2.4.03 Consultation: Involvement of other doctors

1 Aim and purpose

If other doctors are called in for consultation or co-treatment, the question, the scope of the co-treatment, the billing of services and the relationship between the consultant and the treating doctor must be clarified.

- Request form
- Labelling of urgency
- Timely processing
- Consultation in case of uncertainty

Clarification of the interface between "treating physician" and "consultant". Transparency in the process of requesting a consultation. Carrying out a consultation on the day of the request, unless the appointment is agreed separately.

2 Application

The "attending physician" is always the director of the clinic where the patient is admitted. The director authorises the clinic's assistant doctors to provide treatment. Other doctors may be asked to provide co-treatment. The co-treatment takes place formally as a "consultation". The consultant advises and is responsible for the technical content. In addition to the collegial coordination, however, the attending physician remains responsible for the overall treatment of the patient.
Every co-treatment is a medical service. It should be requested, carried out, documented and billed between the clinics in a traceable manner. A formal procedure must be followed for this.
Every X-ray diagnostic service is a consultation service. \\X-ray services are requested via a separate process.
Anaesthesia services are also co-treatments. They are documented in the anaesthesia protocol.

3 Description of the procedure

3.1 Registering a consultation

Consultations (specialist examinations, co-treatments) must be requested in writing. Appointments and questions can be clarified verbally or by telephone, but must then be repeated in writing, at least in the form of key words.
A consultation should always be requested by fax. Each clinic designates a fax number for the consultation service.
The clinics name a contact point to which the consultation requests are to be submitted. (to be phased out gradually) The clinic directors will determine who will be responsible for assigning the consultants. As a rule, consultants should be specialists or senior physicians. The responsibility can be generally defined for individual clinics. Substitutions must be organised.

3.2 Settlement

The requesting ward generates an LES consultation record "Specialist examination / inpatient" for the patient and prints it out (two sheets). . It is sent by fax to the consultation fax number (contact point) of the clinic carrying out the consultation. Consultation requests to specific doctors can be sent directly to them. The requesting centre should enter the date and time of the request.
The date and time of receipt is noted at the contact point. The consultation order is entered in a collective list. The consultation order is forwarded to the responsible consultant.
If consultation requests are accepted directly (i.e. not via the contact point), the documentation should be completed at the earliest possible date.
The consultant must decide whether he wishes to see the patient in the requesting clinic or in his outpatient clinic. Each clinic should announce a general rule. The general rule is that the consultant visits the patient. Exceptions should only be made if the nature of the examination so requires.
If the consultant only works in the outpatient clinic of a hospital, patients should visit the outpatient clinic independently. Transport should only be requested if the patient is unable to walk. The consultant gives an appointment for the patient to see him (outpatient clinic) or to be seen on the ward.
If the patient needs to be transported, the ward will organise the transport in consultation with the consultant.
Examination findings, prescribed measures, medications and recommendations should be recorded on the "Specialist examination (consultation)" form. Longer findings can be recorded on an attachment. The attachment must be named on the form. Carbonless records should be withdrawn step by step. The consultant's records should be copied for duplicate filing. The consultant should mark and sign the records of his or her activities with the date and time of the consultation. For queries, the name in plain writing, telephone number and pager must be given.

3.3 Charging for consultation services

The Service Recording/Billing department settles the services between the clinics. Billing is based on the information on the "Specialist examination/inpatient" form. The service can only be invoiced if page 2 of the form is completed by the consultant and sent to the department. The company organisation sets up a billing system for consultant services between the clinics. A draft form (see attachment) is available. The basis for invoicing is the time spent on the consultation. It is planned to request the services via the LES using the order-entry procedure.

4 Documentation

4.1 Medical records

Consultations for inpatients are requested by fax on the white form. For outpatients, the blue form "Specialist examination" (new regulation: labelled with a capital letter "a"?) is used as before. The examination findings and the consultant's recommendations are recorded on the form. Please do not use the reverse side! (Filming!). (The original is filed in the patient file. A copy is filed in the consultant's clinic. If the consults are not entered in a consecutive collective list, the consults must be numbered consecutively in order to prove completeness. The consults can also be recorded in the computerised system. The clinic providing the consultation must always ensure that the records are archived, preferably by printing out the records and filing them in a consultation folder.

4.2 Performance documentation

(to be specified by the department)

5 Resources

5.1 Time required

The aim is for consultations to be carried out on the same day or the next day at the latest. If the consultation request has to be placed on a waiting list, the requesting centre must be informed. An acceptable time for the consultation should be agreed.
The consultation time, including travelling time, is documented on the service entry page for the respective area. The time of service provision (hour - day - month - year) must be marked at the top right of the note. The times can be added up to a maximum of four hours.

6 Responsibility, qualification

Clinic director: Appointment of a contact point for consultations (fax number) Contact point: Organisation of the consultation request after receipt, check on completion, entry in a collective list Consultants: usually senior physicians or specialists, at weekends and outside working hours also by on-duty physicians Consultants: Send documentation of the service to the billing department

7 Notes and comments

Consultancy work is not insignificant in many clinics. A statistical evaluation of the scope of services is recommended.

8 Applicable documents

8.1 Literature

8.2 Terms

Consil Co-treatment by a doctor from another speciality at the request of the attending physician or the patient

Attachments

Appendix 1: Form for consultation request
Appendix 2: Consultation report