24201_WF1-Grady Staff Manual ID-CS2.indd

TABLE OF CONTENTS
Introduction ....................................................................................viii
Welcome ..........................................................................................ix
General Information ..........................................................................1
Organizations and Responsibilities ...................................................1
Administrative Staff ..........................................................................2
Chiefs of Service ...............................................................................3
Medical Executive Committee ..........................................................3
Patient Care Administration ..............................................................5
Emergency Phone Numbers ..............................................................5
Confidential Information...................................................................5
“Your Rights as a Patient” Brochure Text.........................................6
Employee Health Services (EHS) .....................................................9
Blood and Body Fluid Exposure .......................................................9
Incident Reporting ..........................................................................10
Reporting Medication Errors/Adverse Drug Events .......................12
Corporate Compliance Ethics Program ..........................................13
Medical Ethics Committee ..............................................................13
Section I
Professional Responsibilities
General House Staff Responsibilities .............................................15
Physician Identification Numbers ...................................................15
National Provider Identifier ............................................................16
Discipline and Behavior ..................................................................16
Chaperones......................................................................................17
Consultations, Inpatient ..................................................................17
Consultations, Outpatient................................................................18
Admission of Patients .....................................................................20
Observation Status ..........................................................................22
Business Office ...............................................................................24
Fiscal Responsibilities ....................................................................24
Appeals Review Department ..........................................................25
Discharges .......................................................................................26
Patientʼs Leave of Absence .............................................................27
Patient Transfers to Other Facilities................................................27
Doctorʼs Orders ...............................................................................27
Medication Clarification Orders .....................................................28
Prescriptions....................................................................................28
Restraint and Seclusion Policy........................................................28
Classification of Urgency ................................................................30
Consents ..........................................................................................31
– Blood/Blood Components....................................................31
– HIV Testing ..........................................................................32
– Treatment .............................................................................34
– Abortion ...............................................................................37
– Sterilization ..........................................................................37
Refusal of Treatment .......................................................................38
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Informing Patients/Families of Unanticipated/
Unexpected Outcomes and/or Medical Errors ............................39
List of Items Exempted from Surgical
Pathology Examinations .............................................................41
Autopsy/Post Mortem Examinations ..............................................42
Sample Wording for Requesting an Autopsy
from Legal Next-of-Kin ..............................................................46
Guidelines for Obtaining Autopsies ................................................47
Deaths/Processing of Death Papers ................................................47
– Certificate of Death ..............................................................49
– Dead on Arrival ....................................................................50
– Deaths in Emergency Care Center or
Ambulatory Care Areas.......................................................50
– Still Births/Fetal Deaths .......................................................51
Organ and Tissue Donation .............................................................51
Brain Death .....................................................................................51
Fetal/Neonatal Death ......................................................................54
Medical Examiner Cases.................................................................55
Terminal Patientʼs, Guidelines for Care ..........................................56
Do Not Resuscitate Policy ..............................................................57
Advance Directives .........................................................................71
Living Wills ....................................................................................78
Durable Power of Attorney for Health Care ...................................80
Section II
Clinics
Clinics, Ambulatory Care................................................................86
– Emergency ...........................................................................86
– Primary Care Appointment Center.......................................86
– Advice Nurse Center ............................................................87
– Endoscopy Center ................................................................87
– Georgia Sickle Cell Center ..................................................88
Appointment Clinics
– AIDS – see Infectious Disease Clinic
– Asthma/Allergy, Adult .........................................................88
– Audiology/Speech Pathology ...............................................89
– Comprehensive Breast Center..............................................90
– Cardiac, Adult (Emory)........................................................90
– Cardiac, Adult (Morehouse).................................................91
– Cardiac, Blood Pressure, Adult (nurse)................................91
– Cardiac, Consultation for Preoperative Evaluation ............92
– Cardiac, Rehabilitation Program ..........................................92
– Coumadin .............................................................................92
– Dermatology ........................................................................93
– Dermatology, Pediatric ........................................................94
– Diabetes Detection & Control Center ..................................94
– Diabetes................................................................................95
– Drug Dependence Unit (DDU) ............................................95
– International Medical Center ...............................................96
– Interview/Counseling, Termination of Pregnancy ..............97
– Interview/Counseling, Sterilization .....................................98
– OB/GYN Ambulatory Surgery (Morehouse) .......................98
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– OB/GYN Ambulatory Surgery (Emory) ..............................98
– Pre-Op, OB/GYN Ambulatory Surgery (Morehouse) .........99
– Pre-Op, OB/GYN Ambulatory Surgery (Emory) ................99
– OB/GYN Clinic (Emory) .....................................................99
– Emory Colposcopy.............................................................100
– Pre-Op Clinic Main OR .....................................................100
– Emory GYN Breast ............................................................100
– Endocrine ...........................................................................100
– Family Planning/Womenʼs Health Care.............................100
– Genetic Counseling ............................................................101
– Gastroenterology (GI) Endoscopy .....................................101
– GYN-Infertility Emory ......................................................102
– GYN-URO-GYN, Emory ..................................................102
– GYN-Morehouse................................................................102
– GYN-Continuity, Emory ....................................................102
– GYN-Dysplasia, Morehouse ..............................................103
– GYN-Endocrine Infertility, Morehouse .............................103
– GYN-LEEP, Emory............................................................103
– GYN-LEEP, Morehouse ....................................................103
– GYN- Breast and Loctal, Morehouse ................................103
– Hematology ........................................................................104
– Infectious Disease Program ...............................................105
– Primary Care Center ..........................................................106
– Medical Oncology..............................................................106
– Neurology Clinic, Emory ...................................................107
– Neurology-Seizure, Emory ................................................107
– Neurology General, Morehouse .........................................107
– Neurology Memory Assessment, Emory ...........................108
– EEG/EMG ..........................................................................108
– Obstetrics, Endocrine, Emory ............................................109
– Obstetrics, Cardio-Pulmonary............................................109
– Obstetrics, Morehouse .......................................................109
– Obstetrics, Teen, Emory .....................................................109
– Obstetrics, Teen, Morehouse ..............................................109
– Obstetrics, Continuity, Emory............................................109
– Obstetrics, Psychiatric........................................................ 110
– Obstetrics, Womenʼs Primary Care .................................... 110
– Obstetrics, Nurse Midwifery .............................................. 110
– Obstetrics, Hi-Risk, Morehouse......................................... 110
– Obstetrics, Interview .......................................................... 111
– OB/GYN Womenʼs Urgent Care (WUCC) ........................ 111
– Ophthalmology .................................................................. 111
– Optical Dispensary ............................................................. 113
– Oral Maxillofacial Surgery ................................................ 113
– Otolaryngology-Ear, Nose & Throat Clinic ....................... 113
– Orthopedics ........................................................................ 114
– Pain Clinic.......................................................................... 114
– Rubinʼs Development Clinic .............................................. 115
– Perinatal Center - Maternal Section ................................... 115
– Psychiatric Adult Consultation Liaison ............................. 115
– Psychiatric Emergency Services (PES).............................. 116
– Psychiatry, Child & Adolescent ......................................... 117
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– Psychiatry, Child/Adolescent Consultation/Liaison ......... 118
– Psychiatry, Community Outreach Services (COS) ........... 118
– Psychiatry, Adult Day Treatment Program ............................ 118
– Psychiatry, Extended Treatment Clinic (evenings) ........... 119
– Psychiatry, Extended Treatment Clinic .............................. 119
– Psychotherapy, Individual .................................................120
– Pulmonary, Emory .............................................................120
– Pulmonary, Morehouse ......................................................121
– Preadmission Consultation.................................................122
– Radiation Oncology ...........................................................122
– Rehab Therapy Services.....................................................123
– Physical Therapy ............................................................123
– Occupational Therapy ....................................................123
– Hand Rehabilitation .......................................................124
– Speech-Language Pathology and Audiology .................124
– Rehabilitation Medicine .................................................125
– EMG and Nerve Conduction Studies.............................125
– Renal (Emory)....................................................................125
– Renal (Morehouse).............................................................126
– Rheumatology/Immunology ..............................................127
– Sickle Cell ..........................................................................128
– Surgical Clinics ..................................................................128
– Teen Services/Family Planning ..........................................129
Neighborhood Health Centers Network........................................131
Neighborhood Health Center Directory ........................................132
– Asa G. Yancey Health Center.....................................................132
– Grady Health Center East Point .........................................133
– DeKalb Grady Health Center .............................................133
– North Fulton Community Health Center ...........................134
– North DeKalb Health Center .............................................135
– Grady Health Center South Dekalb ...................................135
– Otis W Smith Health Center ..............................................136
– Center Hill Health Center ..................................................137
– Lindbergh Womenʼs & Pediatric Center ............................137
Section III
Support Services
Care Management .........................................................................140
Health Outcomes Center ...............................................................141
Dept. of Multicultural Affairs (DOMA) .......................................142
Quality Management .....................................................................147
Utilization Management................................................................149
Social Services ..............................................................................150
Customer Service ..........................................................................151
Rape Crisis Center ........................................................................151
Long Term Care Division .............................................................153
– Crestview Health & Rehab Center .....................................153
– Home Health Service .........................................................153
– Hospice Program................................................................154
Drug Information Center...............................................................155
– Clinical Staff Pharmacists ..................................................155
– Drugs and Supplies ............................................................155
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– Pharmacy Telephone Numbers ..........................................156
– Inventory, Distribution & Receiving..................................156
Central Sterile Supply ...................................................................158
Clinical Engineering Department .................................................158
Plant Operations Department ........................................................158
Information Services .....................................................................158
Safety – Fire ..................................................................................160
– Tornado ..............................................................................161
– Bomb Threat ......................................................................161
– External/Internal Disaster ..................................................161
Emergency Response to Cardiac Arrest ........................................161
Emergency Power .........................................................................162
Laboratory Services ......................................................................162
Medical Staff Services ..................................................................162
Medical Records ...........................................................................163
– General Rules .....................................................................164
– Release of Medical Record Information ............................164
– Preparation of Medical Records.........................................165
– Dictation/Dictating Instructions .........................................167
– Research and Educational Studies .....................................172
– Research Project Data Form ..............................................173
– Deficient Records ...............................................................173
– Case Summary Sheet .........................................................174
– Prospective Payment System .............................................175
– Peer Review Organization .................................................175
– Abbreviations .....................................................................176
– Problem-Orientated Medical Record .................................189
Patient Condition Descriptions .....................................................191
Patient Diets ..................................................................................192
– Discharge Diet Instruction .................................................192
– Supplemental and Tube Feedings ......................................193
– Adult Enteral Nutrition Protocol ........................................193
– Radio-Iodine Therapy ........................................................195
– Procedure for Infant Formula.............................................196
Patient Safety Department ............................................................197
Patient Transport Services.............................................................197
– Intrahospital Transport of Adult Patients to &
from Special Care Areas ...................................................198
– Category I - Minimum Transport Support .........................198
– Category II - Moderate Transport Support.........................199
– Category III - Maximum Transport Support ......................199
– Special Considerations .......................................................200
Infection Control ...........................................................................200
– Standard (Universal) Precautions ......................................201
– Expanded Precautions ........................................................202
– Summary of TB Isolation Policy .......................................203
– TB Discharge Plan .............................................................205
– Key to Letters Defining Criteria ........................................206
– Other Diseases/Illnesses.....................................................207
– Droplet Isolation Precaution ..............................................209
– Enhanced Contact Isolation Precautions ............................209
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– Admitting Criteria for 9A:
Special Immunology Services........................................... 211
– Vancomycin-Resistant Enterococcus .................................212
– Recommendations ..............................................................212
– Care and Maintenance of Intravascular Devices ..............213
– Blood Culture Collection ...................................................214
– Reportable Conditions and Diseases ..................................215
Radiology ......................................................................................217
– Central Viewing .................................................................220
– 5K Neonatal ICU Viewing Room ......................................220
– Ordering Examinations on Seriously Ill
or Injured Patients .............................................................221
– Ordering Examinations on Pregnant Patients ...................221
– Pediatric Radiology Program Description .........................221
– Breast Imaging ...................................................................222
– MRI & CT Scanning ..........................................................223
– Ordering Services & Preparation for Studies.....................224
– Pediatric Radiology............................................................229
– Emergency Radiology ........................................................231
– Angiography & Interventional Radiology .........................232
– Nuclear Medicine ...............................................................234
Respiratory Care Department .......................................................237
EKG … .........................................................................................238
Cardiac Function Laboratory ........................................................238
Cardiac Catheterazation Laboratory .............................................239
EEG/EMG Laboratory ..................................................................239
Pulmonary Function Laboratory ...................................................239
Nephrology ...................................................................................240
Oral Surgery Care .........................................................................240
Georgia Poison Center ..................................................................241
Section IV
General Responsibilities and Information
Dining Facilities ............................................................................243
Call Rooms Assignments – Doctorʼs Lounge ...............................243
Sample Drugs ................................................................................244
Insurance .......................................................................................244
Grady Branch Library ...................................................................245
Grady Satellite Library .................................................................247
Telecommunications .....................................................................248
– Telephones .........................................................................248
– Long Distance Calls ...........................................................248
– Hospital-Wide Paging ........................................................249
– Alpha Numeric Paging .......................................................249
Parking ..........................................................................................250
Post Office and Mail .....................................................................250
Medical Illustrations .....................................................................251
Human Resources .........................................................................251
– Interfacing with GHS Employees ......................................251
– Identification Badges .........................................................251
– ID Badge Issuance Renewal ..............................................252
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– Temporary and Replacement ID Badges ...........................252
– Other Information Concerning ID Badges .........................252
– Chaplaincy Services ...........................................................253
Public Affairs ................................................................................254
– News Media .......................................................................254
– Publications ........................................................................254
– Tours...................................................................................255
– Volunteer Services..............................................................255
– Development/Charitable Contributions .............................255
– Photography/Video Recording ...........................................255
Managed Care Department ...........................................................256
Security Services Department .......................................................258
Abusive/Violent Patients and Visitors...........................................260
Smoking and Eating ......................................................................260
Subpoenas .....................................................................................260
Visiting Hours ...............................................................................261
Visitor Badges ...............................................................................262
Emory House Staff Auxiliary........................................................263
House Staff Manual Update Sheet ................................................264
Index ...........................................................................................265
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To the Staff of Grady Health Care System:
The Medical Staff and House Staff Manual provides guidelines for
Attending Physicians, Interns, Residents, Fellows and medical students in their various roles at the Grady Health System. These guidelines apply equally to all ancillary and administrative personnel. This
pocket guide will serve as a reference manual only for all departments and services in the hospital. It does not replace existing policy
and procedure manuals. Policies and procedures that are included in
the Manual are I published in their entirety in other GHS manuals
such as the Infection Control manual and the Administrative/Operations Policy Manual. To the extent that a conflict exists between the
directions of this Medical Staff and House staff Manual and a policy
or procedure in other GHS Manuals (i.e. Infection Control Manual or
the Administrative/Operations Policy Manual) the policy or procedure controls. All policies and procedures referenced were in effect at
the time of the printing of the manual-June 2006. For updates and/ or
clarification, please see the appropriate GHS manuals.
The compliance of each member of the staff with the policies, procedures and philosophies expressed in this brochure will contribute
effectively to the combined efforts of Grady staff in delivering a high
standard of medical care to the sick and injured in this community.
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WELCOME TO THE HOUSE STAFF OF
GRADY HEALTH SYSTEM
It is a pleasure to welcome you to the Grady Health System. As
House Staff to this medical center, you may be assured that your
program has been designed to provide the finest teaching experience
possible.
During your training at Grady, the faculty of the Emory University School of Medicine or the Morehouse School of Medicine assumes the responsibility for educating you to your fullest capabilities
- specifically, as a prime contributor to the total requirements of our
nationʼs overall health care system.
You will be guided in your training program by the Chief of your
Services, by the Medical Staff of the hospital, and by various institutional polices. Your responsibilities in turn, will be to manifest the
highest degree of medical expertise and ethics to your patients at all
times, and to generate and maintain an unremitting atmosphere of
care and sympathy in all phases of treatment delivery and patient
contact. A kind and courteous manner must always be exhibited toward all patients. Prompt approval and supervision by the attending
of treatment, consultation and plans are essential.
It is also important to remember that personal attitude reflecting
both courtesy and patience towards visitors and hospital personnel
is an essential attribute of a truly effective physician. The successful
delivery of superior health care is largely promoted and flourishes
through this type of inter-disciplinary teamwork.
At the beginning of your employment, we want you to know that
the Grady Health System believes in equal employment opportunity
for all without regard to race, color, religion, sex, or national origin.
Grady Health System is proud of its tradition in house staff training
and will continue to support these programs to the maximum extent
possible. We are happy to have you with us as members of our House
Staff. Your cooperation in our mutual endeavors will be most helpful.
Otis L. Story, Sr.
President/ CEO
Curtis A. Lewis, M.D., MBA
Senior Vice President of Medical Affairs
Chief of The Medical Staff
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GENERAL INFORMATION
Vision and Mission of the Grady Health System
Vision: The Grady Health System® will become a world-renowned
leader in health services through its commitment to compassionate
care and medical education.
Mission: The Grady Health System® is a comprehensive health services delivery system which includes affiliations with public health
organizations, medical education programs, and community advocates to provide quality, cost-effective, and customer-focused health
care to residents of metropolitan Atlanta and citizens of the State of
Georgia. The Grady Health System® maintains its commitment of
offering medical services to the under served, including governmentally-sponsored populations. Gradyʼs services will be provided in a
compassionate, respectful and dignified manner.
The Scope of Gradyʼs Care
Grady Health System® is the southeastʼs largest public hospital
system with 953 licensed beds, 70 pediatric beds, and 354 long-term
care beds. Grady provides metro-Atlanta with its only Level One
Trauma Center and is home to the Georgia Poison Center, the Georgia Comprehensive Sickle Cell Center, the Infectious Disease Center,
and 9 neighborhood health centers. Key patient care units include
16 surgical suites, 23 birthing suites, 42 neonatal intensive care bassinets, and a 23-bed regional Burn Center.
Grady is operated under a state charter by The Fulton-DeKalb Hospital Authority to provide medical care for the indigent, and emergency health care for Fulton and DeKalb Counties. Medical care
is provided under contract with Emory University and Morehouse
schools of medicine. Grady cares for over 28,000 in-patients a year,
and its outpatient departments receive more than 731,000 visits annually, including over 36,000 at its Infectious Disease Center and over
79,000 in its Emergency Care Center.
ORGANIZATION AND RESPONSIBILITIES
The House Staff is composed of physicians undergoing training.
Members of the House Staff are under the supervision of their assigned Chief of Service in all matters relating to professional care
of patients; overall coordination of the Professional Services is exercised by the Senior Vice President of Medical Affairs as Chief of the
Medical Staff.
The Medical Staff, through its Executive Committee, operates
under By-Laws and Rules and Regulations approved by the Board
of Trustees, and is responsible for recommending medical policy to
the Board of Trustees. All appointments as house officers are made
for one year from date of entry (normally July 1 – June 30), and are
subject to cancellation by the hospital for just cause.
