Hospital Medicine Policy for Ventilated Adult Patients

Background:

In the current state, some Hospital Medicine providers have privileges to manage ventilated patients in the IMC setting. These patients are either chronically on mechanical ventilation (ex: CWC pts, patients with severe cerebral palsy, patients with quadriplegia, etc.), or are being weaned on their ventilator settings upon transfer out of the ICU. The expectation is that Pulmonary Consult service follows the patients being weaned upon transfer from the ICU, and as needed on the patients who are on chronic ventilation (for Hospitalists without vent privileges, they will always need a pulmonary consult for all ventilated patients they are caring for). There have been instances when consultation has been delayed which has led to safety events.

Proposal:

Discussion between Hospital Medicine & Pulmonary Medicine has occurred, and we recommend the following for ventilated patients on IMC status on the service of Hospitalists with vent privileges:

  1. Chronically ventilated patients: request consultation upon admission to UW, to ensure there are not any changes that need to occur in that ventilated patient while they are hospitalized. Pulmonary Consult service will see the patient at least once, and then as needed after that depending on the needs of the patient and discussion with the Hospitalist.

  2. Weaning ventilated patients: Pulmonary Consult will occur at the time of transfer out of the critical care service (any ICU team).

    a. At time of transfer request from critical care service to Hospital Medicine, the Triage provider will request that the pulmonary consult be placed and called by the critical care service.

    b. Critical Care fellow is requested to give the warm handoff to the Pulmonary Consult fellow.

    c. Hospital Medicine rounders: if you have a patient who is weaning from the vent, reach out to the Pulmonary Consult service to ensure they are following the patient.

    d. A BPA is being developed which will be a hard stop to trigger us to all remember the necessity of placing a Pulmonary Consult.

    e. Decision to sign off these patients will be made mutually between the Pulmonary Consult team and the Hospitalist.

When ventilated patients are on the service of Hospitalists without vent privileges, pulmonary consultation is always required.