Escalation of Care
While the Accreditation Council for Graduate Medical Education (ACGME), via the Otolaryngology Residency Review Committee, provides specifics as to what is expected from residency training programs in the area of attending/resident clinical communication (see Harvard Otorhinolaryngology System Triggers for Attending Communication, p. 28), establishing these lines of communication starts with orientation to the program itself. The faculty and staff should be very clear that residents are encouraged to ask questions and seek advice from more experienced staff.
“Residents absolutely need to know that they should call us if they feel uncomfortable with any issue,” said Stacey Gray, MD, director at the Harvard Otolaryngology Residency Program and assistant professor of otolaryngology at Harvard Medical School in Boston. “The residents know that patient care is the paramount concern in all situations. They are expected to do the right thing for the patient. If they are concerned about making a clinical decision, the consequence of not calling an attending for assistance and making the wrong decision for patient care should override any apprehension about making the call.”
In the clinical setting, certain events should always be brought to the attention of a senior physician. Residency programs often have lists of things that should trigger an “escalation-of-care” call. Although the criteria differ from program to program, they usually cover major changes in condition such as hospital admission, transfer to a higher level of care, changes in medicines, or emergency care of any kind (“Clinical Scenarios In Pediatrics Otorhinolaryngology That Require Prompt Attending Notification”).