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ADMINISTRATIVE STAFF
TITLE
Otis L. Story, Sr. ............................President/Chief Executive
Officer
Craig Tindall .................................Interim Executive Vice President/
Chief Operating Officer
Thompson Arrendale ..................... Executive Director, EMS
Michael Black ...............................Vice President, Human
Resources
Cora Bullock .................................Administrator, Long Term Care/
Crestview
Ozzie Gilbert .................................Vice President, Fiscal Services
Cynthia Griggs-Flournoy ..............Executive Director, Health
Information Services
Leon Haley, MD ............................Deputy Senior Vice President,
Medical Affairs
Kelvin J. Holloway, MD ...............Deputy Senior Vice President,
Medical Affairs
Tim Jefferson, Esq. .......................Senior Vice President, Legal
Affairs
Philip Lamson ...............................Executive Director, Georgia
Cancer Center
Curtis A. Lewis, MD .....................Senior Vice President/Chief of
Staff, Medical Affairs
Polly Meriwether-Lewis ...............Executive Liaison, Board of
Trustees
Doug Miller ................................... Executive Director, Chief of
Pharmacy
Gaynell Miller ...............................Vice President, Patient Care
Howard A. Mosby, CPA ................Vice President, Medical Affairs
Jackie Hunter ................................Interim, Vice President/Chief
Information Officer
Gerald Reed ..................................Chief Purchasing Officer
Rhonda A. Scott, MD ....................Senior Vice President/Chief
Nursing Officer/Patient Care
Joseph E. Taylor ............................Vice President, Ambulatory
Services
Leticia Towns ................................Vice President, Government
Relations
Kirk Wilks .....................................Vice President, Public Affairs
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CHIEFS OF SERVICES
George Birdsong, M.D. .................Chief, Anatomical Pathology, (E)
Geoffrey Broocker, M.D. ...............Chief, Ophthalmology, (E)
Kenneth Carney, M.D. ...................Chief, Urology, (E)
Carlos del Rio, M.D. .....................Chief, Medicine, (E)
Frances Dunston, M.D. .................Chair, Pediatrics, (M)
David V. Feliciano, M.D. ...............Chief, Surgery, (E)
Michael R. Frankel, M.D. ..............Chief, Neurology, (E)
Arthur J. Fountain, M.D.................Chief, Radiology, (E)
Michael O. Gardner, M.D. .............Chair, Chief, OB/GYN, (E)
Robert Geller, M.D. ......................Chief, Pediatrics, (E)
Raphael Gershon, M.D. .................Chief, Anesthesiology, (E)
Odette Harris, M.D. .......................Chief, Neurosurgery, (E)
Leon L. Haley, M.D. .....................Chief, Emergency Medicine, (E)
Vickie James, M.D. ........................Chief, Extended Care
Jerome Landry, M.D. .................... Chief, Radiation Oncology, (E)
Steven T. Levy, M.D. ....................Chief, Psychiatry, (E)
Roland Mathews, M.D. .................Chair, GYN/OB, (M)
Charles E. Moore, M.D. ................Chief, Otolaryngology, (E)
Sareeta R.S. Parker, M.D. .............Chief, Dermatology, (E)
Vaddadi R. Rao, M.D. ....................Chief, Rehabilitation
Medicine, (E)
James Reed, M.D. ..........................Chief, Medicine, (M)
David Reznik, M.D. .......................Chief, Dental
Hogai Nassery, M.D. ......................Chief, Family & Preventive
Medicine, (E)
Gregory Strayhorn, M.D. ...............Chair, Family Medicine, (M)
William L. Weaver, M.D. ..............Chair, Surgery, (M)
George E. Wright, M.D. ................Chief, Orthopedics, (M)
Andrew N. Young, M.D. ................Chief, Laboratory Services, (E)
MEDICAL EXECUTIVE COMMITTEE
Curtis A. Lewis, M.D .....................Senior Vice President Medical
Affairs
Thomas M. Aaberg, M.D. .............Chair, Ophthalmology, (E)
Otis L. Story ...................................President/Chief Executive Officer, GHS
Wayne Alexander, MD ...................Chair, Medicine (E)
Daniel L. Barrow, M.D. ................Chair, Neurosurgery, (E)
Sarah L. Berga, M.D ......................Chair, Chief, OB/GYN, (E)
Geoffrey Broocker, M.D ................Chief, Ophthalmology, (E)
Kenneth Carney, M.D. ..................Chief, Urology, (E)
William J. Casarella, M.D ..............Executive Associate Dean,
Interim Chair, Rehabilitation
Medicine, (E)
Robert A. Swerlick, M.D. .............Interim Chair, Dermatology, (E)
Lawrence W. Davis, M.D. .............Chair, Radiation Oncology, (E)
Frances J. Dunston, M.D. ..............Chair, Pediatrics, (M)
David V. Feliciano, M.D. ..............Chief, Surgery, (E)
Michael R. Frankel, M.D. .............Chief, Neurology (E)
Arthur J. Fountain, M.D.................Chief, Radiology, (E)
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Robert Geller, M.D ........................Chief, Pediatrics, (E)
Raphael Gershon, M.D ..................Chief, Anesthesiology, (E)
Leon L. Haley, M.D., MHSA. .......Deputy SVPMA, Chief, Emergency Medicine, (E)
Odette Harris, M.D. ......................Chief, Neurosurgery, (E)
Katherine L. Heilpern, MD ............Chair, Emergency Medicine, (E)
Eve J. Higginbotham, M.D ............Interim Dean, SVP, Academic
Affairs, (M)
Kelvin J. Holloway, M.D. .............Deputy Sr. Vice President of
Medical Affairs
Vickie James, M.D. .......................Chief, Extended Care, Crestview
Michael E. Johns, M.D. ................EVP, Health Affairs, Emory
University
Thomas J. Lawley, M.D. ...............Dean, Emory University School
of Medicine (E)
Allan Levey, M.D. ........................Chair, Neurology (E)
Steven T. Levy, M.D. ....................Chief, Psychiatry, (E)
Lawrence J. Lutz, M.D. ................Chair, Family, Community &
Preventive Medicine, (E)
Fray Marshall, M.D. ......................Chair, Urology, (E)
Roland Matthews, M.D. ................Chair, GYN/OB, (M)
Douglas Mattox, M.D. ..................Chair, Otolaryngology, (E)
John E. Maupin, Jr., D.D.S ............President, Morehouse School of
Medicine
Carolyn C. Meltzer, M.D ...............Chair, Radiology, (E)
Charles Moore, M.D ......................Chief, Otolaryngology, (E)
Hogai Nassery, M.D .......................Chief, Family & Preventive
Medicine
Charles B. Nemeroff, M.D .............Chair, Psychiatry, (E)
Sareeta R.S. Parker, M.D. .............Chief, Dermatology, (E)
Tristram Parslow, M.D ...................Chair, Pathology, (E)
Vaddadi R. Rao, M.D .....................Chief, Rehabilitation Medicine,
(E)
James Reed, M.D. .........................Chief, Medicine, (M)
David Reznik, M.D. ......................Chief, Dental
James Roberson, M.D. ..................Chair, Orthopedics, (E)
Myra Rose, M.D. ..........................Interim Chair, Medicine, (M)
Lawrence Sanders, M.D .................Associate Dean, Clinical Affairs,
(M)
Rhonda Scott, PhD. ....................... Senior Vice President, Patient
Care, GHS
William R. Sexson, M.D. ..............Associate Clinical Dean, (E)
Barbara Stoll, M.D .........................Chair, Pediatrics, (E)
Gregory Strayhorn, M.D ................Chair, Family Medicine, (M)
William L. Weaver, M.D. ..............Chair, Surgery, (M)
William C. Wood, M.D ..................Chair, Surgery, (E)
George E. Wright, M.D. ................Chief, Orthopedics, (E)
Andrew N. Young, M.D. ...............Chief, Laboratory Services, (E)
James R. Zaidan, M.D. ..................Chair, Anesthesiology, (E)
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PATIENT CARE ADMINISTRATION
The Vice President for Patient Care provides executive directions
for Patient Care. There are five departments, each with a Director.
These departments are: Medical-Surgical Nursing, Critical Care
Nursing, Perinatal Nursing, Perioperative Nursing and Emergency
Care Services. For other areas such as Pediatrics, Womenʼs Health,
Psychiatry, Ambulatory Care and Long Term Care, the Vice President, Patient Care, collaborates with the appropriate Vice President
and/or Administrator.
EMERGENCY PHONE NUMBERS
EXTENSION
FIRE ......................................................................................... 5-3333
(See General Fire Plan)
CARDIAC ARREST ............................................................... 5-5555
CHAPLAIN ............................................................................. 5-4270
CRISIS INTERVENTION SERVICE ..................................... 5-4762
EMERGENCY CLINICS
Emergency Care Center ....................................................... 5-6200
Womenʼs Urgent Care Clinic ............................................... 5-8621
Pediatric Emergency Clinic (PEC) ...................................... 5-4373
Psychiatric Emergency Clinic .............................................. 5-4762
INTERPRETERS..................................................................... 5-9626
POISON CONTROL ............................................................... 5-9000
SECURITY .............................................................................. 5-4025
CONFIDENTIAL INFORMATION
Information obtained from patients must be treated confidentially.
It should also be noted that psychiatric information is to be treated
with extreme care as is alcohol and drug abuse and HIV status information. All personnel must take care not to release any such information without justification or authorization from the patient. With
special reference to lawyers, it should be noted that information may
be released to the patientʼs own lawyer upon authorization of such release by the patient. Such authorization should be in writing. If a form
is desired, you may check with the Medical Records Department for
the release of information form utilized in connection with the release
of medical records. Patient information should not be discussed in
elevators, corridors, cafeterias, and similar places where confidential
information may be overheard.
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For your general information, following is text of the brochure of the
same name that is given to patients.
YOUR RIGHTS AS A PATIENT
The Grady Health System believes that each patient has the right
to considerate care that protects personal dignity and respects cultural
and spiritual values. This brochure is designed to help you understand
your rights as a patient. The Grady Customer Service Department is
available at (404) 616-5349 to help answer questions about the information contained in this brochure and about patient rights. TDD/TTY
users may contact us by calling (404) 616-9136. PC (ASCII) users,
please call 1-800-855-2882. For Telebraille, call 1-800-855-2883.
As a valued patient of the Grady Health System, you have the right
to:
Access to Care
You will receive medical treatment and services regardless of your
race, color, gender, age, national origin, religion, disability, language,
or source of payment.
Respect, Dignity and Comfort
Care will be courteous, considerate and respectful at all times and under all circumstances. To meet your spiritual needs, our chaplains are
available by calling 404-616-4270. After 5:00 p.m. and on weekends,
page the duty chaplain at 404-703-1670. We will also assist you in
contacting your personal clergy.
Privacy
Your personal privacy will be protected during personal hygiene
activities, when receiving medical or nursing treatments, when discussing clinical care issues with your doctor or other staff, and when
requested at other times as appropriate.
Confidentiality
Your clinical records and patient information will be kept confidential and shared only when necessary to provide care and services, or
by your authorization, or when reporting is required or permitted by
law.
Clear Information
You will be kept informed of your health status, prognosis, and any
proposed treatments or procedures. You will be given the name of the
physician with primary responsibility for your care, and the identity
and professional qualifications of those authorizing or performing
treatment. If you are unable to receive this information, it will be
given to the person legally acting on your behalf. The Grady Health
System is a teaching institution. Supervised health care providers in
training may be involved in your care and treatment. You will be given opportunities to discuss your health care with your doctors.
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Language Assistance Services
If you are deaf/hard-of-hearing, blind, or have limited English proficiency (or have any other recognized impediment to standard communication), free language assistance services and/or assistive devices will be made available to you when necessary. Please identify
yourself as a person needing such assistance, or call (404)616-9626,
24 hours a day, 7 days a week.
Access to Medical Records
You may see and obtain a copy of your medical record within a reasonable time after your request is made, except when restricted by
law.
Notification of Family & Physician
You have the right to have a family member or representative of your
choice and your own physician notified promptly of your admission
to the hospital.
Participation in Planning Care
You will be an active participant in your plan of care, including requesting or refusing treatment. Though we promote family involvement in your care, you have the right to exclude any or all family
members from participating in decisions about your care.
Effective Pain Management
Our staff is committed to pain prevention. We will respond quickly to
your reports of pain.
Advance Directives
You have the right to make advance directives regarding your wishes
for end-of-life care or appointing a representative to make health care
decisions for you, but you are not required to do so to receive services. If you do have or make any advance directives, the staff and others
who provide care in this hospital will comply with your directives.
Consultation With Specialists
We will help you consult with specialists or other medical practitioners if requested and at your own expense.
Communication
You may generally have access to visitors, mail, telephone calls, or
other forms of communication. If any restrictions are necessary as a
part of your care, we will explain them to you and your family and
determine them with your participation, unless otherwise required by
law.
Transfer
Should it be necessary for your care and medically advisable, we may
transfer you to another health care facility. You may also request such
a transfer. Decisions regarding transfers are based on our ability to
provide the type and quality of care you need.
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Security
You have the right to receive care in a safe setting and to be free from
all forms of abuse or harassment. You have the right to be free from
seclusion and restraints of any form that are not medically necessary
or are used as a means of coercion, convenience, or retaliation by
staff.
Rules and Regulations / Patient Responsibilities
As a patient of the Grady Health System, you agree to provide us
complete and accurate information about your medical condition and
to keep us informed of any changes. You are expected to let us know
if you do not understand the medical information or instructions given to you. You must comply with our smoking, fire, noise control, and
other policies regarding patient activities and safety. We expect you
to keep all appointments and call in advance when you need to cancel or change an appointment. You are responsible for keeping your
Grady card and financial counseling information up-to-date and for
arranging payment for the care and treatment provided to you.
Resolution of Complaints
Our policies and procedures, our day-to-day activities, and the way
we provide services, are all designed to reflect our concern and respect for the rights of our patients. If you are experiencing a problem
or feel your rights have been denied, please speak with your doctor,
the nursing clinical manager, or the department supervisor. If you
need further assistance, please call the Customer Service Department
at (404) 616-5349 or visit Room GH005 on the main floor (Atrium)
of the main hospital building.
The Grievance Process
If your patient issue cannot be resolved promptly, you have the
right to submit a formal grievance in person, by phone, or in writing
to the Customer Service Department. We will review your grievance
as quickly as possible and you will receive a written notice of the
decision within thirty days, together with a description of the steps
taken to investigate your grievance, the date the investigation was
completed, and the name and phone number of the health system contact person. You may also address your concerns to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) at
One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, or
through their toll-free number: 1-800-994-6610 , or to the Ga. Office
of Regulatory Services, Ga. Dept. of Human Resources, 2 Peachtree
St., N.W., Suite 21-325, Atlanta, GA 30303-3167, (404) 657-5700.
You may contact JCAHO or DHR regardless of whether you have
first notified the Grady Health System. Medicare patients may have
additional rights to file a grievance with the hospitalʼs Peer Review
Organization. Call the Grady Quality Utilization Management Department at (404) 616- 7706 for help. The voicing of a complaint
or grievance will in no way depreciate the quality of care given the
patient.
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We provide you with the following referral/resource
information:
DeKalb County Services:
Child Abuse & Neglect
Community Service Board (Mental Retardation)
Senior Connections
Adult Abuse & Neglect
(404)370-5066
(404) 892-4646
(404) 370-4081
(404) 370-5079
Fulton County Services:
Adult Abuse & Neglect
Refugee Services
Child Abuse & Neglect
Mental Retardation
Office of Aging
(404)699-4399
(404)656-6086
(404)699-4399
(404)730-1600
(404) 730-6000
The “Your Rights as a Patient” brochure is turquoise-color and
available in both English and Spanish, and is distributed to all
newly-admitted inpatients. Brochures also are available in clinics, nursing stations, and offices throughout the health system.
Notices advising patients of these rights and the availability of
the brochure are on display in all areas. For additional information or clarification, please call the Customer Service Department at 5-5349.
EMPLOYEE HEALTH SERVICES (EHS)
PHONE # :
(404) 616-4600 (In-house: 5-4600)
LOCATION:
15A - Grady Hospital access via A & B
elevators
HOURS:
7:00 am - 5:00 pm Monday - Friday
(except official hospital holidays)
BLOOD & BODY FLUID EXPOSURE HOTLINE:
Phone # 616-STIX (5-7849)
NOTE:
1. Physicians are available from 9:00 am to 4;00 pm.
2. A current Grady ID Badge is required for all services; A “Grady
Card” obtained through Financial Counseling on
the Ground Floor is required.
3. After calling the hotline, Emergency Care Center is to be accessed for follow-up with Needlesticks, Blood and Body Fluid
exposures during the hours and days that EHS is closed.
BLOOD AND BODY FLUID EXPOSURE
The steps listed below should be followed by employees and housestaff who sustain a needlestick, puncture or cut from a sharp object,
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or other incident involving possible exposure to another individualʼs
blood or body fluids (e.g., blood or body fluid exposure to open
wounds, irritated hands/skin, or mucous membranes such as a splash
to the eye, mouth or nose).
1. Immediately wash any exposed skin area with soap and water OR
copiously flush eyes or mucous membranes with water or saline.
2. Notify supervisor immediately.
3. Fill out “Employee Special Incident Report” (#303-26896).
4. Call BLOOD & BODY FLUID EXPOSURE HOTLINE: 616STIX (5-7849)
Listen carefully to the recorded message, which will instruct
you regarding what information to document and what to do next.
Record your name, work area, and the 4-digit Grady extension and/or other telephone or pager number where you can be
reached.
5. The Employee Health Services Hotline staff checks messages and
returns calls at least hourly during the day and every 2 hours during
the evening, on weekends and holidays (until 2200).
6. Serious injuries requiring suturing or other immediate physician
intervention should be promptly evaluated and treated in the Emergency Care Center (ECC).
INCIDENT REPORTING
Using the Special Report
A Special Incident Report is a confidential report used to notify
the Risk Management Department of an unexpected and adverse
event which occurred to either an Inpatient, Outpatient, Visitor, Student, Volunteer, Physician, Emory Employee, or Agency Personnel.
Special Incident Reports can be initiated by any Physician or Grady
Health System employee. Every effort should be made to complete
the report and deliver it to the Risk Management Department within
24 hours of the occurrence.
Confidentiality of the Special Incident Report
The Special Incident Report is a legal document, intended for internal purposes only. To maintain the confidentiality of these reports,
copies of the Special Incident Report should not be made for any
reason.
The Special Incident Report is not a part of the patientʼs Medical
Record and therefore should neither be placed in the Medical Record
nor referred to in the Medical Record.
Using Voice Mail or a Phone Call to supplement the written Special
Incident Report
The Risk Management Department should be contacted immediately whenever an unexpected event results in serious injury. If the
event occurs after regular business hours, the Hospital Administrator can assist in contacting the Risk Manager who is “on-call”. The
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Risk Management Department can be notified of less serious events
via Departmental Voice Mail to 616-7701, however a written Special
Incident Report should still be completed and forwarded to the Risk
Management Department within 24-hours.
Incidents involving Inpatients and Outpatients
Any incident involving an Inpatient or Outpatient should immediately be brought to the attention of the physician primarily responsible for the care and treatment to that individual. If treatment is indicated, the patient should be transported to the appropriate treatment
area. The physician should promptly evaluate the patient, order any
indicated diagnostic tests, initiate indicated treatment interventions
and then include a summary statement of the physicianʼs assessment,
diagnostic intervention, results and treatment outcome on the Special
Incident Report, in the section titled Physician Finding and Treatment.
