining Informed
Consent prior to the provision of care (See Medical Center Policy No. 0024,
“Informed Decision-making”).
7. Explain to each patient the outcome of any treatment or procedure once
care has been provided,including unanticipated outcomes (see Medical Center
Policy No. 0024, “Informed Decisionmaking”and Medical Center Policy No.
0293, “Disclosure of Outcomes”).
8. Communicate the patient’s condition and treatment plan to the patient,
the patient’s family members, and to the referring physician (as
appropriate).
9. Be personally available to his/her patient and family members, or arrange
for coverage by an Attending Physician who has all necessary privileges at
the University of Virginia Medical Center to properly care for the Attending
Physician’s patient(s) in the event of his/her absence or unavailability.
10. Document in the patient’s medical record transfer of care to another
Attending, and notify all appropriate parties, including GME Trainees, prior
to the transfer.
11. Personally ensure that his/her contact profile is up to date within the
paging system to ensure affective and timely communications during changes
in patient condition.
a. Respond within five (5) minutes to pages indicating, “changes in
patient condition.” Nurses and other staff can be expected to communicate
patient information in an efficient and effective manner using techniques
such as SBAR (situation, background, assessment, recommendation).
b. If unable to respond to page within five (5) minutes, the Attending
Physician shall designate someone to respond on his/her behalf whenever
physically possible.
c. If an urgent response is needed and there is no response from the
Attending Physician within five minutes, nurses and other staff shall page
the Attending Physician again or follow physician/service escalation
guidelines.
d. An Attending Physician covering inpatient services shall sign-out a
pager when not on call or forward to the appropriate covering person when
not on service. If pager is left on, in service, there is an expectation
that all pages will be answered.
12. A Medical Emergency Team (MET), pediatric or adult, will be called if
the patient’s condition meets guideline criteria (See Medical Center Policy
No. 0187, “Emergency Response and Cardiopulmonary Resuscitation (CODE 12))
. The Attending Physician shall receive a text page when the MET call is
activated to assure his/her awareness of the activation.
13. Support and fully engage in the GME escalation of care policy, which
states that the attending physician of record is to be notified as soon as
possible (and always within 90 minutes) of the following events and
scenarios:
a. Patient admission to the hospital and/or service i. Notification can be
up to 180 minutes for acute care stable patients if the fellow is involved
in the admission process
b. Transfer of patient to or from the intensive care unit or to a higher
level of care
c. Need for intubation or ventilator support
d. Cardiac arrest or significant changes in hemodynamic status (i.e. Code 12
or MET team activation)
e. Development of significant neurological changes
f. Development of major wound complications
g. Medication errors requiring clinical intervention
h. Any significant clinical problem that will require an invasive procedure
or operation
i. Patient death
j. Notification of patient representative that family wishes to lodge a
formal complaint
k. Activation of IRPA for anything other than routine procedures
l. Patient or patient’s family request to see, or to speak, with the
Attending Physician
Note: Individual departments may have additional events that qualify for
notifying the responsible Attending Physician.
14. Communicate to GME Trainees involved in the care of the patients that
the Attending Physician (or Clinical Fellow as the Attending Physician’s
designee) shall receive evening reports from the GME Trainees as to the
status of any patient who is not progressing according to the established
plan of care.
【在 A*****a 的大作中提到】
: 认为医生不在造成什么事故，找『不在』和『事故』之间的因果关系
: 病人和医生的关系不是一对一责任制那么简单
| A*****a
发帖数: 52743 | 4 也许是出了事，事故的认定没那么简单的。而问的问题对解决事故纠纷没有什么帮助
weekdays
the
team
(
the
,
Center
arrange
at
Attending
prior
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communicate
Policy
))
12
procedure
【在 t**x 的大作中提到】
: 感觉答非所问。 估计真出了事故人家才这么问，不按照规章制度肯定容易出问题。建
: 议家里有老人小孩的看看。
: 我查了一下，估计ICU医生的，感觉很多医生都做不到。
: 1. Visit and personally evaluate each patient admitted by 5pm on weekdays
: and NOON on weekends (Saturday or Sunday) by close of day, and complete
: documentation in the EMR within 24 hours of the visit.
: 2. Visit and personally evaluate each patient admitted after 5pm on weekdays
: and NOON on weekends (Saturday or Sunday) by the following morning, and
: complete documentation in the EMR within 24 hours of the visit.
: 3. Visit and personally evaluate each patient on all subsequent days of the
| N*********c
发帖数: 330 | 5 1, 我理解主治医只有一个。其他是consult.
2, 如果ICU主治大夫不在医院，the covering physician will be responsible.
3, if one doctor is out of town, his/her partners will be rounding and
taking care of patients. I never know if one specialty (department) has only
one physician.
Not sure if that answers your question.
【在 w*****s 的大作中提到】
: 好心人请回答或PM，多谢。
: 第一个病人在ICU应该有几个主治大夫？是不是最少两个。一个是医院ICU的， 一个是
: 病人这个病的。 比如心脏病人住ICU。应该是一个心脏科attending physician, 一个
: 是ICU的。 对吗？这两个主治医生的职责都是什么，有什么不同？
: 第二个如果ICU主治大夫不在医院， 比如家里正好出点事情， 得回去一个小时。这时
: 候是不是其他手下的可以集体商量下一步怎么办。 而因为病情紧急等不到主治大夫回
: 来。 这个决定是否符合程序。 如果不符合程序，这种情况怎么办？人家主治大夫也是
: 应该有情况的。
: 第三个就是如果一个主治大夫需要出去旅游半个月，比如心脏科医生。 大概还有6天回
: 来的时候医院来了个重症病人。这个病人正好是这个大夫的专科。 所以病人被分配给
|
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