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Anesthesia Consultation

The following workflow will take you through the process of:

·         Write the Consult Note

·         Cosign the Note

·         Pending a Note

·         Sharing a Note

·         Viewing a shared note

·         Completing a shared note

You receive a telephone call asking for an anesthesia consultation.

It is the responsibility of the consulting service to complete the consult in EPIC.  The anesthesia consult form is highly modified compared to all other services.

All the red exclamation points indicate mandatory completion, otherwise the service cannot sign the consult request.

 

 

Below is the entire consult blown out.

 

 

 

 

Once the consult has been signed and released, it will appear on the Anesthesia Consult list.

 

If the patient is not populating the list, it most likely reflects the fact that the consultant has not released the order.  If you want to help out, tell the MD to go to the Orders section of the chart and click on the “Signed and hold” tab.  The consult order should be there and he/she needs to hit “ Click here to release Signed and Held Orders”

 

 

 

 

 

 

 

 

Write the Consult Note

Highlight the patient and information relative to said patient appears at the bottom of the screen.

Under “consult and followup”, click on “ Inpatient Anethesiology  consult ” and the body of the consult will be shown.

Close the window

With the patient highlighted, click on “Consult (Pre-Proc)” or double click.

You will see the following.  This is important. 

The system knows you want to do a consult and it is trying to link it up to a relevant event.  In the case below, the ORIF femur is linked by default.  We want the consult to be linked to this procedure and the system has done it for us.  Hit “ Accept ” (you do not hit Anesthesia consult).  Following this logic (??), the system will marry the consult to the procedure such that when the patient eventually gets to the OR, the consult will be readily visible to the Anesthesia team without having to go and search the chart for a consult.

If no such logical link exists, proceed to click on “Anesthesia Consult”.  The end result is the same. It is simply a matter of the consult being linked to the procedure or existing in isolation as a consult note in the chart.  Later on, this consult can be linked to the most appropriate event.

 

You are now in the Consult-Pre Procedure Navigator.

Click “ +Create Note “and a familiar looking screen should appear with a Review area on left, Problem List in the center and Anesthesia Note on the right.  The Review area allows you to scan the patient’s history as documented by multiple health care providers.  You need to confirm that you have “mark as reviewed”, the medications/allergies and medical Hx.  This was covered in detail during your initial teaching session and can also be found in the PAU workflow document.  If you want to include the result of a scoring system (STOP BANG, DASI, RCRI), it should be completed before you open your note.  The note will only link in fields that have been completed at time that it is opened.  Otherwise, you need to refresh your note.

 

 

Cosign the Note



Anesthesia consults should always be reviewed by Anesthesia Staff.  It is very important to click “Cosign Required”.

This allows the note to be easily retrieved, addended and signed.

 

 

 



Pending a Note

Pending a note saves your note as incomplete.  Only the original author can go back in and edit.  A pended note is not available for viewing by anyone else.

 

 

 

 



You can find the incomplete note in the notes section of the chart under “Incomplete”

 

 

 

 

 

 

 

Sharing a Note



Sharing a note allows for the note to be visible to all users.  The following dialogue box is seen when you click, “ Share

 

 

The note is still deemed incomplete but is shareable.

 

 

 

 

 

 

 

 

 

Viewing a shared note

If a consult is passed on for completion, you must access the note from the chart.  In the example below, I am logged in as a different user than the original author of the consult. If you want to review what is already there, follow steps below.



Highlight the patient and click “Chart Review”

 

 



Under the “ Notes ” tab, you will see the Anesthesia Preprocedure Eval. The yellow exclamation point indicates it is incomplete.

 

 

 



Another way to access the same thing.

 

 

 

 

 

 

 

 

 

Completing a shared note



A dialogue box similar to when the consult was first initiated appears. Click “ Accept

 

 

 

 



The “Incomplete Anesthesia Preprocedure Evaluation” note appears.  Click “Edit in Notewriter”, complete the note (Cosign box ticked as per above) and “ Sign

 

 

 

 

 

 



Once the consult is complete, highlight the patient in the consult roster and click “Complete”.  This will drop the patient off the consult list.

 

 

 

 

 

 

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