Incidents involving Visitors, Students, Volunteers, or Agents of GHS
and non-employees
If a Non-patient, i.e., Visitor, Student, Volunteer, Physician, or
Agent of GHS is involved in an event which results in personal injury
or potential injury, the individual should be offered care in the Emergency Care Center and then immediately transported to the Emergency Care Center (ECC) for evaluation and treatment. Individuals being
treated for injuries sustained on the premises should be evaluated and
treated as quickly as appropriate.
The Special Incident Report should be completed and forwarded
to the Risk Management Department immediately. The Physicianʼs
Statement section should be completed by the discharging physician
prior to forwarding the report to the Risk Management Department.
The Grady Health Systemʼs Medical Device Reporting Program and
The Safe Medical Devices Act
If an event results in the individual being harmed and if any type
of Medical Device and/or Medical Equipment was involved in a way
which suggested the device either caused the event or contributed
to the event, a separate form (“The Product, Supply, and Equipment
Incident Report GHS# 30385280 salmon) will need to be completed.
Risk Management should be immediately notified at (404) 616-7703
or (404) 616-7704 for equipment variances which result in patient
harm or injury. Risk Management will then be responsible for completing the Incident Report. Medication Variance Reports are considered privileged information for peer review only.
The suspect device should not be altered or adjusted in any way.
Employees or physicians should first insure the individualʼs safety,
leave all of the deviceʼs setting undisturbed, notify the Clinical Engineering Department of the occurrence, inpound the device and any
attached accessories, replace the device if necessary and finally, complete the report.
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If the event did not result in actual or potential harm to an individual, then the questionable Medical Device should be removed from
service and returned to the issuing department for further evaluation.
This type problem, which does not directly involve a patient, visitor, etc., should be reported on the Grady Health System Equipment,
Product and Supply Problem Incident Report, G5- 303 pink.
Medication Error Surveillance Reporting
It is the goal of the Grady Health System to provide accurate prescribing, dispensing, administration and documentation of medication. All medications shall be prescribed, dispensed and administered
in accordance with written standards and based on current professional requirements. A medication variance is defined as a deviation
from established standards for prescribing, data entry, dispensing, administration, and documentation / transcription of medication. Medication variances may be categorized as potential (“near miss”) or actual variances. A potential medication variance is a variance which is
discovered and resolved prior to reaching the patient, thereby avoiding deviation from expected standards of care. An actual medication
variance occurs when there is a deviation from established standards
for medication prescribing, dispensing, documenting or administration and the medication is administered to the patient.
Medication variances will be promptly reported, evaluated and
necessary action will be taken to minimize untoward effects. Physician assessment of the patient should include the clinical significance
of the error, recommended duration of follow-up and outcome for actual errors requiring additional monitoring or any change in treatment
plan. All medication variances will be reported on the Medication
Variance Report (Form #MRC 30303203) and forwarded in a sealed
envelope labeled “Confidential” to the Drug Information Center, Box
26041 within 24 hours of discovery. Risk Management should be immediately notified at (404) 616-7701 for medication variances which
result in patient harm or injury. Risk Management will then be responsible for completing the Incident Report. Medication Variance
Reports are considered privileged information for peer review only.
Adverse Drug Reaction Surveillance and Reporting
An adverse drug reaction (ADR) is any untoward or unintended
response to a drug that occurs with dosages normally administered
to humans for the diagnosis, therapy, prophylaxis, or modification of
physiological function. Therapeutic failures and overdose situations
are excluded from this definition.
It is the policy of the Grady Health System that all healthcare professionals document a suspected adverse drug reactions in the medical record and report the event on the ADR report (Form #30315521).
The ADR reporting form is stocked on the patient care areas and is
available through Relizion. Documentation should include the suspected drug, dose, route, dates of administration, treatment of the
reaction and patient outcome. Please refer to Pharmacy Department
Policy and Procedure #2.04 for additional information.
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CORPORATE COMPLIANCE AND ETHICS PROGRAM
The Grady Health System is committed to at all times to abiding
by the highest legal and ethical principles. It is with this commitment
in mind that the Grady Health System has established a Corporate
Compliance and Ethics Program. All members of the House Staff are
required to abide by The Grady Health Systemʼs Corporate Compliance Standards of Conduct and Policies and Procedures. These Standards of Conduct and Policies and Procedures are located in Gradyʼs
Corporate Compliance “Standards of Conduct” and “Policies and
Procedures” handbooks. House Staff should obtain their copy of the
Compliance “Standards of Conduct” handbook from the Office of
Medical Affairs. Each House Staff member must sign for their own
individual copy of the Standards of Conduct handbook. Additionally,
on an annual basis, the House Staff is required to attend a Corporate
Compliance and Ethics training session at The Grady Health System.
These training sessions are offered regularly on-campus, and a schedule of the sessions can be obtained from the Office of Medical Affairs. Training on the Corporate Compliance and Ethics program will
also be conducted during the House Staff orientation. If any member
of the House Staff has any questions or concerns regarding compliance program violations or issues they should immediately contact
the Office of the Corporate Compliance Officer at (404) 616-1706 or
the Office of the General Counsel at (404) 616-5147.
THE MEDICAL ETHICS COMMITTEE OF THE GRADY
HEALTH SYSTEM
The Grady Medical Ethics Committee is a multi-disciplinary
group, a moral community, whose purpose is to: 1) provide education, 2) participate in consultations and make ethical recommendations, and 3) provide ethical guidance in policy decisions which will
enhance patient care and promote professionalism.
William Sexson, MD, and Jeronia Blue, RN, serve as Co-Chairs of
the Medical Ethics Committee. Deborah Cruze, JD, MA is the Clinical Ethicist for the Grady Health System. The Medical Ethics Committee is an “open” committee and its services can be requested by
GHS patients, their families, GHS staff and Emory and Morehouse
physicians.
The Medical Ethics Committee can be reached by pager
(404) 278-4753, 24 hours per day, seven days a week. The Clinical
Ethicist or an Ethics Committee member will contact you within an
hour of paging the Medical Ethics pager, when possible.
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SECTION I
PROFESSIONAL RESPONSIBILITIES
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GENERAL HOUSE STAFF RESPONSIBILITIES
The proper care of patients at all times imposes a requirement for
strict adherence by the House Staff to established policies governing
procedures, schedules and duty hours. It is expected that the House
Staff will comply with the standards established by the Hospital.
A. Schedules: Schedules of assignments are arranged by Services
and are posted prior to changes in service. Compliance with these
schedules is mandatory and no changes may be made without approval of the Chief of Service or his representative.
B. Duty Hours: Off-duty hours and vacations for House Staff members are established by individual Chiefs of Service. When emergencies arise such as natural disaster or civil disturbance, house
officers may be called upon to work additional hours until the
emergency is declared ended.
It is essential that during hours of duty each member of the House
Staff keep the telephone operator advised concerning his exact whereabouts if he is not within the paging system capability. Should it become necessary for a member of the House Staff to leave the Hospital
at any time when he normally would be expected to be present, he
will inform the telephone operator at the time he departs, designate
the name of the physician who will cover his service in his absence,
and indicate to the operator an estimated time of return. Under no
circumstances will a House Staff member leave the Hospital while
on duty without first obtaining permission from his Senior Resident
or Chief of Service.
PHYSICIAN IDENTIFICATION NUMBERS
Personal Code Number – Each member of the House Staff is assigned a “personal code number” as a means of providing positive
physician identification in connection with the performance of certain
duties at Grady. This number is to be written following the signature
on requisitions, reports in patient charts, prescriptions, and so forth.
An example is as follows:
Joe Brown, M.D. (961234)
or
J. B. Brown, M.D. (961234)
Note: Caution should be exercised so as not to confuse the personal
code number with the Drug Enforcement Agency number.
Drug Vendor Number – The Georgia Drug Vendor Program requires that each member of the House Staff write his personal code
number (as outlined above), on all prescriptions written in connection
with his duties at Grady. In the event a House Staff physician has a
permanent license to practice medicine in the state of Georgia, the
Office of the Executive Director should be so notified, and permission will be granted to use that number in lieu of a hospital assigned
drug vendor number.
DEA Number – Physicians must have a license to practice medi-
15
cine in Georgia in order to apply for a DEA number. The registration is required annually and must be resubmitted when physicians
change their name or address as shown on the registration. The Office
of the Executive Director will supply this form. The physician will be
notified of his number by the Drug Enforcement Agency. House Staff
physicians who do not have Georgia licenses must use the Grady
DEA Number which should be placed on the prescription blank in the
space provided under his name.
Note: Prescriptions written for controlled drugs at Grady must reflect both the DEA number and the drug vendor or Georgia license
number of the prescribing physician. Grady DEA number must be
used at Grady Memorial Hospital only.
National Provider Identifier (NPI) - The National Provider Identifier (NPI) has been adopted by the US Department of Health and Human Services to meet the HIPAA health care provider identification
mandate. It is a 10 digit number assigned to health care providers.
Once a provider has an NPI, it will not change regardless of job or
location changes. It replaces all health care provider identifiers including numbers assigned by Medicare, Medicaid, Blue Cross, etc.
on standard HIPAA transactions. The compliance date mandating
use of an NPI number by was scheduled for May 23, 2007 however
the implementation date has been extended until May 23, 2008 with
demonstration of contingency plans to comply with NPI provisions.
Thus, the requirement and expectation for health care providers to
acquire an NPI remains in place. Providers must apply for an NPI
through the Center for Medicare and Medicaid Services (CMS) by
completing the application at: https://nppes.cms.hhs.gov/NPPES/
Welcome.do. Providers must advise the Medical Staff Services
deoartment at 404-616-4262 as to their NPI number when it is assigned.
Identification Badges – Upon compliance with the Grady Health
System (GHS) Tuberculosis Control Policy, each House Staff physician will be given an identification badge. This badge must be worn
at all times while on GHS premises. ID Badges are usually issued
annually but must be renewed through Employee Health Services at
six month intervals
The wearing of a valid ID Badge is mandatory for purposes of
identification, safety, security, and ensuring compliance with the Tuberculosis Control Policy. Without a valid ID Badge you may be unable to gain access to hospital areas and find yourself significantly
inconvenienced in the conduct of your duties.
ID Badges are issued by GHS Human Resources in Room 108,
Georgia Hall, 36 Butler Street, S.E. ID Badges with six month validations are renewed via a special punch through the appropriate date on
the badge by Employee Health Services, 3rd Floor, Armstrong Hall.
In order to replace a lost ID Badge, you must have proof that
you are in compliance with the GHS Tuberculosis Control Policy.
Verification of your compliance must be obtained in-person through
GHS Employee Health Services (616-4600). You will be given an ID
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Badge Authorization Form which you will take to Human Resources.
There is a $5.00 replacement fee for lost badges.
Human Resources ID Badge Section
Hours: 0800 - 1700 hours
Location: First Floor, Georgia Hall
Telephone: 616-1908
Scope of Services: ID Badge issuance/changes/replacement
ID Badge questions
DISCIPLINE AND BEHAVIOR
House Staff at Grady are subject to the rules and regulations governing the operation of the Hospital and its staff and employees.
Throughout their training period, members of the House Staff are supervised and counseled by the Chiefs of Services and the faculty attending staff. House officers should feel free to discuss with the Chief
of Service, resolutions and problems directly or indirectly associated
with their medical education. Should any infraction of the rules by the
House Staff be observed, or reported, corrections will be made by the
appropriate Chief of Service or his designated representative. If, after
proper counseling, there is no improvement, discipline may be taken
by the appropriate Chief of Service or his designated representative.
Other appropriate measures may be taken by the Hospital.
CHAPERONES
Physical examinations of all patients should be performed with regard for the privacy and comfort of the patient, and should be appropriately chaperoned as the situation may require. The patient should
cooperate fully with the examiner and realize that certain portions
of an examination are inherently uncomfortable. Pelvic examinations
should never be performed without a chaperone, and consideration
should be given to using a chaperone for rectal examinations.
CONSULTATIONS, INPATIENT
Clinical pharmacists are available for consultation on drug therapy
assessment or managment, as well as pharmacokinetic monitoring of
drug levels. There is a clinical pharmacist or pharmacy resident onsite 24 hr/7 days. Consults may be obtained by calling the on call
pager at 404-283-0587 or by requesting a consult via a prescription
order.
Frequent consultations between the various specialities of the medical services and other services, e.g., Physical Therapy, Therapeutic
Recreation Services, and Occupational Therapy, etc., are encouraged
at Grady, both as a means of ensuring optimal patient care, and as
a method of providing valuable training for the physician. It is incumbent upon each member of the House Staff, therefore, to make
consultation requests as needs arise and to comply promptly with requests received from other services.
The physician requesting consulting must clearly state what he de-
17
sires from the consultant; he also must provide the consultant with
adequate clinical information on the patient. The JCAHO requires
the consulting physician, in turn to clearly state his diagnosis, therapy
and reasons for same.
All requests for consultation must be made on Grady Form #30315350 (Inpatient Consultation Form), available at all nursing stations; they should be placed in the appropriate Grady Health System
consultant box or they may be delivered or faxed to the consulting
service.
Additionally, each House Staff physician is encouraged to frequently call upon faculty personnel to either concur in a treatment
plan, disposition, or offer advice, as indicated.
CONSULTATIONS, OUTPATIENT
PHARMACOTHERAPY CONSULT CLINIC
Patients who are seen in Medicine Clinics I, II, and III can be referred to the Pharmacotherapy Consult Clinic for medication management and disease state follow-up appointments. Services include:
diabetes management and education, blood pressure checks, assistance with polypharmacy and noncomplaince, and 24 -hour pressure
monitoring. Patient referrals can be made by checking off the pharmacy box on the progress note and indicating the timeframe in which
the patient needs to be seen, or by paging the clinical pharmacist.
The following are excerpts from the Ambulatory Care Services/
Maternal Child Health Referral Policy:
Policy Statement:
To ensure the efficiency of processing all outpatient clinic referrals/ consultations throughout the Grady Health System® utilizing
the process defined below. All referrals/consultation requests must be
written on a GHS Outpatient Clinic Referral Form.
Objective:
Compliance with this policy will ensure appropriate and timely
processing of outpatient referrals/consultations throughout the Grady
Health System®.
Tools/Forms Used:
• Outpatient Clinic Referral Form #30315352 - Form revised 3/96.
• Master Referral Log Book - Referrals Sent - Each clinic will use
this log to track the patients that they refer to other clinics.
• Master Referral Log Book - Referrals Received - Each clinic will
use this log to track the patients that are referred to them.
• Referral Consultation File - Each clinic will file their Referral/
Consultation Forms by appointment date.
Definitions:
• Emergent Referral - A referral in which the provider determines
that the patient needs to be seen in less than 48 hours.
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• Urgent Referral - A referral in which the provider determines that
the patient needs to be seen within 3-5 working days.
• Routine Referral - A referral in which the provider determines that
the patient can be seen in greater than 5 working days, however the
appointment will be scheduled within 4 weeks, as otherwise specified by the physician, as available.
*Note: these definitions apply to Referral status versus clinical status/assessment.
Procedure:
Initiate Referral
• Referring Provider determines that a referral is needed for the
patient.
• Referring Provider obtains an Outpatient Clinic Referral Form
(#3031532) and legibly completes the following information:
-Section I: Authorization Information
-Section II: Appointment Information (may be completed by Referring Provider or Referring Clinic Clerk
-Section III: Problem(s)
• Referring Provider records their Authorization number on the
Outpatient Clinic Referral Form if it is required by the patientʼs
insurance, i.e. GBHC.
• Referring Provider determines if the referral is Emergent (less
than 48 hours) Urgent (3-5 working days) or Routine (greater
than 5 working days).
Emergent/Urgent Referrals
• Is Referral made during clinic hours?
-YES Referred Clinic Open:
- Referring Provider calls the Referred Provider to determine if
the patient can be seen in less than 48 hours for Emergent Referrals and 3-5 calendar days for Urgent Referrals.
-NO Referred Clinic Closed:
- Referring Provider calls the appropriate Service for the referral.
- Service Physician on-call will determine if referral is an emergent or urgent consult.
- If referral is deemed emergent, then the Service Physician oncall may conduct the referral prior to the patient leaving the area
(ECC, UCC, WUCC).
- Service Physician completes the response section on the Outpatient Clinic Referral Form, if the patient is seen.
Responsibility
• It is the responsibility of the Referred Provider to complete the designated Grady Health System® Outpatient Clinic Referral Form,
and attach any additional information to the Outpatient Clinic Referral Form.
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For a copy of the entire policy, please see the Policy and Procedure
Manual at each clinic.
ADMISSION OF PATIENTS
The Chief of each Service and his/her designated attending physicians have the authority to admit patients to the hospital. The House
Staff physicianʼs participation in the admission of patients is conducted under the auspices of the Medical Staff members with admitting privileges. It must be remembered that this is a privilege and not
a right, and implicit in this privilege is a degree of responsibility. The
following general policies of the Hospital are delineated to guide the
physician in this area.
1. In order to improve patient care, to maintain a more accurate census, and to eliminate confusion regarding bed assignments, the
Admitting Department (Room GA007; Ext. 5-4058) is responsible
for the release of beds at the Grady Health System. All beds are
assigned on the basis of patientsʼ needs. Beds cannot be released
without prior approval of the Admitting Office. The ultimate authority for the assignment of beds rests with the Admitting Department.
2. Beds are allotted to each team and service based on the patient
volume, and the allotment is reviewed periodically and modified
based on usage. Beds are assigned based on the request of the
physician as noted on the Bed Assignment Form. When a team or
service has filled all of its available beds, the patient will be assigned a bed on another area. Every attempt will be made to place
medicine patients on medicine floors and to place surgical patients
on surgical floors.
3. Determination of whether a patient should be admitted or provided
treatment on an outpatient basis is left to the discretion of the examining physician with consultation as required.
4. Discovery of or suspicion of communicable disease in a patient
must be reported immediately to the resident in charge. When the
admission of such a patient is necessary, isolation must be effected
at once, and the bed assignment form should be revised and resubmitted with notation of the type of isolation needed. Guidelines
for diseases requiring isolation precautions and techniques for carrying out isolation precautions can be found in the separate booklet
with red and yellow cover entitled “Isolation Techniques for Use
in Hospitals,” that is available at the nursesʼ station on each patient
care area. Members of the Epidemiology Unit (PIC #15029) and
the Infectious Diseases Service (ext. 5-3598) are available at all
times for consultation and/or assistance with isolation problems.
5. Policy and Procedures manuals relating to specific patient care
techniques are available in all patient care areas.
6. All scheduled patient admissions must be coordinated with the Admitting Office.
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Admission Procedures
Scheduled/Elective Admissions: A scheduled or elective admission
is a non-emergent admission to the hospital. Medicare, Medicaid and
some commercial insurance companies require preadmission certification for certain elective admissions and outpatient procedures.
The Admitting Department is responsible for obtaining the approval
based on information provided by the physician. Questions concerning preadmission certification should be addressed to the Admitting
Manager at 5-6979. These admissions should be scheduled for a future date that allows seven (7) business days to obtain precertification or authorization from third party payers. This time period will
also allow the patient an opportunity to pay a required deposit prior
to his scheduled date if one is required. When the physician decides
that a patient needs to be scheduled for a future date, he must:
1. establish the admission date
2. coordinate time with the Operating Room or other special treatment areas
3. complete the green Elective Admission Form or Perioperative
Data Form along with the Physicianʼs Admitting Orders and
4. instruct the patient to go directly to the Admitting Office or Preadmission Clinic on 6J with these forms for financial clearance
for the scheduled admission or outpatient procedure.
