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Transfer and Handover Protocol

Vanderbilt Allergy & Immunology Transfer and Handover Protocol

Transfers:  The Vanderbilt Allergy & Immunology Service is strictly consultative and there is no inpatient A&I Service.  As there is no inpatient service, the Vanderbilt A & I section does not accept transfers from other hospitals or other services within Vanderbilt Hospital or the Monroe Carell Children’s Hospital at Vanderbilt.  Any transfers from other hospitals must be accepted by a primary Internal Medicine, Pediatric, or ICU team.

Handover:  The call schedule for both Vanderbilt Allergy & Immunology residents and faculty is published on line at https://synergy.mc.vanderbilt.edu/.  This is instantaneously available to all Vanderbilt physicians and staff after entering their VUNet ID and password.  The call schedule lists the resident and faculty members’ e-mail address and pager number.  The primary handover tool is StarPanel, the Vanderbilt electronic medical record.  All pediatric and adult A & I consults are generated by the referring physician entering the consult into StarPanel.  In addition, all referring physicians are requested to call the A & I resident to provide additional history and the clinical question for which an answer is desired by the consult.  The StarPanel tool is used by both the resident and faculty for handovers, as all patients currently being seen in consultation must be listed in StarPanel for a consult to be generated.  There are specific “Patient Lists” in StarPanel for both adult and pediatric patients.  When a resident is ending her or his on call responsibility, the A & I policy is that this resident communicates in writing or orally the reason for the consult, the work-up to date that has been undertaken, the current plan, and the pertinent issues that are still outstanding at the time of the handover.  There are separate pediatric and adult on call physicians who also utilize the StarPanel handover tool.  The use of the StarPanel handover tool provides optimal continuity for patient care.


DNR Policy

Allergy/Immunology Do Not Resuscitate Policy

1.  “Do not resuscitate” orders must be entered into WIZorder by a physician or nurse practitioner.

2.  Vanderbilt University Hospital policy states that a decision about DNR status must be entered into the WIZorder system within 24 hours after inpatient hospital admission.  If such an order is not entered within 24 hours, the WIZorder system will prompt the physician that one of three orders must be entered, “Full code”, “DNR” (Do Not Resuscitate), or “DNI” (Do Not Intubate).

3.  Do not intubate / resuscitate (DNI/DNR) orders should always be made in conjunction with discussion with the patient, whether the patient is seen in the clinic or as an inpatient.  Families may be involved in this discussion to the extent that it is possible, but only if the patient is in agreement with this inclusion of family members.  After proper consultation with the Allergy/Immunology attending faculty physician, Allergy/Immunology residents can and should write DNR/DNI orders.  Although such orders must be co-signed by a faculty member, faculty signature is not required for the order to be in-force during the first 24 hours of hospitalization.  It is assumed that all patients are “full codes” unless orders limiting intervention have been written.

Guidelines for resident contacting the attending physician about complex patients

Allergy/Immunology Residency Program

Guidelines for resident contacting the attending physician about complex patients

Allergy and Immunology is primarily an outpatient specialty and the majority of patients are seen in the clinic with an attending physician immediately after the resident has performed his or her evaluation.  However, there are circumstances where the resident sees a patient in the clinic in an emergency setting, is on call and takes a phone call from a complex patient, or is on call and has been asked to consult on a complex patient.  The attending should establish an environment such that the resident: 1) has autonomy, but with supervision available as needed and 2) feels comfortable and not afraid of calling the attending when needed.

Residents should contact the attending physician for the following:

1.    Outpatients experiencing anaphylaxis as a result of an immunotherapy injection given in the clinic that does not respond to a single dose of injectable epinephrine

2.    Patients experiencing anaphylaxis as a result of a food challenge

3.    Patients with severe asthma exacerbations that do not respond to three nebulizer treatments of inhaled beta-agonist therapy

4.    Patients calling from home who are experiencing severe or life-threatening health problems who have been told by the resident to go to the nearest emergency department immediately

5.    Serious unexpected change in status of an inpatient consult (e.g., anaphylaxis during drug desensitization, cardiac arrest, intubation, need for marked escalation in level of care, transfer to a higher unit of care, change in end of life goals of care, death).

6.    Significant conflicts between or among personnel (inter-service, family, staff, referring physicians).

7.    When assistance is needed navigating the health care system to optimize patient care.

8.    Anytime they feel the need to discuss patient care or system issues.

ICU Transfer Policy

Vanderbilt Allergy & Immunology ICU Transfer Policy

Transfers:  The Vanderbilt Allergy & Immunology Service is strictly consultative and there is no inpatient A&I Service.  As there is no inpatient service, the Vanderbilt A&I section does not accept ICU transfers from other hospitals or other services within Vanderbilt Hospital or the Monroe Carell Children’s Hospital at Vanderbilt.  Any transfers from other hospitals requiring intensive care must be accepted by an ICU team.  If a patient that is being seen by the A&I Consult Service is transferred to the ICU, then the A&I resident will notify the A&I faculty attending physician on call that the patient has been transferred to the ICU service to: 1) assess whether the immediate cause for transfer is related to the reason for the A&I service consult and therefore immediately provide medical care appropriate for the cause of the ICU transfer, and 2) maintain continuity of care in the new patient location

Reporting Procedure for fellows Remaining on Duty beyond Scheduled Hours

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Moonlighting Policy and Forms

Download the PDF Form for Moonlighting Policy and Forms.