Escalation to the Attending of record (or Night Hospitalist after 7PM) is expected for all of the following situations:
- Upgrade to higher level of care (e.g., stepdown or ICU)**
- Unanticipated change in mental status
- Any time an RRT is called
- Significant new abnormality in vital signs (e.g., sustained BP < 90 or drop by >30mmHg, sustained HR < 50 or HR > 130)
- Significant new lab abnormality (e.g., lactate > 4, Hgb drop >3)
- New high-flow nasal cannula, nonrebreather, or BiPAP requirement
- Any new or suspected acute emergent condition (e.g., cord compression, bowel perforation, acute coronary syndrome)**
- Unexpected death*
- Procedure requiring consent
- Change in code status*
- Disagreement regarding plan of care (with patient, family, or consultants)**
- AMA discharge*
- New admissions in RESUS or requiring stepdown
- Any event, preventable or non-preventable, that results in harm to a patient
- Any situation in which an intern or resident feels uncomfortable or has a concern**
For patients on the Oncology Teaching service, all of the above situations should be escalated to the Oncology Fellow/Attending during the day, or the Night Hospitalist after 7PM. Select situations should additionally be escalated to the Oncology Fellow On-Call overnight via page/call ** or Epic chat/email. *
The following Oncology-specific situations should be escalated directly to the Oncology Fellow On-Call via page/call:
- Questions or concerns regarding chemotherapy
- Any oncologic emergency (e.g., cord compression, tumor lysis, rapidly increasing WBC)