Clearance: If a patient is being admitted for a scheduled/elective
procedure and has not been financially cleared, the Admitting Physician will be notified.
Emergency Admissions: At the time of the decision to admit, the
physician will complete the Emergency Provider Sheet and a Bed
Assignment Form. These will be forwarded to the Admission Nurse
Case Manager to review for appropriateness. The admitting physician or team may be called by the Admission Nurse Case Manager
to request additional information to justify the admitting setting as
observation or inpatient.
Direct Admissions from Outpatient Clinics: All unscheduled, emergent admissions from the outpatient clinics are called stat admissions. A Bed Request Assignment Form along with a Stat Admission
Form needs to be completed and should contain clinical information
supporting the emergency status of the admission. This information
is forwarded to the Admission Coordinator to review for appropriateness. The admitting physician may be called to request additional
information to justify the appropriate admitting setting as observation or inpatient.
Transfer Patients: All transfers should be coordinated by the Admission Nurse Case Managers in the Central Admissions/Transfer
Center. The transfers must be medically necessary. This means that
Grady must be able to offer a service or level of care needed by the
patient that the transferring facility cannot provide. In addition, a
bed must be available to accommodate the transfer. A member of the
21
House Staff may be contacted by a private physician or institution
regarding the transfer of a patient to Grady. The House Staff physician should refer all inquires to the Central Admissions/Transfer
Center at ext. 5-4061 or 1-866-GradyTx. The Admission Nurse Case
Manager will coordinate a physician to physician conference call..
Upon determination that a patient is eligible for transfer to Grady and
bed availability, the Admitting Department will notify the appropriate
parties. The Admitting Nurse Case Manager will preadmit all accepted transfers. If a patient does not meet the transfer criteria of the
hospital, both the Grady physician and the requesting institution physician will be notifi ed by the Admitting Department. All questions or
problems concerning transfers or admissions should be referred to the
Admitting Manager, who may be reached at extension 5-6979 or by
digital pager at (404) 650-4267.
OBSERVATION STATUS
Observation is a form of outpatient treatment for a patient with
an emergent/urgent condition. Physicians are encouraged to write
orders for observation on patients which they believe will only require some short-term monitoring or treatment. This observation
period will allow the physician to determine whether the patientʼs
condition will respond to short-term treatment or whether the patient
needs to be upgraded to inpatient status for more intensive therapy.
These patients are treated on the regular patient care areas, but they
are technically in an outpatient setting. Many third party payers will
deny an entire claim if there is not documentation of an attempt to
manage the patient in an outpatient setting in observation.
Orders must say “Admit to Observation Status”. Most observation
services should not exceed 23 hours. Some patients may require additional monitoring or treatment beyond 23 hours. The limits on the
observation time period are set by the individual third party payer
sources. Observation services should not exceed 48 hours. If services
exceed 48 hours, billing claims will be denied and suspended for
medical review. As part of the claim appeal, the admitting physician
will then be required to submit an explanation of why the patient
remained in observation greater than 48 hours.
OBSERVATION RECORD DOCUMENTATION
A. History and Physical
HCFA quality screen calls this an intake assessment. It should offer clear information as to the patientʼs course prior to treatment
that supports the medical decision for admitting patient as observation.
B. Rationale for Care
Reasons for care and the expectations of the physician must be
clear.
C. Supportive progress notes
Progress notes to support continued care.
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D. Conversion from Observation to Inpatient Status
If a physician determines that conversion to inpatient is appropriate, an order must be written to convert from observation to inpatient status. ORDERS MUST SAY: “ADMIT TO INPATIENT.”
ADMIT DATE AND TIME MUST BE SPECIFIED. This date
and time should reflect the time when it was determined that the
patientʼs condition would require a more intensive level of care.
E. Discharge Status
Condition of the patient on discharge and their response to care.
F. Discharge Instructions
Documentation of medication instructions, dietary advisement,
home care, and necessary follow-up.
OBSERVATION GUIDELINES/REQUIREMENTS
1. Physicianʼs order to admit patient to observation status documented in the medical record.
2. Patientʼs condition meets observation criteria.
3. Prior to expiration of 24- hour time frame, physician documentation in the record to support admission to hospital, discharge home
from observation status, or to extend the patientʼs stay in observation
for an additional 24 hours.
4. If stay in observation is extended, there is sufficient information
documented in the record by the physician to justify extended stay.
5. If patient is admitted to the hospital from observation status, the
case must meet admission criteria for acute care setting.
6. There is an order documented by the physician to admit the patient from observation status to inpatient status.
HCFA RULE: When a hospital places a patient under observation,
but has not formally admitted him as an inpatient, the patient initially
is treated as an outpatient.
SERVICES NOT COVERED AS
OUTPATIENT OBSERVATION
Medicare claims for the following services will be denied as not
reasonable and necessary under section 1862(a)(1)(A) of the Social
Security Act. This will include denying claims for services which are
not medically necessary, which duplicate other services, or which are
provided in inappropriate settings.
• Observation services which exceed 48 hours, unless the fiscal
intermediary grants an exception based on the particular facts of the
case.
• Services which are not reasonable or necessary for the diagnosis
or treatment of the patient but are provided for the convenience of the
patient, his or her family, or a physician.
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• Services which are covered under Part A, such as a medicallyappropriate inpatient admission, or as part of another Part B service,
such as postoperative monitoring during a standard recovery period,
which should be billed as recovery room services.
• Similarly, in the case of patients who undergo diagnostic testing
in a hospital outpatient department, routine preparation services furnished prior to the testing and recovery afterwards are included in the
payment for those diagnostics services. Observation should not be
billed concurrently with therapeutic services such as chemotherapy.
• Standing orders for observation following outpatient surgery.
• Services which were ordered as inpatient services by the admitting physician, but billed as outpatient by the billing office.
• Claims for inpatient care, such as complex surgery clearly requiring an overnight stay, billed as outpatient.
Although the guidelines above are specific for Medicare claims,
these are basic truths for most other third party payers. Consequently,
these guidelines are used as a rule when dealing with patients who
have other types of coverage.
BUSINESS OFFICE
The Business Office is located in Room 1B024, and the phone extension is 5-4231. The hours of operation are as follows: Monday
through Friday, 0800 - 1700. The office is closed on the hospitalʼs
observed holidays. The following services are provided during its
hours of operation:
• Free notary service
• Payment collection on patient accounts
• Deposit collection for scheduled patients
• Deposit collection from medical staff for scrubs, lab jackets,
and other apparel.
• Payments are accepted in the following forms: cash, check,
money order, VISA, Mastercard, American Express, and
Discover.
FISCAL RESPONSIBILITIES
The Health Care Industry is rapidly changing, and it is becoming
an increasingly strictly regulated business. Compliance with current
regulations is a responsibility that the medical staff share with the
entire Grady community.
As a part of your complete medical education it is essential that
you understand the regulatory environment as well as the medical
and technological environment of the field you are about to enter.
The immediate benefactors of your cooperation with the outlined
rules and regulations include the Hospital, the Medical School and
the patient. The ultimate benefactors, however, may indeed be you,
24
the physician, and the health care industry as a whole.
APPEALS REVIEW DEPARTMENT
Location:
Days/Hours Held:
100 Edgewood Boulevard (United Way Building 14th Floor)
0800-4:30 p.m. Monday through Friday
Phone:
(404) 616-7163
The Appeals Review Department is under the supervision of the
Chief of Staff/Medical Affairs. In an effort to ensure that Grady
Health System is reimbursed for services according to guidelines
set forth by regulatory agencies of both state, federal and NCQA,
the Appeals Review department appeals all claims that are denied
for lack of medical necessity, insufficient clinical information or
failure to obtain precertification.
Goal:
To ensure Grady Health System remains financially solvent during
continuous payment reductions from state, federal, and third
party payers.
This is accomplished by ensuring all services provided are aligned
with the Health Systemʼs mission, vision, and strategic plans.
Each case denied will be reviewed for medical necessity to determine whether or not all aspects of a patientʼs care at every level
were medically necessary and appropriately delivered. Also, the
departmentʼs ensures all denials are appealed within the time
frame required by third party payers.
Objective:
To enhance revenue collection for the Grady Health System by composing letters or by providing additional information to insurance
companies/managed care organizations when authorization for
payment cannot be obtained.
Process:
All claims that are denied for lack of clinical information, lack of
medical necessity or failure to precertify, will be forwarded to the
Appeals Review department.
A. Upon receipt of the denials, using the above parameters, the Appeals Review department will review the medical records to substantiate the medical necessity, level of care appropriateness, and
for extenuating circumstances.
B. The department will coordinate all of the departmentʼs activities
by sharing with the various departmentʼs leaders, administration,
medical staff, and hospital authority by reporting quarterly to the
Utilization Review Committee of all activities including reversal
of denials, final denials, the reason (s) for the denials, and financial impact to the Health System.
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DISCHARGES
Complete familiarization by House Staff with the general discharge
policies and procedures outlined below will keep discharge problems
at a minimum.
1. Except under unusual circumstances, discharge orders should be
completed no later than 1900 on the day before a patient is to be
discharged. The case summary sheet must be completed at the
time the discharge order is written.
2. To be considered valid, each discharge order must include a discharge diagnosis; a discharge summary must also be prepared
prior to the discharge. (For details, refer to the “Medical Records” section of this manual.) All patients are required to have
Business Office clearance before the service area may discharge
the patient. All patients will be discharged by 1100 Patients discharged after 1100 will be charged for an extra day.
3. The Hospital will assist the patient with problems associated with
discharge in terms of transportation, post-hospital care, admission
to other institutions, and so forth. Toward this end, the appropriate
department or agency, such as Case Management should be contacted for assistance. (Refer to appropriate sections of this manual
for details.)
4. Instructions which patients are to follow after discharge must be
written and the physician should assure himself that they are fully
understood by the patient. If the patient is Limited English Proficient contact Language Interpreter Services at 5-9626.
5. The proper procedure for referring discharged patients to Outpatient Clinics is contained in the Interim Ambulatory Care Services/Maternal Child Health Referral Policy (4/20/96). Followup is not to be done in inpatient areas, but referred to the proper
clinic.
6. Floor stock drugs and dressings are not to be given to patients
upon discharge; however, patients being discharged may have
their drugs charged on their account if the physician orders such
drugs on duplicate prescription blanks.
7. If the physician desires for the patient to take home any medications used during the inpatient visit, then the medication and a
prescription must be forwarded to pharmacy for proper labeling.
No medication intended for ambulatory use will be given to a
patient without being labeled according to state regulations.
Discharge Contrary to Medical Advice: Cases occasionally arise
wherein the patient or his family insist upon the patient being discharged, contrary to the advice of the Medical Staff. If the patient is
Limited English Proficient contact Language Interpreter Services at
5-9626. In such instances, the House Staff physician in charge of the
patient will observe the following procedure:
1. Attempt to dissuade the patient, making clear the danger inherent
in such action.
2. When the patient cannot be dissuaded, have him sign Grady form
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30210074, “Authorization of Release,” copies of which are available at all nursing stations and clinic areas.
3. Fully note the circumstances of the incident in the patientʼs medical record.
Note: The same “Authorization of Release” form is to be used for
emergency patients who are presented at the Hospital, but who
refuse treatment or who accept treatment on an outpatient basis
but refuse to be admitted.
PATIENTʼS LEAVE OF ABSENCE
On special occasions it is felt that we are justified in granting certain patients a temporary leave of absence of a few hours in order that
they may attend to essential personal business. To grant this leave
without discharging the patient and requiring a readmission, the
nurse follows an established procedure, and the physician in charge
of the patient writes a statement on the chart as to the patientʼs condition and the safety of the public from the patientʼs contact. Any
medications to be given to the patient while on leave must be labeled
according to state regulations; forward to pharmacy for labeling.
When it is necessary for a patient to remain away from the Hospital
overnight, the patient is to be discharged. Should a patient not return
within three (3) hours of the time designated on the pass, unless the
patient contacts the physician to extend the time, the patient shall be
deemed discharged AMA from the Hospital.
PATIENT TRANSFERS TO OTHER FACILITIES
Patient transfers and discharges are subject to federal laws called
“anti-dumping” laws. Under these laws, patients may not be transferred or discharged from a hospital when they are in an unstable condition except in very limited circumstances. Furthermore, medical
care may not be delayed due to financial or insurance reasons when
the patient is in an emergency condition. Transfers of a patient in
an unstable emergency condition require a physician to certify such
transfers before the transfer may properly be made. All transfers of
patients in an unstable condition must be made pursuant to EMTALA
provisions; therefore, you should contact the Office of Legal Affairs.
Questions about such discharges or transfers must be referred to the
Medical Directorʼs office.
DOCTORSʼ ORDERS
Except under emergency conditions, all orders for medication, XRayʼs, respiratory therapy and laboratory work and/or treatment must
be in writing; further, no order may be written more than twenty-four
hours prior to the time it is to be initiated.
When circumstances warrant the necessity for transmitting orders
via telephone, such dictation must be made to a licensed nurse (RN
or LPN) or other authorized person, and signed by him/her with the
name of the physician per his or her name. The physician dictating
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such orders will, upon his appearance, personally sign the order. For
details on “Stop Orders on Dangerous Drugs,” refer to Formulary
Section of this manual. Orders written by a medical student are not to
be carried out until signed by a House Officer.
MEDICATION CLARIFICATION ORDERS
A medication shall not be dispensed from the pharmacy if the potential exists for patient harm, unintended therapy, or lack of therapeutic effect due to a questionable medication order. A medication
clarification order is defined as an order that modifies or changes an
order previously written by a physician, where the previously written order is unclear, outside normal recommended doses, incorrect,
or otherwise not in the patientʼs best interest as written, or where
the patient is receiving therapy which requires specific monitoring
with a lab or serum drug concentration. The pharmacist must discuss
the previously written order with the responsible physician who must
agree to the suggested modification or change of the order before
a clarification order is initiated. The medication clarification order
must be written in the medical record by the pharmacist. Such order
will not require the co-signature of that physician, and will not be
considered a “verbal order”.
PRESCRIPTIONS
Grady health System prescription blanks may not be removed from
a GHS facility. Grady pharmacies are prohibited by federal regulations from filling prescriptions for patients not properly registered
and seen in a GHS clinic.
It is the policy of the medical staff of the Grady Health System not
to “rewrite” outside prescriptions without a thorough evaluation of
the patient. This policy stems from the following:
1). It is not permitted, as per Federal Regulations that govern pharmacies which receive federal support for purchase of pharmaceuticals.
2). It exposes the physician and the health system to unnecessary
risk and liability.
3). It is bad medical practice which does not lead to quality of
care.
See “Prescriptions: Requirements of” in the Pharmacy and Clinical Laboratory manual for more information regarding writing of
prescriptions.
RESTRAINT AND SECLUSION POLICY
Use of Restraints
It is the policy of Grady Health System to use the least restrictive
method of restraint that meets the patientʼs assessed need in response
to:
• Emergent and dangerous behavior
• As an adjunctive to planned care based on standard practices
• As a component to an approved protocol
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Use of Clinical Protocols
Restraint use for the prevention of falls and interruption of therapy
may be guided by clinical protocols. Ten clinical protocols with restraint use criteria have been approved for this purpose.
The approved protocols with restraint use criteria contained in them
are adult GI intubation, adult oxygen therapy management, artificial
airway management, central line management, complicated wound
management, fall/injury prevention, GU intubation, new ostomy
management, peripheral IV therapy, and chest tube management.
Criteria for initiation, discontinuation and reapplication of restraints
are outlined only in these protocols. If restraint use becomes clinically justified to prevent falls/injury and/or interruption of therapy as
identified in the ten approved protocols, the register nurse may apply restraints and notify the physician that the patient meets criteria
approved in one of the above listed clinical protocols. However, the
use of clinical protocols does not berate the physicianʼs responsibility for the assessment and re-assessment of the patient as it relates to
the use of physical restraints. Additionally, clinical protocols may not
be used to apply restraints under any circumstances for patients who
meets the definition of primary behavior health needs (psychiatric
disorders) or with patients who are mentally retarded.
Guidelines for Instituting Restraint or Seclusion
Only independent licensed practitioners are permitted to write restraint orders; application of leather or 4 point or higher restraints
requires an attending physicianʼs order.
1. Exhaust all alternatives prior to restraint use
2. Assess the individual patientsʼ need for restraints
3. Use the least restrictive and most effective type of restraint
4. Provide verbal or written individual orders for initial use or reauthorization of continuing emergency use of restraints and seclusion
5. Sign all verbal orders for restraints or seclusion within 24 hours
6. Write time limited orders for all individual restraint use every 24
hours. Time limited orders are not to exceed: a) 24 hours for restraint use in justified situations except for patients with primary
behavioral health needs; Patients with primary behavioral health
needs are patients receiving care and service in the psychiatric
unit of the hospital and/or patients hospitalized on the medicalsurgical unit for the primary purpose of treating a psychiatric
disorder; b) 4 hours for adults with primary behavioral health
needs; c) 2 hours for children and adolescents ages 9 to 17 with
primary behavioral health needs; and d) 1 hour for patients under
9 with primary behavioral health needs
7. Document the use of restraint in the medical record, including
assessment and clinical justification
8. After the original order expires the patient receives a face-to-face
reassessment by an independent licensed practitioner who then
writes a new time-limited order if restraint or seclusion is to be
continued
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Restraints Excluded from Documentation Requirements
• Temporary application of IV arm boards and medical immobilization devices for radiation therapy based on standards of practice
for the procedure
• Application of orthopedic appliances and adaptive support devices for postural support
• Application of helmets, table top chairs and bed rails based on the
assessed needs of the patient as a standard of practice for protection
• Therapeutic holding or comforting of children or to a timeout
when the person to whom it is applied is physically prevented
from leaving a room for 15 minutes or less and when it is consistent with the behavior management standards; and
• Forensic and corrective restriction used for security purposes
CLASSIFICATION OF URGENCY
The purpose of this policy is to standardize the nomenclature used
to communicate the level of urgency required to ensure quality of
care. Medical situations frequently require different levels of response depending on the urgency of the patients condition. Classification of urgency using standard terminology communicates orders
in a consistent manner and allows consistent prioritization and response throughout the health system. The following terms are to be
used throughout the health system to prioritize the level of urgency
associated with physician orders:
•
The term EMERGENCY or CODE is the highest level of urgency.
The patient is in an immediate life threatening situation. Orders
are to be carried out immediately. Failure to respond immediately
is likely to result in death and/or serious harm.
• The term STAT is used to assign a level of priority for situations
which are less urgent than EMERGENCY but orders should be
processed with top priority. The term STAT is reserved only for
situations which meet this description. STAT orders require providers to give such orders top priority, with suspension of all
other work (except EMERGENCY or CODE issues) until the
STAT situation is resolved.
• The terms AS SOON AS POSSIBLE (ASAP) or NOW are used
to identify orders that are not STAT but are very important to patient care. ASAP and NOW orders require providers to prioritize
such orders ahead of all other routine orders.
• All other orders will be considered NORMAL or ROUTINE.
ROUTINE orders are those that are processed according to standard scheduled times.
Please refer to Pharmacy Department Policy and Procedure
Manual Policy #2.12 for additional information.
30
CONSENTS
CONSENT FOR ADMINISTRATION OF BLOOD
OR BLOOD COMPONENTS
* The blood transfusion consent form must be signed prior to infusion of blood or blood components including the following:
Whole Blood
Red Blood Cells
White Blood Cells
Cryoprecipitate
Platelets
Fresh Frozen Plasma and Equivalent Products
* For surgical patients, the blood transfusion consent form is reviewed and signed with the surgical consent form. For all other patients, the patientʼs physician or knowledgeable designee is responsible for obtaining informed consent prior to transfusion. Associated
risks, benefits and alternative methods of therapy (autologous, designated or homologous blood transfusion or infusion of fluids not derived from blood) must be explained with opportunity for questions
and discussion prior to consent or refusal.
* Consent must be obtained whenever there is reasonable possibility that a blood or blood component transfusion may be necessary as
a result of a medical or surgical procedure. When non-emergent and
there are no medical contraindications, informed consent should allow adequate time prior to scheduled procedure for pre-donation or
directed donation to occur (3 or more days).
* When the patient is unable to provide informed consent, consent
must be obtained from the authorized individual as defined in the
GHS policy and procedure manual. Verbal consent should be witnessed and signed by two individuals (MD or RN).
* In an emergency situation, when 1) the patient is unable to consent and no proxy decision maker is available and 2) a delay in transfusion could reasonably be expected to jeopardize the life or health
of the person affected, two (2) physicians, an Attending and another
licensed physician, must document the emergency situation in the
medical record. The patientʼs record should document his/her inability to consent, and absence of proxy decision maker. Both physicians must sign the Progress Note. Physicians should NOT sign the
Consent form. Transfusion in an emergency situation should not be
delayed.
* For patients admitted to the hospital, the signed transfusion consent form is valid for the duration of the current hospitalization. For
patients needing repetitive transfusions in ambulatory care areas,
consent is valid for the duration of therapy for the specific condition,
subject to review and renewal at least every 12 months.
* If the patient refuses to receive a transfusion after signing the
consent form, the physician should be notified and the transfusion
31
should not be administered.
* In the event of initial or subsequent transfusion refusal, there
should be notation in the patient record regarding reason(s), alternative plans and medical risk. All discussion regarding transfusion
therapy must be documented.
HIV TESTING
In accordance with Georgia law and consistent with the Centers for
Disease Control guidelines, written consent must be obtained prior to
the drawing of body fluids for testing for the presence of HIV, except
as specifically delineated under the section on healthcare provider
exposure. Consent by minors and incompetents should be provided
by their respective parents or guardians. In addition, if the patient is
unconscious, temporarily incompetent, or comatose a next of kin may
consent to testing. Prior to testing, the patient (or the next of kin) must
be provided pre-test counseling by a designated healthcare provider
ordering the test. Counseling should include information medically
appropriate and applicable to the patient including, but not limited
to, the patientʼs rights to confidentiality and the social and medical
implications of the test, both positive and negative. The counseling
requirements can be met if the patient is provided an opportunity to
read the brochures provided by the Department of Human Resources
(DHR) with regard to HIV testing and/or other brochures approved
by DHR and GHS. Subsequent to review of the brochures and/or the
counseling session the patient should be afforded an opportunity to
ask any questions and all questions should be answered satisfactorily. Except as delineated below, subsequent to counseling, the patient
(or the patientʼs next of kin) has a right to refuse to be tested. If the
patient (or the patientʼs next of kin) refuses to be tested, no blood
or body fluids should be drawn for the purpose of HIV testing, nor
should a HIV test be performed.
Georgia law does not provide an implied consent for HIV testing,
therefore, the emergency exception to obtaining consent does NOT
apply. This means that two physicians cannot “consent” to HIV testing. Moreover, obtaining a CD4 count without consent violates the
spirit, if not the letter, of the Georgia HIV consent law and should
NOT be done.
If the patient (or the patientʼs next of kin) consents to testing in
writing, the consent form should be included in the patientʼs chart.
After the last confirmatory test is completed, the healthcare provider
who ordered the HIV test must also counsel the patient with regard
to the test results. Again, all information that is medically appropriate
in light of the condition of the patient including information about
HIV and AIDS, behaviors necessary to reduce any risk of transmitting the disease, and other appropriate medical treatments should be
discussed.
The patientʼs consent, as well as indications that pre and post test
counseling occurred, should be documented appropriately in the patientʼs medical records, including the appropriate consent forms.
In addition, when a healthcare provider has an “exposure” (as de-
32
fined below) to the body fluids of a patient in one of the manners as
delineated below such that the healthcare provider might become
an HIV infected person if the patient was HIV infected a physician
otherwise authorized to order an HIV test may order an HIV test on
the patient and obtain the results if:
(1) The patient (or the patientʼs next of kin if the patient is a minor,
otherwise incompetent or unconscious) consents in writing to
an HIV test after being provided counseling and an opportunity
to refuse the test in accordance with the above; or
(2) If the patient (or his representative) refuses the test and body
fluids have previously been drawn, pursuant to which a HIV test
can be performed, a HIV test may be performed on the patient
if:
(a) The physician ordering the HIV test documents in the patientʼs medical record the circumstances surrounding the
exposure of the healthcare provider in accordance with the
policy outlined below;
(b) In addition, the patientʼs attending physician concurs in
writing that an exposure has occurred that may create a risk
such that healthcare provider may become HIV infected.
(If the patient is an outpatient or if the patientʼs attending
physician is not otherwise available authorization may be
obtained from another member of the medical staff of the
service following the patient.) The attending physicianʼs
concurrence must be documented in the patientʼs medical
record and must specifically delineate the type of exposure
that has occurred such that the physician concurs that a
risk exists such that the healthcare provider may become
HIV infected. (See below.) (Please note the patientʼs record
should not contain the name of the healthcare provider.)
(c) The patientʼs attending physician shall place a verbal order
with the immunology lab for the HIV test.
(d) The patient is counseled by a physician as to the test results; and
(e) The occurrence of the test is not made a part of the patientʼs
medical records if the results are negative, without the
patientʼs written consent.
As indicated above if the patient refuses to consent to testing, and
blood or body fluids necessary to perform the test have not previously been drawn the test may not be performed irrespective of the
attending physicianʼs concurrence. In such cases the Hospital Attorney and Hospital Epidemiologist should be contacted.
An “exposure” which occurs in such a manner as to create any risk
such that an exposed healthcare provider might become infected and
which would authorize a physician to order an HIV test in accordance
with the above shall be limited to:
(1) Massive Exposures – transfusion of blood; large volume injection of blood/body fluid (≥1 ml); or parental exposure to laboratory specimen containing high titer of virus.
(2) Definite Parental Exposures – intramuscular (IM/“deep”) injury
with a blood/body fluid-contaminated needle; non-massive injection of blood/body fluid (≤ 1 ml); laceration or similar wound
33
produced by a visibly blood/body fluid-contaminated instrument
which causes bleeding in the health care worker; laceration or
similar fresh wound inoculated or contaminated with blood/
body fluid; or any parental inoculation with HIV/HBV virus
samples (usually in research setting).
(3) Possible Parental Exposures – subcutaneous (SQ/“superficial”)
injury with a blood/body fluid-contaminated needle; wound
produced by a blood/body fluid-contaminated instrument which
does not cause visible bleeding; prior wound or skin lesion contaminated with a blood/body fluid; or mucous membrane (eyes,
mouth, nose, etc.) inoculation with blood/body fluid.
(4) Doubtful Parental Exposures – subcutaneous (SQ/“superficial”)
injury with a non-blood/body fluid-contaminated needle or instrument; superficial wound produced by a non-blood/ body fluid-contaminated instrument which does not cause visible bleeding; prior wound or skin lesion contaminated with non-bloody
body fluid; or mucous membrane inoculation with non-bloody
body fluid.
(5) Other Exposures – as specifically delineated in writing by the
hospitals Epidemiologist.
“Body fluids” as used in this section is limited to body fluids containing visible blood; semen; vaginal secretions; cerebrospinal fluid;
synovial fluid; pleural fluid; peritoneal fluid; and amniotic fluid.
“Body fluids” does not include feces, nasal secretions, sputum, sweat,
tears, urine, vomitus, or other body fluids unless they contain visible
blood, or unless otherwise designated by the Hospital Epidemiologist in accordance with the Center for Disease Control guidelines.
CONSENT FOR TREATMENT
Grady Memorial Hospital requires a signed authorization of treatment for all in-patients, and all patients treated in the Birthing Center, Obstetrical Service. All such consents are obtained routinely by
the Admitting Department on the “Authorization of Treatment” form
(30368708). When the patient is legally unable to consent for himself, the required Authorization of Treatment should be signed by one
of the persons authorized by law (see below).
In addition to the “Authorization of Treatment” which must be
signed by the patient, or other authorized person upon admission to
the Hospital, there is an “informed consent” form to be filled out. (For
abortions or sterilization procedures, please also see sections on Consent for Abortion and Consent for Sterilization.) This form should be
used for all non-routine invasive procedures or operations and must
be completed for: (1) any surgical procedure under (a) general anesthesia, (b) spinal anesthesia, or (c) major regional anesthesia; (2)
when a person undergoes an amniocentesis diagnosis procedure; or
(3) a diagnostic procedure which involves the intravenous or intraductal injection of a contrast material. Prior to any such procedure,
the patient must be informed in general terms of: (1) his or her diagnosis requiring the proposed procedure; (2) the nature and purpose of
the proposed procedure; (3) the material risks generally recognized
and accepted by reasonably prudent physicians of infection, allergic
reaction, severe loss of blood, or loss of function of any limb or organ,
34
paralysis or partial paralysis, paraplegia or quadriplegia, disfiguring
scar, brain damage, cardiac arrest, or death involved in the proposed
surgical or diagnostic procedure which, if disclosed to a reasonably
prudent person in the patientʼs position could reasonably be expected
to cause such prudent person to decline such proposed surgical or
diagnostic procedure on the basis of the material risk of injury that
could result from such proposed surgical or diagnostic procedure.;
(4) the likelihood of success of the proposed surgical or diagnostic
procedure; (5) the practical alternatives to the proposed surgical or
diagnostic procedure which is generally recognized and accepted by
reasonably prudent physicians; and (6) the patientʼs prognosis if he
does not agree to the procedure. It is essential that this information
be explained in understandable terms, by the physician who does the
surgery or carries out the procedure. If the patient is Limited English
Proficient use a Language Interpreter. (7) Any surgical procedure
requiring the attendance of a sales representative in the surgical suite must have the patientʼs authorization on the operative
consent prior to the procedure. The name of the sales representative that will be in the suite must be included in the Operative
Consent.
We recommend that you adhere to the following procedure in order to facilitate this process without delay to your patient of your
service.
a). A written request including the patientʼs name, date of surgery,
attending physician, instrumentation and the name of the sales
representative must be received in the Perioperative Department Office no later than 24 hours prior to procedure. Please
address all requests to Gloria B. Miller, RN, Director and send
a carbon copy to Mark Tarver, Materials Manager. Please remember that ample time must be allowed for acquisition and
sterilization of instrumentation.
b). The sales representative must sign in at the Perioperative
Department Office and receive a pass into the OR.
The quality of care a patient receives is a multifaceted endeavor
and we must work together to ensure that patients receive the highest quality care. Such explanation is an important part of securing
consent. Where persons who are legally unable to consent for themselves are involved, the required explanation should be made to the
person who is authorized by law to sign the consent. If the patient is
Limited English Proficient use a Language Interpreter. The form must
be signed by the patient (or authorized person), a physician and a
witness prior to the performance of the procedure and write the name
of the interpreter used if the patient is Limited English Proficient.
Except in emergencies, the patient must have a signed “informed consent” form on the medical chart before a patient can be anesthetized
or operated upon. A prior written informed consent received preceding the surgical or diagnostic procedure and which complies with
the above requirements remains valid for 30 days, unless there is a
material change in the patientʼs condition which would cause a material change in any of the above requirements, in which case, another
informed consent form must be completed.
In an emergency situation, Georgia law presumes that the patient
35
would want to be treated. This is the principle of “implied consent.”
The term “emergency” means a situation wherein: (1) in accordance
with competent medical judgement the proposed surgical or medical
treatment or procedures are reasonable necessary and; (2) a person
authorized to consent is not readily available and any delay of treatment could reasonably be expected to jeopardize the life or health
of the person affected or could reasonably be the result in disfigurement or impaired faculties. It does NOT mean “urgent”, “medically
necessary”, “vital” or “convenient”. If an emergency situation exists, two (2) physicians, an attending faculty physician and another
licensed physician, must document and sign in the medical record,
the existence of an emergency, the emergency treatment required and
any alternatives, the inability of the patient to consent and the lack of
a proxy decision maker. This note should be completed prior to the
performance of any emergency operative procedures and should be
placed on the medical chart. Physicians should NOT sign the consent
form.
Policy: The general policy of the Hospital regarding proper authorization for treating patients is as follows:
There should be a written Authorization of Treatment, signed by a
legally responsible person (the patient if he is legally able to consent); however, to preserve life and limbs, treatment should not be
delayed, particularly in emergency situations (as defined above),
due to lack of proper authorization for that treatment.
Proper authorization should be sought while the indicated treatment is in progress.
NOTE: Consent for DO NOT Resuscitate is discussed extensively
in the DNR section of this manual.
Persons who may sign the Authorization of Treatment: (It is always
required that the forms be signed by the patient unless he or she is
legally or medically unable to do so).
1. The following persons may consent to surgical or medical treatment [except abortion or sterilization procedures (see page 49 of
this Manual)]
a. Any adult, for himself, whether by living will or otherwise;
b. Any person authorized to give consent for an adult under a
durable power of attorney for healthcare;
c. In the absence or unavailability of a living spouse, any parent, whether an adult or minor for his minor child;
d. Any married person, whether an adult or a minor for himself
and for his spouse;
e. Any person temporarily standing in loco parentis whether formerly serving or not, for the minor under his care; and any
guardian, as appointed by the courts for his ward;
f. Any female regardless of age or marital status for herself
when given in connection with pregnancy, or the prevention
thereof, or child birth;
g. Upon the inability of any adult to consent for himself in the
absence of any person to consent under paragraphs c-f above
the following persons in the following order of priority:
36
(1) any adult child for his parent(s);
(2) any parent for his adult child;
(3) any adult for his brother or sister;
(4) any grandparent for his grandchild;
2. “Inability of any adult to consent for himself” shall mean a determination by two (2) physicians (an attending faculty physician
and another licensed physician) noted in the medical record by
these licensed physicians, after the physicians have personally
examined the adult that the adult “lacks sufficient understanding
or capacity to make significant responsible decisions” regarding his medical treatment or the ability to communicate by any
means such decisions.
a. If a patient has been declared mentally incompetent by the
courts, consent of the legal guardian is required.
b. If a patient is not adjudicated incompetent and having no
guardian is unable to consent or is unable to understand to
what he or she is consenting by reason of mental incapacity
or illness, consent should be obtained (after explanation by
the physician of the treatment to be rendered) from the “nearest living relative” which can embrace the spouse if living
and reasonably available. Consent is implied as to emergency
treatment.
CONSENT FOR ABORTION
The OB/GYN Ambulatory Surgery Service will perform abortions
on Grady eligible patients who request abortion within safe limits
of gestation as established by the Department of Gynecology and
Obstetrics.
Patients desiring or considering abortion should be referred as early as possible after conception to the OB/GYN Ambulatory Surgery
Office, telephone extension 5-3866. OBGAS personnel will coordinate the necessary investigation, evaluation and certification. The
physiciansʼ cooperation with regulations will reduce the incidence of
litigation and facilitate third-party reimbursement.
The Parental Notification Act of 1991 prohibits the performance of
an abortion upon an unemancipated minor unless the parent or legal
guardian has been notified personally, by phone or by mail or the
juvenile court has waived the requirement of parental notification.
Procedures for meeting these requirements are also carried out in the
OB/GYN Ambulatory Surgery Office.
For purposes of this section, only “unemancipated minor” means
any person under the age of 18 who is not or has not been married or
who is under the care, custody, and control of such personʼs parent
or parents, guardian, person standing in loco parentis, or the juvenile
court of competent jurisdiction.
CONSENT FOR STERILIZATION
Elective female sterilization procedures are functions of the OB/
GYN Ambulatory Surgery Service.
Prior to the performance of any sterilization procedure, a written
37
request must be received from the patient. In addition, the request and
consent for sterilization must be signed at least 30 days prior to the
procedure; any exception such as abdominal surgery and premature
delivery must be approved by an attending physician. These forms
are available in the OB/GYN Ambulatory Surgery Office and the OB/
GYN Clinic. It is the responsibility of the physician who is to perform
the sterilization procedure to insure that all statements on these forms
are understood and signed by the patient. The reverse side of each
form must also be completed by the physician performing the operation or sterilization.
The sterilization of a person judged mentally incompetent is rigidly
controlled by current Georgia law. These requests should be referred
to the Office of Legal Affairs and/or the Medical Director. It is also
recommended that each house staff physician become familiar with
this law when first beginning the obstetric rotation. Copies of the law
are available in the Office of Legal Affairs.
Requests for male sterilization procedures should be directed to the
Urology Service.
In doubtful or unusual cases, clarification may be sought from the
Office of Legal Affairs and/or Medical Director.
REFUSAL OF TREATMENT
In Georgia, any patient, eighteen (18) years of age or older, who
has decision making capacity, has the RIGHT to REFUSE medical
treatment. In the situation where an adult patient is refusing treatment which is medically advised, the house staff and attending physician should explain the procedure to the patient, including risks, benefits, alternative treatments and the likely outcome or consequences
of refusing the treatment. Family members may be helpful in persuading the patient; however, medical information and treatment recommendations cannot be discussed with family members without the
patientʼs consent. If the patient continues to refuse, assistance may
be sought from the Medical Ethics Committee, pager 404-2784753 or
the Office of General Counsel (Ext. 5-6162-weekdays or the Grady
Operator).
The attending physician should assess the decision making capacity
of the patient to ensure that the patient understands the nature of the
treatment and the potential consequence of the refusal for treatment.
The attending physician may request assistance from the Psychiatric
Consultation Service (Ext.5-4762) to assure that the patient has the
decision making capacity to consent to or to refuse the treatment. If
there is substantial doubt about the patientʼs ability to understand the
risks and consequences of the refusal, the surrogate decision maker
(next of kin or durable power of attorney for health care) should be
consulted for consent. If, after a diligent search for family member,
it is determined that the patient does not have an appropriate decision maker, the Office of General Counsel should be contacted to
petition the court for a guardian or court order for the recommended
treatment.
If the patient is a minor (under the age of 18), the parents have
the right to consent or refuse on behalf of the patient. If no accept-
38
able alternative treatment exists and the life or health of the patient
is jeopardized, the Office of General Counsel should be contacted to
discuss the possibility of obtaining a court order for the treatment.
The Medical Ethics Committee should also be contacted.
If the patient has been declared legally incompetent and has had a
guardian appointed and the guardian papers are presented, the guardian has the right to make decisions on behalf of the patient. This
includes the right to refuse treatment. If the attending physician suspects that the guardian is not acting in the patientʼs best interest, the
Medical Ethics Committee and the Office of General Counsel should
be contacted to determine the appropriate course of action.
INFORMING PATIENTS AND/OR FAMILIES
OF UNANTICIPATED/UNEXPECTED OUTCOMES
OF CARE AND/OR POSSIBLE MEDICAL ERRORS
DIVISION OF MEDICAL AFFAIRS
POLICY STATEMENT
The Grady Health System supports that patients have the right to
be well informed about their diagnosis, treatment, prognosis, possible
treatments, and likely outcomes. Patients have the right to discuss
this information with their doctor in understandable terms and have
the right to know the names and roles of people who are treating
them.
The Grady Health System requires that patient(s), and when appropriate, their families are informed about the outcomes of care, including unanticipated outcomes and/or possible medical errors. It is the
responsibility of the Attending Physician, and/or his or her designees
to clearly explain the outcome(s) of any treatment(s) or procedure(s)
to the patient and, when appropriate, to the family whenever those
outcomes differ significantly from the anticipated outcomes.
This policy will also be adhered to for occurrences that meet the
definition of a Sentinel Event (Ref: Sentinel Event Policy)
GUIDELINES
1) Actions to be Taken Immediately Following the Recognition of
the Adverse Event
a) It is the responsibility of the patientʼs Attending Physician to
ensure that this policy is followed when an unanticipated/unexpected outcome and/or possible medical error has occurred.
A patient(s) and when appropriate, their families are to be informed about the outcome(s) of care, including unanticipated
outcomes in a timely fashion. They should be notified by the
Attending Physician and/or his/her designee as well as the
primary resident assigned to the patient, as soon as reasonably possible (generally within two (2) or three (3) hours of
the adverse occurrence. All pertinent information should be
discussed at that time. In many cases, the information about
39
the etiology/cause of the event or the planned interventions
may not be known. An investigation should be immediately
initiated in order to determine the root cause/etiology of the
event.
b) Immediately following the event/occurrence or recognition of
the occurrence, the Department of Risk Management should
be notified about the event at 5-7701 (24 hours a day 7 days a
week).
c) The Attending Physician and/or his/her designee should arrange a follow-up person-to-person communication meeting with the patient and when appropriate, the family, within 24 hours of the occurrence of the event. No telephone
conference(s) should be held except under unusual and exceptional circumstances.
2) The Attending Physician and/or his/ her designee should take the
following steps as soon as reasonably possible, and prior to the
24-hour post-event communi-cation meeting:
a) Discuss the nature and cause of the unanticipated outcome
with key members of the healthcare team, other key health
care providers and the Department of Risk Management. The
purpose of these discussions is to clarify the course of events
and outcomes prior to discussing this information with the
patient and/or family.
b) Contact Chaplaincy and/or Social Services for assistance in
informing families and providing emotional, spiritual and
psychological support.
c) Accurately document only the factual/clinical information regarding the occurrence in the patientʼs medical record. Speculation regarding blame and unsubstantiated theories of cause
are not appropriate for the medical record.
3) The following communication guidelines are strongly recommended during the communication meeting:
a) People to involve in the communication meeting:
i) A primary individual for the institution (most commonly
the Attending Physician) should be identified as the singular individual for providing com-munication to the patient
and when appropriate to a family member;
ii) If possible, a single family member should be identified
as the primary contact for the patient and family. When
possible, this should be the legally identified surrogate
decision maker and/or guardian.
iii) Other family members can be present at the communication meeting, at the discretion of the patient or other
guardian/legal decision maker.
b) Frequency of communication:
i) Generally, there should be at minimum, one daily communication. If necessary, more frequent meetings with
the attending physician, patient, guardian or legally designated decision maker may occur as needed.
ii) Hospital personnel, physicians and nursing staff should
generally defer their comments about the adverse event/
error to the principle meeting between the attending phy-
40
sician and patient/family.
iii) This meeting should take place in a location that is appropriate and assures patient privacy and confidentiality.
c) Information to be provided by the Attending Physician and/or
his/her designee at the communications meeting. The information should be provided in clear and understandable terms,
including:
i) The course of events that lead to the unanticipated outcome;
ii) The patientʼs current clinical state;
iii) Acknowledgement of error, if the presence of error is evident;
iv) Statement of continued support for the patient and family;
v) Statement of apology or regret, if appropriate;
vi) Plans to mitigate the consequences of the unanticipated
outcome for the patient;
vii) Any plans for further diagnosis or therapeutic interventions;
viii)Plans for systemic changes to prevent future similar
events, if appropriate;
ix) The Departments of Social Services and Chaplaincy are
available to facili-tate family meetings and will provide
counseling and support to families as needed.
d) No participant in the discussion should state or acknowledge
legal liability for the unanticipated outcome nor broach any
offer of settlement. Issues regarding legal liability will be
addressed by the Department of Risk Management/Legal Affairs.
ONGOING EDUCATION
The Grady Health System through the Division of Medical Affairs,
and/or Emory and Morehouse Schools of Medicine, should provide
training for nurses and physicians on how to appropriately communicate adverse events with these patients and families.
Mar 10 2005
LIST OF ITEMS THAT ARE EXEMPTED FROM SURGICAL
PATHOLOGY EXAMINATION
All tissues and specimens removed in operations, except as specifically noted herein, shall be sent to the hospital pathologist, who shall
make such examination as he or she may consider necessary to arrive
at a pathological diagnosis.
The following specimens will be exempt from the requirement to
be examined by a pathologist, unless specifically requested otherwise
by the physician:
A. Cataracts
B. All orthopedic implants1
41
C. Placentas that are grossly normal from routine, uncomplicated
deliveries that have resulted in a normal infant.
D. Teeth without an associated bony or soft tissue lesion.
E. All non-absorbable sutures.
F. Ureteral stents
G. Myringotomy tubes
H. Foreign objects removed endoscopically, e.g., coins, etc. 1, 2, 3
I. Torn Menisci from joints that are clinically normal.1
J. Pacemakers
K. Normal Ribs removed for the exposure of an operative field.
L. Foreskin, neonatal and pediatric patients.
1
The responsibility for documentation (recording of abnormalities,
e.g. hardware defects) and storage (if appropriate) is the responsibility of the physician who performs the procedure.
2
This automatic exemption does not include stones, or IUDʼs.
Urinary tract stones are examined, documented and forwarded for
stone analysis. Gallstones are examined and classified.
Continued examination of IUDʼs is recommended because of previous litigation involving IUDʼs and the presence of Actinomyces.
3
Although the decision not to submit a foreign body for examination rests with the clinician, each clinician should be aware that if
either the identity of the foreign body is unknown, or the foreign
body is in an unusual site or the foreign body is associated with potential medicolegal action, then this specimen should be submitted
to the pathologist for appropriate action.
SCARS and DEBRIDED TISSUE: Tissue of this type cannot be
exempted from examination. In a minority of cases unexpected pathology may be discovered after histologic examination of this material. These lesions are often not obvious on gross examination.
AUTOPSY/POST-MORTEM EXAMINATIONS
The performance of any and all post-mortem examinations is considered to be an autopsy, regardless of location or proximity to the
time of death, and even limited post-mortem examinations may not
be done without signed approval. Because of the extreme value of
autopsy findings to medical scientific advancement, it is most important, however, that permission for autopsy be obtained whenever possible. The responsibility for this at Grady rests with the physician in
charge of the patient at the time of death, in consultation with the Attending or House Staff physician of record. It follows, therefore, that
all House Staff physicians must familiarize themselves with those approaches most suitable for obtaining autopsy permission from whoever has custody of the body.
Before talking with the family about an autopsy the physician must
determine whether or not a case should be reported to the Medical
Examiner/Coroner (refer to Medical Examiner Cases). To assist the
physician, a check list of questions appears on the Medicolegal Clearance Form (30342646PD).
NOTE: Since the performance of an autopsy without a legal permit
is unlawful and may subject the pathologist and Hospital to suit for
damages by the family of the deceased, the pathologist must refuse to
42
perform such an examination if the permit is not in order (e.g., when
the permit is signed by a daughter when the wife is living).
A provisional anatomical assessment can be expected three days
following the date of autopsy with the final report to follow at a later
date.
The reporting of autopsies will usually be done in a problemoriented fashion providing the patientʼs chart is a problem-oriented
one.
If the answer to any of the questions in the gray box on the Medicolegal Clearance Form is “yes,” then the physician must report the
case to the Medical Examiner/Coronerʼs (ME/C) Office of the county
where the injury leading to death occurred, or if there is no known
injury, in the county where death occurred. The ME/C may either assume jurisdiction of the case or indicate that the death is not a ME/C
case. In the latter event or if the ME/C will not need the body for an
autopsy, the physician may then request consent for autopsy from
the family. When there is a question whether or not the case should
be reported to the ME/C, the physician should discuss the case by
telephone with the ME/C in the area in which the incident occurred
and proceed according to his decision. This conversation must be recorded on the Medicolegal Clearance Form in the space provided.
The physician must indicate who he/she spoke with at the ME/C Office, as well as the time and date of the conversation.
Once it has been established that the case does not come under the
jurisdiction of the Medical Examiner, the physician must comply
with the following guidelines in seeking permission for autopsy.
1. Permission for autopsy may be discussed before death occurs, if
discussion is initiated by the patient or family.
2. Neither duress nor threats of any nature may be used in attempting to secure autopsy permission–for example, misrepresentations, refusal to sign insurance papers, etc.
3. Consent for post-mortem examination must be secured on the
proper consent form (30208607), or by telegraph, preferably FAX
(404) 524-2501 if the situation warrants. Consent by telephone is
acceptable, and instructions are provided on the Autopsy Authorization Form.
4. Permission for autopsy may be granted only by the legal “nextof-kin.” The following order of relationship must be considered
in determining the legal next of kin, those standing highest in the
list taking precedence over all below:
a. Healthcare Power of Attorney with power to dispose of decedentʼs remains (Advance Directives).
b. Husband or wife.
c. Adult child or children.
d. Father or mother.
e. Adult brother or sister.
f. Next-of-kin (grandparents, aunt, uncle, cousin, nephew,
niece). When there are several relatives of equal rank, one
may give consent (e.g., one of several living children).
g. In the absence of any of the foregoing, whoever assumes the
responsibility of burial may grant permission for autopsy, including a county agency.
43
5. The consent form must be completed in full, with any restriction
clearly noted, and witnessed by someone in addition to the physician obtaining authorization.
MEDICOLEGAL CLEARANCE FORM
44
AUTHORIZATION FOR AUTOPSY FORM
45
SAMPLE WORDING FOR REQUESTING AN AUTOPSY
FROM LEGAL NEXT-OF-KIN
I am Dr.__________________________. I would like to extend
my sympathy regarding the death of your (brother, sister, mother etc),
who died (earlier this evening, this morning etc). We believe that
death was due to ___________________________________.
It is my responsibility to inform you that you have the right for an
autopsy to be performed to help answer questions you may have about
your (sisterʼs, brotherʼs etc) death. Although an autopsy is an expensive procedure, Grady Health System does not charge the patientʼs
account or the family when an autopsy is performed. An autopsy
should not delay the funeral or interfere with viewing of the body.
We are grateful when the family gives consent for an autopsy because we can often learn more about the cause of death, the diseases
that were present, and the circumstances surrounding death. Autopsy
findings are also helpful for us in evaluating and improving our care
of patients. An autopsy does not always answer all of the questions
that may be asked, but like other medical studies, an autopsy usually
provided useful and helpful information.
If needed, the following may be added:
It is possible to perform a partial autopsy. If you do not want a
complete autopsy to be performed, I would recommend that we at
least examine the ____________________________________ in order to _______________________________. Of course, if a limited
autopsy is performed, the information we learn from the autopsy may
also be somewhat limited.
As the responsible person, do you want an autopsy to be performed
by Grady Health System? If yes, you will need to sign this Authorization for Autopsy, which will be explained to you. I will be glad to
answer any questions you may have.
Note:
1. Authorization for autopsy may be given in person (preferable) or
by phone or fax, if needed (see manual for details).
2. The responsible next-of-kin should be made aware that, as explained in the authorization for autopsy form, a limited (partial)
autopsy may be performed even when consent has been granted
for a complete autopsy because of potential risks or other considerations.
46
GUIDELINES FOR OBTAINING AUTOPSIES*
1. Family interest. For all deaths in which the medical examiner will
not be performing an autopsy, the appropriate next of kin should
be informed that an autopsy can be performed by Grady if they
desire for one to be performed (see “Sample Wording”).
2. Clinical, hospital, and public interest. The responsible clinician
should make a dedicated effort to obtain permission for the performance of an autopsy if the medical examiner is not going to
perform an autopsy and the death meets one or more the following criteria:
A. The underlying disease or condition that caused death (such
as cancer, diabetes, lupus, coronary atherosclerosis, hypertensive heart disease etc.) is not known with a reasonable degree
of medical probability;
B. The fatal complication (such as pulmonary embolism, cerebral hemorrhage, pneumonia etc.) of an underlying condition
is not known with a reasonable degree of medical probability;
C. Death appears, in whole or in part, to be related to the complication of a medical treatment, therapy, or medical device,
including intraoperative and postoperative deaths;
D. Death occurs while pregnant, during delivery, or within 6
weeks of delivery.
E. There is a real or perceived liability on the part of the hospital
or staff;
F. The need exists to retrieve an implanted medical device;
G. The autopsy findings may be useful to allay concerns of the
family or public;
H. The patient has participated in clinical trials;
I. The patient is a neonate, infant, or child;
J. It is believed that an autopsy would disclose a known or suspected condition that could have a bearing on survivors or
recipients of tissues or organs;
K. Death is known or suspected as having resulted from occupation or employment;
L. An autopsy is required by a protocol.
M. The need exists to correlate autopsy findings and diagnostic
tests, imaging studies, or clinical diagnoses.
*Adapted from “Criteria for Performing Autopsies,” published by
the College of American Pathologists in its manual “Autopsy Performance and Reporting.”
DEATHS/PROCESSING OF DEATH PAPERS
IN THE DEATH PACK
When the death of a patient appears imminent, the physician should
notify, or have the patientʼs family so notified, and deter- mine if the
presence of a clergyman is desired. If the family so desires, every
effort should be made to obtain one.
47
It is the duty of the house staff physician to be present, if at all possible, at the time of death of a patient, or as immediately as possible
thereafter, so that he may render all possible help to the deceasedʼ
family and initiate procedures necessary for autopsy or removal of
the body from the Hospital.
All bodies must be transported to the morgue immediately after
death and before release to the Medical Examiner (Coroner) or Funeral Home. A copy of the Body Release Form, generated by Decedent Affairs personnel, must be presented to Pathology (Morgue)
before a body is released.
Papers in the Death Pack must be immediately completed according to instructions and hand-delivered to Decedent Affairs for immediate processing, and to avoid any hardship or inconvenience to
relatives of the deceased. If a Death Pack with all deathrelated paperwork is not available on the ward, call the Decedent Affairs to
obtain one.
Completion of Medicolegal Clearance Form and Death Certificate
Worksheet
Certain types of deaths, by law, must be reported by Grady physicians to the Medical Examiner/Coroner (ME/C) to determine whether
an official investigation will be conducted and death certificate completed. The types of death that should be reported to the ME/C are
listed on the Medicolegal Clearance Form which must be completed
for all patients who die at Grady.
If responses on the Medicolegal Clearance Form indicate that the
death is not reportable to the ME/C, or the ME/C has been notified of
the death and will not accept the case for investigation (i.e., the ME/C
will not sign the death certificate), the physician caring for the patient
is responsible for completion of the Death Certificate Worksheet.
All bodies must be transported to the Morgue within two (2) hours
of pronouncement of death. Staff will be allowed two (2) hours to
facilitate transport from the treatment area to the Morgue. Guest Services should be contacted at extension 5-5265 to assist with transport
to the Morgue; Public Safety should be contacted at extension 5-4024
to meet staff at the Morgue.
Papers in the Death Pack must be completed immediately according to instructions, and hand delivered from the Morgue to the Decedent Affairs Office (or Health Information Services is Decedent
Affairs is closed) for immediate processing.
Completion of Certificate of Death
A physician or designee appointed by the Hospital Administration and Medical Staff (referred to as a “Certifier”) may review the
Death Certificate Worksheet and complete and sign the actual Certificate of Death, in consultation with the physician who completed
the Worksheet, if necessary. The Certificate of Death will be given to
the appropriate Funeral Director by Decedent Affairs. The original
Certificate Worksheet must still be completed by the physician caring
for the patient when the performance of an autopsy at Grady Health
System is anticipated.
These procedures must be followed when any patient is pronounced
48
dead at Grady Health System, is pronounced dead on arrival, dies in
the Emergency and the ME/C refuses to assume jurisdiction in the
case.
NOTE: This procedure does not apply to the Stillbirth Certificate
which is covered under a separate section.
The following procedures will be followed by the house staff physician upon the death of a patient:
1. Pronounce the patient dead.
2. Notify the next-of-kin if they are present, or, if not, request the
Charge Nurse to contact the family and advise them of a change
in the patientʼs condition and request them to come to the Hospital. In some cases, it may be advisable to notify the next-of-kin of
the patientʼs death during the phone conversation.
3. Report Medical Examinerʼs cases (see also section on “Post Mortem Examinations”) immediately to either the Fulton County
Medical Examiner (telephone 404-730-4400, all hours), the
DeKalb County Medical Examiner (telephone 404- 508-3500),
or other appropriate ME/C.
4. Request permission for post-mortem examination and insure that
the proper consent form (30308607) is signed and witnessed (see
also section on “Post Mortem Examinations.”)
5. The physician in charge of the patient at the time of death must
enter a brief Death Note in the patientʼs medical record and dictate the death summary when appropriate. According to Grady
Health System Policies and State Laws the responsible physician
must complete and authenticate all documents that are generated
as a result of a patientʼs death. The physician must complete the
following documents which make up the Death Pack:
a) Deceased Patient Data
b) Certificate of Death/State of Georgia
c) Medicolegal Clearance Form
d) Infectious Disease Report
e) Authorization for Autopsy
f) Autopsy Quality and Safety Assurance
A checklist for Adult/Infant Death is completed by Area Clerk
to ensure that all Death Papers are forwarded to Decedent Affairs.
If a patient dies in an ancillary treatment area (e.g. Radiology,
Cardiac Catherization, Lab), the Medical Staff of the referring
service will be responsible for completing the above listed forms.
The Medical Staff will contact the next of kin. If appropriate, the
Medical Staff will contact the Medical Examiner/Coroner.
6. The Medical Examiner/Coroner must complete the death certificate if death was due to accident, suicide, homicide or external
causes involving injury or poisoning.
CERTIFICATE OF DEATH
The Certificate of Death is an important legal and scientific document, and as such must be filled out completely, legibly, and in a
prescribed manner promptly after death. The Death Certificate Work-
49
sheet must be printed in black ink (or type- writer). No corrections
or correction fluid may be used on the form. All times must be in the
military format (ignore the “A.M.” and “P.M.” on the form). The
cause of death must be described in terms which are accepted medical descriptions of diseases and pathological conditions and should
include the complications directly causing death as well as any and
all antecedent, specific underlying causes or conditions.
It is extremely important that the Certificate of Death reflect concise and authoritative expressions of the physicianʼs opinions as to
the cause of death. If sepsis is the cause of death, be sure to indicate
more specific underlying causes. Be sure to indicate AIDS when it is
a causative or contributing factor and include the Infectious Disease
Form (30245674). In the event that the exact cause of death is indeterminable, a provisional cause should be noted.
Upon completion of the Death Certificate Worksheet, send it to
Decedent Affairs with the other documents in the Death Pack. This is
hand-delivered with the patientʼs record to Decedent Affairs. Ensure
that all forms in the Death Pack are forwarded promptly to Decedent
Affairs.
DEAD ON ARRIVAL
When a body is Dead on Arrival (DOA) at Grady, the Emergency
Registration Representative, the physician who pronounced the patient dead, and the transporter must complete their sections of the
“DEAD ON ARRIVAL DOCUMENTATION FORM”, and the
White Demographic Sheet. The Emergency Registration Representative initiates the forms. Supplies of the “DEAD ON ARRIVAL
DOCUMENTATION FORM”, #NCR 40- 245 may be obtained from
the Printing Department.
The Demographic Sheet and two copies of the DOA DOCUMENTATION FORM are immediately hand-delivered to Decedent Affairs, and the third copy of the DOA DOCUMENTATION FORM is
given to the transport agency removing the body from Grady.
An autopsy may be obtained for a patient pronounced DOA if the
appropriate paperwork is completed and the ME/C has waived jurisdiction. In such cases, a Death Pack is to be completed and the body
is to be logged into the Morgue in the same manner as for any death
occurring in the ECC.
If there are any questions regarding these procedures, please contact the Office of Decedent Affairs at 616-4295.
DEATHS IN THE EMERGENCY CARE CENTER (ECC)
OR AMBULATORY CARE AREAS
When a death occurs in the Emergency or Clinic Area, the nurse
assigned to the patient informs the ME/C Office, in accordance with
guidelines on the Medicolegal Clearance Form. Nursing is responsible for ensuring that the body is taken to the Morgue. All relevant
forms in the Death Pack must be completed and immediately handdelivered to Decedent Affairs along with the patientʼs medical record.
50
STILLBIRTHS/FETAL DEATHS
1. The physician must notify the patient/family, complete a Death
and Disposition Report, Stillbirth Certificate (GA Fetal Death
Certificate for Spontaneous Abortion or Stillbirth), Medicolegal
Clearance Form, and Authorization for Disposition Form.
2. The Authorization for Disposition Form must accompany the
body to Pathology. The other forms are hand-delivered to Decedent Affairs. The original Stillbirth Certificate must be forwarded
to the County Vital Records Registrar by Decedent Affairs.
3. If a live born infant dies after birth, a Live Birth Certificate must
be completed. A Death Certificate Worksheet must then be completed and processed in accordance with this policy.
ORGAN AND TISSUE DONATION
Grady Health System has contracted with Lifelink of Georgia as
our official organ procurement organization (OPO). Recent changes
in Medicare Conditions of Participation for Hospitals requires that
we follow very specific practices regarding approaching potential
donors.We have determined that all interaction with potential donors
or their families will be handled by the OPO, not GHS employees or
medical staff. The approved GHS policy can be reviewed in the Administrative Policy and Procedure Manual which is located in every
department. Please address any questions you have concerning your
role to your Chief of Service or the Office of Medical Affairs.
BRAIN DEATH
DEFINITION OF BRAIN DEATH
Traditionally, the cessation of heartbeat and respiration have been
necessary conditions for the diagnosis of death, and it is recognized
that these will remain the criteria for the diagnosis of death in most
cases. However, modern life support systems enable us to maintain
both heartbeat and respiration by mechanical means, therefore, it has
become necessary to diagnose whether or not death has occurred
in persons whose respiration and heartbeat are being mechanically
sustained.
The term “brain death” means irreversible cessation of brain function, including the brain stem, established by neurological criteria.
Once the criteria have been met, there have been no instances of
prolonged survival despite the most vigorous resuscitative attempts.
“Brain death” means the death of the patient.
The guidelines for establishing brain death below should be followed in all patients in whom brain death is being considered. This
would include, but not be limited to, potential organ donors. The criteria apply only to the diagnosis of death. We are still unable to predict with certainty the outcome of seriously brain damaged patients
who do not meet those criteria, and it is not yet possible to ascertain
whether they will improve, and to what extent they will improve. The
decision as to whether or not life support systems should be maintained in such patients remains a matter of judgement for the physician and family.
51
In establishing the diagnosis of brain death the following criteria
will be met.
1. Unresponsiveness
There is total unresponsiveness to externally applied stimuli and
inner need. Even the most intensely painful stimuli evoke no vocal or
other purposeful responses, not even a groan, cough, or gag.
2. No Movements or Breathing
Observations of the patient should establish that there are no spontaneous muscular movements or spontaneous respiration and none
in response to stimuli such as pain, touch, sound or light other than
on a spinal cord basis. After the patient is on a mechanical respirator,
establishing the total absence of spontaneous breathing should accompany one clinical examination. This is determined by turning off
the respirator with a sufficient period of time to elevate the PCO2 to
above 60 mm Hg or 20 mm Hg greater than the patientʼs pre-morbid
baseline if the permorbid baseline is greater than 40 mm Hg. This test
should be carried out with the patient pre-oxygenated for 10 minutes
on 100% O2. A tracheal suction catheter administering 10 liters of O2
per minute should be placed above the level of the carina just prior
to disconnecting the ventilator for apnea testing. This should provide
for enough passive apneic oxygenation while the ventilator is off. An
adequate blood pressure should be maintained during examination.
The use of fluids and pressers such as dopamine is acceptable.
3. No Cranial Reflexes
Irreversible coma with abolition of CNS activity is evidenced in
part by the absence of elicitable cranial reflexes. The pupil will be
fixed and will not respond to a direct source of bright light. Ocular
movements to head turning and to irrigation of the ears with ice
water are absent. There is no evidence of postural activity (decerebrate, or other). Swallowing, yawning, and vocalization are absent.
Corneal, pharyngeal and cough reflexes are absent.
As a rule, deep tendon reflexes cannot be elicited, and plantar or
noxious stimulation gives no response. However, because deep tendon reflexes and extensor plantar responses are integrated at a purely
spinal level, their occasional preservation does not in itself negate the
diagnosis of brain death.
4. Electrocerebral Silence
An EEG recording demonstrating electrocerebral silence is of confirmatory value in the diagnosis of brain death, but the diagnosis is
a clinical one, and an EEG is not required for the diagnosis. In the
case of a potential organ donor one of the examining Physicians must
be either a neurologist or a neurosurgeon, either Senior Resident or
Attending Physician. The patientʼs physician should document in the
chart that there is no dispute or question by the family or guardian
with the clinical diagnosis of brain death. When this cannot be done,
an EEG or cerebral blood flow study should be obtained to provide
further objective evidence of brain death. These tests should not be
obtained to confirm brain death unless the clinical criteria for the
diagnosis have already been met. Only one EEG is sufficient unless
52
there is some doubt as to whether or not electrocerebral silence truly
exists with the initial recording. When an EEG is done, it should conform to the “Minimal Technical Standards for EEG in Suspected Cerebral Death” as proposed by The American Encephalographic Society “Guidelines in EEG 1980,” pages 19-24. Also optional are tests
demonstrating the absence of cerebral blood flow such as cerebral
arteriography, radioisotype flow studies, etc. The patientʼs attending
physician should be involved in any decision regarding withdrawal
of care in case of brain death.
5. Timing and Circumstances
For the diagnosis of brain death to be established, two clinical assessments must be made no sooner than six hours apart. The findings
and conclusions as to whether or not brain death exists should be
documented in the chart. It is essential for two physicians to make
the diagnosis/determination of brain death and document such in the
medical record. At least one of the physicians should be a senior resident in neurology or neurosurgery, chief resident or attending physician. If the patient is a potential organ donor, no member of the organ
transplantation team may participate in establishing the diagnosis.
The diagnosis of brain death depends upon the exclusion of hypothermia (temperature below 90∞ F or 32.2∞ C), central nervous
system depressants such as barbiturates and neuromuscular junction
blocking agents.
If the cause of the patientʼs adverse condition is not apparent, then
the responsible physician will obtain serum levels for intoxicants and
administer an opiate antagonist such as naloxone prior to establishing the diagnosis of brain death.
RESPONSE TO THE BRAIN DEAD PATIENT
1. Inform the patientʼs family of the death of the patient. “Brain
Death” means the death of the patient. As such, there is no decision
to be made about any ongoing medical therapy or continuation of life
support. The decisions available to the family are generally similar to
those made around the patient who has experienced cardiovascular
death; that is, autopsy, organ donation, funeral home, etc.
2. Contact Lifelink of Georgia as per the statement in the section
of this manual on “Organ AND TISSUE DONATION” (above).
3. Contact the Hospital Chaplain or the familyʼs own faith-support
person, as desired by the family.
4. Stop medication, ventilation and other therapies within minutes
to hours after establishing brain death. The timing of discontinuation
of these therapies should be coordinated with the patientʼs family. A
brief delay in discontinuing therapy (a few hours) may be appropriate if this is done to better support the faith or psychosocial needs
of the family.
53
FETAL AND NEONATAL DEATHS
NEWBORN DEATH
If an infant shows any sign of life after birth, no matter how small
the fetus, it is termed a Live Birth in the state of Georgia. The following is a quote from the Georgia Code, Chapter 31-10- 1. “Live
birth means the complete expulsion or extraction from its mother of
a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes, or shows
any other evidence of life such a beating of the heart, pulsation of the
umbilical cord, or definite movement of voluntary muscles, whether
or not the umbilical cord has been cut or the placenta is attached.”
If an infant breaths or shows any other evidence of life (as determined by the attendant at birth) after complete delivery, even though
it may be only momentary and subsequently dies, the birth must be
registered as a live birth and death certificate must also be filed. The
entire death packet must be completed for all deaths, and Life Link
notified. The physician is responsible for completing the following
portions of the death packet: Certificate of Death, Authorization for
Autopsy (if indicated), Autopsy Quality and Safety Assurance Form
(if autopsy indicated), Death and Disposition Report, Medicolegal
Clearance and Infectious Disease report.
The physician, of course is also responsible for pronouncing the
death and notifying the next of kin. If the parents do not wish a funeral, and want Grady to dispose of the remains, a Request & Authorization for Disposition of Infant Body will need to be completed.
FETAL DEATH
According to Georgia Code, there is a live birth and subsequent
death or a fetal death. Stillborn or spontaneous abortion are not
terms used by the law. According to the Georgia Code, a fetal death is
“death prior to the complete expulsion or extraction from its mother
of a product of human conception, irrespective of the duration of
pregnancy; the death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical
cord, or definite movement of voluntary muscles.” This definition
also applies to voluntary interruptions of pregnancy. The physician
must notify the mother of death, if spontaneous, and must complete
a Fetal Death Certificate for all fetal deaths. Life Link is not called
for fetal deaths. If the fetus is not recognizable, a pathology report
will be filled out and the specimen sent to pathology. If the fetus is
recognizable but the parents do not wish a burial or cremation, permission to dispose of the remains must be granted by the parents as
noted by completion of the Request for Authorization for Disposition
of Infant Body form. If autopsy is desired, the Authorization for Autopsy, Autopsy Quality and Assurance form, Death and Disposition
Report, Infectious Disease Report, and Medicolegal Clearance form
must be completed. If the fetus is recognizable but there is no autopsy
the Death and Disposition Report, Medicolegal Clearance Form, and
54
the Infectious Disease Report must be completed. If the parents will
have a funeral home or cremation society retrieve the body a Body
release Form must also be completed. The nursing staff will complete the papers concerning the funeral or disposition of the body if
the parents are not decided, however, the physician must complete
the Fetal Death Certificate. If there is to be an autopsy, all related
forms must also be completed by the physician.
The attending physician is responsible for reporting a fetal death
to the Medical Examiner and for insuring that the fetus, placenta and
umbilical cord are transferred to the Medical Examiner if there is a
determination that it is a Medical Examiner case.
MEDICAL EXAMINER CASES
The Georgia Death Investigation Act states that Medical Examiners/Coroners shall require post-mortem examinations to be performed and inquests held in the respective counties as follows:
1. When any person shall die as a result of violence, or suicide, or
casualty, or suddenly when in apparent good health, or when unattended by a physician, or within 24 hours after admission to a
hospital without having regained consciousness, or in any suspicious or unusual manner. All homicides, suicides, and other
injury/poisoning deaths are ME/C cases.
2. When any inmate of a state hospital, or a state, county, or city penal institution shall die suddenly without an attending physician
or as a result of violence.
3. Whenever ordered by a court having criminal jurisdiction.
In compliance with this law, all such details, without exception,
must be reported to the cognizant Medical Examiner/Coroner by the
attending physician.
The ME/C may then either assume jurisdiction of the case, or advise that the death does not fall within his jurisdiction. In the former
event, the ME/C normally determines the cause of death and completes and signs the Death Certificate. In the latter instance however, the physician in charge will then complete the Death Certificate
Worksheet in the normal manner and he may then request consent for
autopsy from the family (refer to section concerning Post-Mortem
Examinations).
When there is a question of whether a case should be reported to
the ME/C, the physician must himself discuss the case with the ME/
C and proceed according to his decision. The Decedent Affairs will
provide assistance in obtaining the telephone number of the cognizant ME/C.
IMPORTANT: When either a definite or questionable ME/C case
exists, the physician must always so advise the family; likewise, he
must inform them that if a ME/C case does exist, a postmortem examination can be required by law. The clarity with which this point
is impressed upon the family is of vital importance to avoid the impression that the Hospital is using the law as a permissive device to
perform a post-mortem procedure when the family would otherwise
refuse to allow one. Permission for autopsy at Grady should not be
sought from the family until it is confirmed that the death is not a
55
ME/C case, or the ME/C has authorized Grady to make such request.
TERMINAL PATIENTS,
GUIDELINES FOR MEDICAL CARE
Methods are currently available whereby various organ functions
can be maintained temporarily for the purpose of defining and treating reversible organ dysfunction. The goal of employing these lifesustaining measures is to provide critically ill patients the best opportunity to recover from their illness.
However, in many situations it becomes apparent that the patient
will not survive without continuous critical care, despite the fact that
all abnormalities have been defined to their highest order of resolution and treatment has reached a point of maximum benefit. In those
instances where medical treatment can offer no further benefit, it may
be appropriate to reduce the intensity of medical care by withdrawal
of certain methods of support by de-escalation of care. The following
procedures must be used in the process of withholding or withdrawing treatment from a terminally ill patient.
When the senior house officer of an admitting service believes
that a patient has achieved maximum benefit from critical care and
it is probable that the patient will not survive without this care, the
physician shall review again, in depth, the patientʼs status. The goal
of this review will be to uncover previously unrecognized problems
contributing to the patientʼs lack of progress and to assure that all
reversible conditions have been maximally treated. This review will
be carried out in a consultation with the nursing staff. If the house
officerʼs initial impression is confirmed by this review, he/she will
summarize the review in a progress note. The house officer then will
proceed as follows:
A. If the patient has decision making capacity, i.e., the ability to understand and appreciate the nature and consequences of any treatment or procedure, including but not limited to the withdrawal of
certain methods of support or de-escalation of care, the benefits
and disadvantages of such treatment, and is able to reach an informed decision regarding such treatment, the patient retains the
right and should be permitted to affirm or deny his/her wishes for
or against such measures.
B. In the event the patient has previously indicated his or her desires
not to be resuscitated or have terminal care prolonged through an
executed advance directive, i.e., a living will or durable power
of attorney, the patientʼs wishes will be complied with in accordance with the patientʼs living will or a durable power of attorney, the house staff will consult with the agent set forth in the
durable power of attorney. (Also included in this Manual.)
C. If the patient does not have decision making capacity, has not
previously indicated his or her wishes in the form of an advance
directive, or is a minor, the house officer will discuss with the
next-of-kin or in the case of a minor, the parent(s) or legal guardian the patientʼs condition including any recommendation not to
resuscitate [in accordance with the Do Not Resuscitate policy
56
(Also included in this Manual) or not to prolong terminal care if
the patient is in a chronic vegetative state without any possibility of regaining cognitive function. This determination must be
made by two (2) licensed physicians, including one (1) attending
faculty physician. Also, this determination must be documented
in the patientʼs medical record by the two (2) licensed physicians. If the nextof- kin or legal guardian concurs, progress notes
summarizing the conversation(s) must be entered in the patientʼs
medical record. Note: in Georgia an intern is not a licensed physician.
D. If the next-of-kin or legal guardian does not agree to de-escalation of medical care or withdrawal of support, the refusal shall
be entered in the record and full medical care will continue.
The Ethics Committee and the hospitalʼs Office of Legal Affairs
is available for consultation at the request of any hospital employee,
physician or family member in such decisions. The Ethics Committee can be reached 24 hours a day on pager (404) 278-4753. Without
exception in all instances the house officer shall consult with his/her
attending physician. This can be done by telephone with a witness
from the nursing or house staff included in the conversation. If the
attending physician concurs, the house staff shall enter this fact in
the record and write the appropriate order. The order must be counter-signed by the attending physician within twenty-four (24) hours.
The order will be implemented unless (1) the legal guardian or nextof-kin indicates to the nursing staff or any physician caring for the
patient a change in their willingness to consent; such indication shall
be entered into the patientʼs medical record; or (2) a change occurs
in the patientʼs clinical condition that contradicts the implementation
of any order.
DO NOT RESUSCITATE: POLICY STATEMENT
I.
INTRODUCTION
A. Every patient shall be presumed to consent to administration
of cardiopulmonary resuscitation (CPR) in the event of cardiac
or respiratory arrest unless there is a Do Not Resuscitate (DNR)
order issued in accordance with this policy. However under
certain circumstances, as described in this policy, a patientʼs
attending physician can order that no attempt be made at CPR
on the patient.
B. Although cardiopulmonary resuscitation has proven to be
invaluable in limited circumstances of sudden, unexpected cardiac/respiratory arrest, it may be appropriate for patients and
their families to request, and attending physicians to order, that
CPR should not be initiated in certain circumstances. It is the
intent of this policy to protect individual patient autonomy and
dignity and to prevent unnecessary pain and suffering in relation to CPR. This policy recognizes the right expressly given
to patients to instruct health care providers to refrain from CPR
and to make it as easy as possible for them to exercise this right
within the law.
57
II. DEFINITIONS
A. Adult. For purposes of this policy, an “adult” is any person
18 years of age or older, any parent of a child (if making decisions on behalf of the child), or any person who is or has been
legally married.
B. Advanced Directive. A Living Will, Pre-Hospital EMSDNR, or Durable Power of Attorney (including the documents
under the “Critical Decisions” program in Georgia).
1. Living Will. Patients who have executed a living will may
still be subject to an order to withhold CPR. Under Georgia law,
the preconditions necessary to implement a living will are more
restrictive than those preconditions necessary to implement an
order to withhold CPR. Thus, a patient who has executed a living will and who also meets the requirements order to withhold
CPR may still have resuscitation services withhold in accordance with this policy.
2. Durable Power of Attorney for Health Care. For patients
who have executed a Durable Power of Attorney for Health
Care, the agent designated in that document, if reasonably available, shall be responsible for decisions to withhold CPR from a
patient who lacks decision-making capacity and who expressed
no previous consent to an order being entered in compliance
with Section IV.A. of this policy (“DNR Consent in the Adult
Patient with Decision-Making Capacity”).
3. Pre-Hospital EMS-DNR. An order direction EMS not to
institute DNR as allowed by Georgia law. This order may be
indicated by the patient wearing an orange armband.
C. Aggressive physiologic care. The care typically given
in an ICU situation, where full monitoring, aggressive use of
medications, and aggressive use of diagnostic and therapeutic
technologies are a mainstay of care. The goal of care is the maintenance of physiologic functioning of the patient.
D. Aggressive supportive care. The care typically given in
a hospice-like situation or when aggressive physiologic care
is unlikely to be successful in saving the patientʼs life. With
“aggressive supportive care,” the goal of therapy is pain relief,
family and faith support, and the humane care of the dying patient. Usual and customary nursing and comfort care is a part of
this aggressive supportive care. Such care may include: suctioning of the airway, feeding, fluid administration, oxygen administration and medication for comfort and pain relief.
E. Authorized decision-maker. Person authorized to make
decisions for a patient when a patient lacks decision-making capacity. (see IV.C.4 below)
F. Candidate for non-resuscitation. A patient, who (as determined to a reasonable degree of medical certainty by both
the patientʼs attending physician and one other licensed physician) meets any one (or more) of the following three
(3) criteria:
1. Has a medical condition that can reasonably be expected to
result in the imminent death of the patient; OR
2. Is in a non-cognitive state with no reasonable possibility of
58
regaining cognitive functions; OR
3. Is a person for whom CPR would be medically futile.
Specifically, this means that it is likely that such resuscitation
would:
a. either be unsuccessful in restoring cardiac and respiratory function; OR
b. only restore cardiac and respiratory function for a brief
period of time, so that the patient would likely experience the need for repeated CPR over a short period of
time; OR
c. be otherwise medically futile.
4. Even though the patient may meet all of the criteria as a
“candidate for non-resuscitation,” if there is no consent for a
DNR, the patient is still to receive full cardio-pulmonary resuscitation if he/she arrests. The fact that a patient is a “candidate
for non-resuscitation” does NOT imply that the physician can,
in fact, write a DNR order. The certification that a patient is a
“candidate for non-resuscitation” is only one of several issues
that must be addressed before the DNR order can be written.
G. Cardiopulmonary Resuscitation (CPR). Only those measures used to restore or support cardiac or respiratory function
in the event of cardiac or respiratory arrest. The term “CPR”
generally follows the format defined in the American Heart
Associationʼs courses on “Advanced Cardiac Life Support”
(ACLS); “Pediatric Advanced Life Support” (PALS); or “Advanced Trauma Life Support” (ATLS). CPR includes any stimulation, massage or artificial pumping of the heart and/or the assistance to respiration by oral (mouth to mouth) or mechanical
means. Generally, CPR is considered to be a part of “aggressive
physiologic support” of the patient. It is presumed that all patients wish to have CPR performed unless otherwise ordered.
H. Decision-making capacity.
1. The ability to understand and appreciate the nature and consequences of an order not to resuscitate, including the benefits
and disadvantages of such an order and to reach an informed
decision regarding the order. Every adult is presumed to have
decision-making capacity. Lack of decisionmaking capacity
should be determined clinically by the attending physician or by
some alternative consultative person (e.g., psychiatry). Alternatively, the competence of a patient to make decisions may be
determined pursuant to a court order. The determination should
be documented in writing in the patientʼs medical record.
2. Specifically, each of the following issues should be assessed.
The patient must be able to:
a. understand the nature of his/her condition; under 6262
stand the outcome of his/her condition if left un treated;
b. understand the outcome of his/her condition if treated;
c. understand the nature of the treatment involved;
d. express a wish for treatment or non-treatment based on
this above understanding.
I. Diligent effort. A “diligent effort” depends on the circum-
59
stances. In emergency situations this effort may take place over
a shorter time than if the patient were hospitalized for a prolonged period
J. Do Not Resuscitate (DNR) Order. An order, usually initiated by the patient or the patientʼs family and written by the attending physician, which instructs the hospital staff NOT to initiate or attempt CPR. A DNR order does not preclude providing
indicated medical and surgical therapy and usual and customary
nursing and comfort care.
K. Consent for DNR. A process leading to a DNR order, but
not the same as a DNR order. The consent process must be completed prior to writing the order.
L. Patientʼs attending physician. For purposes of this policy,
a physician who is:
1. licensed in the State of Georgia;
2. privileged to provide care at the Grady Health System;
AND
3. directly responsible for the direction of the current care
and treatment of the patient. Where more than one physician shares such responsibilities, any of these physicians
may act as an attending physician. M. Licensed physician. Any physician who holds a medical license in the
State of Georgia. This usually means resident and fellow
physicians from one of the affiliated medical schools, but
NOT interns. PGY 1 / interns are not licensed in the state
of Georgia.
III. SYNOPSIS OF ISSUES TO ADDRESS PRIOR TO WRITING A DNR ORDER
A. As the subject of DNR is being considered, the resident (licensed physician), attending physician, and appropriate hospital
staff should discuss the patientʼs condition and the appropriateness of DNR status.
B. The physicians and hospital staff should address the following issues in the medical record as DNR consent is being
considered:
1. What are the most appropriate diagnostic, therapeutic
and humane/supportive measures that could be used in
treating this patient at this point in his/her disease process?
2. Why is the medical team considering the need for DNR
status?
3. Is there an existing advanced directive, and is it in the
medical record?
4. If the patient has decision-making capacity, what are
the patientʼs wishes for his/her care?
5. If the patient lacks decision-making capacity, is the patient a “candidate for non-resuscitation?”
6. If a patient without decision-making capacity is a candidate for non-resuscitation, is there an “authorized decision-maker” available to make decisions about the care
60
of the patient?
7. If an “authorized decision-maker” is not available, has
there been a diligent search for this person?
8. If there is no authorized decision-maker available following a “diligent search,” has the ethics committee been
notified to confirm that the patient is a “candidate for nonresuscitation?”
IV. CONSENT FOR DNR
In general, the consent process requires the signature of two
members of the health care team on the consent form or the
progress note, documenting consent. Once the consent is properly documented, the patientʼs attending physician or licensed
physician may sign the DNR order. It is a good idea, although
not mandatory, that the DNR order be signed by both the patientʼs attending physician and licensed physician.
A. DNR Consent In The Adult Patient With Decision Making Capacity
1. Any adult with decision-making capacity can consent to a
DNR order at any time. The patient does not have to be a “candidate for non-resuscitation” in order to direct that no resuscitation be performed on them.
2. The patientʼs attending physician and/or the patientʼs licensed physician should have discussed the DNR consent process with the patient.
3. Information supporting the patientʼs decision-making
capacity (see definitions, above) shall be documented in the
patientʼs record. The capacity of a patient to make decisions
should be assessed and documented by the patientʼs attending
physician.
4. In general, an adult with decision-making capacity has the
right to refuse medical treatment, including life-sustaining procedures. Thus, an adult with decision-making capacity does not
have to meet the criteria of being a “candidate for non-resuscitation” before he/she directs that a DNR order be issued.
5. When an adult patient with decision-making capabilities
consents to a DNR order, the patientʼs attending and/or licensed
physician must document a summary of the discussion which
leads to the DNR consent in the progress notes, and enter a
DNR order in the patientʼs medical record. Two members of the
health care team, preferably the patientʼs attending physician
and the patientʼs licensed physician, should sign the progress
note documenting the patientʼs DNR consent.
6. If the patient or the patientʼs attending physician wishes,
the patient may sign the appropriate DNR consent form.
7. If the patient refuses to consent to the DNR, this fact and
the discussion leading to this decision should be documented in
the medical record. In this situation, if the patient experiences a
cardio-pulmonary arrest, CPR should be instituted.
8. Generally, once an adult with decision-making capacity
61
has consented to DNR, no other decision-maker, even if they
are the authorized decision-maker, can revoke this consent. The
exception to this is if the patientʼs condition has changed substantially such that, given the new conditions there is reason to
believe the patient would have decided differently.
B. DNR Consent In Minor Patients
1. The patient must be determined to be a “candidate for nonresuscitation.” Two physicians, including the attending physician and a licensed physician should make this determination.
The determination should be recorded in the patientʼs medical
record.
2. If the patient is a minor and is a “candidate for non-resuscitation,” any custodial parent or legal guardian may consent to
a DNR order. If there are questions about the parentsʼ custodial
status, the patientʼs attending physician or his designee should
request copies of the appropriate legal documents supporting
such status.
3. If the patientʼs attending physician determines that the minor is mature enough to understand the nature and effect of the
DNR order, the order shall not be issued without the minorʼs
assent. This assent should be documented in the progress note.
4. When a parent or guardian of a minor child consents to a
DNR order, the patientʼs attending physician or licensed physician shall write a note in the patientʼs chart, noting both:
a. the basis for the determination that the patient is a candidate for non-resuscitation; and
b. documentation of the conversation with the parent or
guardian.
In the case of oral consent, another health care provider should
witness the discussion with the parent or guardian and co-sign
the progress notes. That is, at least two members of the health
care team should sign the note.
5.
If the patientʼs attending physician or licensed physician
wishes, they may request that the parent or guardian sign the
appropriate consent form.
C. DNR Consent In Adult Patients Without Decision Making Capacity
1. The patientʼs record must be reviewed to be certain whether
there is or is not an advanced directive in effect.
2. The patientʼs attending physician or licensed physician
should evaluate the patientʼs decision-making capacity. The
patientʼs attending physician should write a note in the medical
record. This note should review the evaluation and state that the
patient lacks decision-making capacity. Alternatively, a written
consultation by Psychiatry may attest to the patientʼs lack of
decision-making capacity. Additionally, patients with a courtdetermined incompetence also lack decision making capacity.
3. In the absence of a patient-directed DNR, the patientʼs
attending physician AND one other licensed physician should
make the determination that the patient is a “candidate for non-
62
resuscitation.” There should be a note by the attending physician
in the medical record reflecting the basis for this determination.
The fact that a patient is a “candidate for non-resuscitation”
does NOT imply that the physician can, in fact, write a DNR
order. The certification that a patient is a “candidate for non-resuscitation” is only one of several issues that must be addressed
before the DNR order can be written.
4. If an adult patient does not have decision-making capacity and is a candidate for non-resuscitation, an appropriate authorized decision-maker may consent to a DNR order for the
patient. The “authorized decision-maker” who can provide this
DNR consent shall include, in order of legal priority:
a. any agent appointed by the patient pursuant to the Durable Power of Attorney for Healthcare Act;
b. the patientʼs spouse;
c. the patientʼs guardian appointed by the courts;
d. any son or daughter 18 years of age or older;
e. a parent of the patient (parent means a parent who has
custody of a minor or is the parent of an adult without
decision making capacity);
f. any brother or sister 18 years of age or older of the patient.
5. In attempting to contact the authorized decision-makers
listed above, a determination should be made as to whether the
authorized decision-maker is “reasonably available.” The patientʼs attending physician in consultation with Social Services
should make this determination. “Reasonably available” means
available either in person or over the phone in a timely enough
fashion to participate in medical decision-making. The attending
physician should assure that a “diligent effort” is made to contact a person authorized to make decisions on behalf of the patient The details of this “diligent effort” should be documented
in the medical record.
6. If the attending physician, nursing staff, social work staff,
or other hospital staff personnel cannot reach an authorized decision-maker listed in higher priority within a reasonable period
of time, but an authorized decision-maker listed next in priority
can be contacted, the latter should be contacted in the interest of
time. A “diligent effort” depends on the circumstances. In emergency situations this effort may take place over a shorter time
than if the patient were hospitalized for a prolonged period.
7. If this “diligent effort” to locate an “authorized decisionmaker” is unsuccessful, consultation of the hospital Medical
Ethics Committee is appropriate.
8. The decision of the appropriate authorized decision-maker
should reflect what the patient would have wanted had the patient understood the circumstances and consequences of the different therapies being proposed. This decision is based on the
ethical principal of substituted judgment and should be made after thorough discussion between the authorized decision-maker
and the medical team.
9. The patientʼs attending or licensed physician must docu-
63
ment a summary of the discussion with the authorized decisionmaker in the progress notes. In the case of oral consent, another
heath care provider should witness the discussion and co-sign
the progress note. Two members of the health care team, preferably the patientʼs attending physician and the patientʼs licensed
physician, should sign the progress note documenting the patientʼs DNR consent.
10. The attending physician may wish to have the authorized
decision-maker sign the appropriate consent form.
11. The decision of the authorized decision-maker will be implemented unless:
a. There is a reason to believe that the authorized decision-maker has bad faith motives in making the decision (the hospitalʼs General Counsel will be consulted
immediately if bad faith motives are suspected); OR
b. The patientʼs attending physician is unable or unwilling
to comply with the decision of the authorized decisionmakers. If the patientʼs attending physician is unable or
unwilling to comply with the authorized decision-makerʼs decision either to perform or withhold CPR, he/she
shall advise the authorized decision-maker of this and
make a good faith attempt to transfer the patient to another physician who will effectuate the authorized decision-makerʼs decision. If an appropriate transfer cannot
be arranged, hospital administration, the Chief of the
Medical Staff or the hospitalʼs General Counsel must
be notified immediately.
D. DNR Consent When The Patient Lacks Decision-Making Capacity And When There Is No Authorized DecisionMaker Available.
If the patient is a “candidate for non-resuscitation,” AND does
not have decision-making capacity, AND no authorized decision-maker is reasonably available to make a decision with regard to a DNR, the patientʼs attending or licensed physician may
issue a DNR order ONLY after the following items have been
accomplished:
1. The patientʼs attending or licensed physician and the concurring attending or licensed physician document in the medical
record, that the patient is a “candidate for non-resuscitation” in
accordance with the criteria listed above; AND
2. The patientʼs attending physician or licensed physician has
documented the lack of decision-making capacity on the part of
the patient; AND
3. The patientʼs attending or licensed physician has documented the lack of any advanced directive following a thorough
search of the medical record; AND
4. Prior to the physicianʼs issuance of such an order, he/she
must document the diligent efforts to contact other “authorized
decision-makers” to assist in decision-making. The patientʼs attending or licensed physician should document the absence of an
authorized decision-making; person; AND
64
5. The hospital Medical Ethics Committee should be contacted to act as the DNR panel. The committee must concur with the
determination that the patient is a “candidate for non-resuscitation.” This concurrence must be listed on the appropriate GHS
form (i.e., 303-19636 PD 6/02: “DNR Candidacy Certification,”
for patients WITHOUT decision-making capacity, WITHOUT
an authorized person available for consent, and WITHOUT an
advance directive.) This form should be available on all critical
care nursing units.
V.
ISSUING THE DNR ORDER
A. Once the criteria for consent to a DNR have been met and
appropriate documentation completed, a DNR order can be
written. The DNR order may be initiated either by the patientʼs
attending physician or by the patientʼs licensed physician. Although a single licensed physician can write the DNR order, it
is suggested that the DNR order have both the signatures of the
patientʼs attending- physician and the patientʼs licensed physician.
B. If the patientʼs licensed physician initiates the progress note
and DNR order, the patientʼs attending physician may concur by
telephone to the patientʼs registered or charge nurse. The nurse
must witness the phone consent and indicate the attending physicianʼs concurrence in writing in the patientʼs progress note and
order sheet The patientʼs attending physician should co-sign the
progress note and DNR order within 72 hours.
C. The patientʼs attending physician should re-evaluate the
patient at least every seven (7) days to determine if the patient
still qualifies as a candidate for DNR, and should record such
determination in the patientʼs chart Failure to make this determination does not, in and of itself, result in cancellation of the
DNR order. Georgia law states that a DNR order is to remain in
effect until it is rescinded.
D. The DNR order never implies withdrawal of all medical
and nursing care or termination or withdrawal of life support or
appropriate nutrition or hydration. In all cases, “aggressive supportive care” is appropriate when “aggressive physiologic care”
is no longer of medical benefit.
VI. DUTIES OF PHYSICIANS AND HOSPITAL SfAFF
WHILE AN ORDER TO WITHHOLD LIFE SUPPORT IS
IN EFFECT
A. CPR wiIl not be withheld unless the patientʼs attending
physician has entered an order in writing to such effect in the
patientʼs chart It is important to note that a DNR order is compatible with any and all levels of care up to initiation of CPR (in
selective cases it may be appropriate to intubate a patient that is
not to be resuscitated). THE DNR ORDER NEVER IMPUES
WITHDRAWAL OF ALL MEDICAL AND NURSING CARE,
OR TERMINATION OR WITHDRAWAL OF UFE SUPPORT,
65
OR APPROPRIATE NUTRITION OR HYDRATION. The types
of fluid, nutrition, pharmacological agents, antibiotics, and cardiorespiratory support the patient should receive must be clearly
delineated in both the progress notes and physicians orders.
B. In making these decisions, the attending physician and hospital staff should attempt to provide maximum comfort to minimize pain and preserve the patientʼs dignity.
VII. REVOCATION OF DNR CONSENT
A. Revocation by the Patient.
1. A patient may, at any time and regardless of medical condition or mental capacity revoke his or her consent to a DNR order.
This revocation can be made by making either a written or oral
declaration to any member of the medical or nursing staff of
the hospital. Revocation of a DNR order may also occur if any
physician or member of the hospital staff becomes aware of any
other act by the patient that would provide evidence of a specific
intent to revoke the DNR consent.
2. Allowing a patient who lacks decision-making capacity
to revoke a DNR order is problematic. If this situation arises,
the DNR should be revoked and the hospital General Counsel
should be contacted immediately.
B. Conflicts regarding DNR decisions may arise among or between the physician, patient or authorized decision-maker. The
following is a list of alternative methods to attempt to resolve
such conflicts:
1. If the patient had decision-making capacity at the time he
or she consented to a DNR order, the physician shall honor the
patientʼs wish to have CPR withheld, even though the patientʼs
subsequent medical condition or mental capacity has deteriorated and despite objection from family members and/or authorized decision-makers, unless such order is revoked or canceled
(see above).
2. If an adult patient lacks decision-making capacity, the attending faculty physician may honor the wishes of the appropriate persons listed in Section III above despite objections from
other authorized decision-makers who are in lower priority according to the policy.
3. For any situations which are not addressed by this policy or
any other Hospital policy concerning advance directives, contact
the Medical Director, Chief of Service, the General Counsel, or
Medical Ethics Committee (404) 278-4753, depending on the
nature of the situation.
C. Disagreement between authorized decision-maker and
other decision-makers
If there is disagreement between the duly determined “authorized decision-maker” and other subordinate decision makers,
the disagreement should be discussed with the medical team and
the family members involved. If resolution of this conflict is notaccomplished, the Ethics Committee should be consulted.
66
PATIENT CONSENT FORM FOR DNR
67
CONSENT FOR DNR BY AUTHORIZED PERSON FORM
68
CONCURRING PHYSICIANʼS STATEMENT
69
DNR CANDIDACY CERTIFICATION FORM
70
ADVANCE DIRECTIVES
I.
PURPOSE AND POLICY STATEMENT
It is the policy of The Fulton-DeKalb Hospital Authority d/b/a/
Grady Health System to honor, in accordance with applicable
Federal and Georgia law, an adult patientʼs right to make decisions regarding treatment, including the right to consent to,
refuse or alter treatment plans, and the right to formulate advance directives which will govern if the patient should become
incapacitated. In the absence of a written directive, the Hospitals
policies and procedures will be as followed, including, but not
limited to, general consent procedures and DNR policies.
II. DEFINITIONS
For the purpose of this policy the following terms shall be defined as:
A. Agent – A person appointed to make decisions for someone else, as in a durable power of attorney for healthcare
(also called a surrogate, proxy or attorney in fact).
B. Attending Physician – The faculty physician assigned to
the patient who has primary responsibility for the treatment
and care of the patient. When more than one (1) faculty
physician has such responsibility, any such faculty physician may act as the attending physician.
C. Advance Directive – A document in which a person either
states choices for medical treatment, or designates who
should make treatment choices if the person should lose
decision-making capacity. Examples of these documents
are a Living Will or Durable Power of Attorney for Health
care, though the patient may possess another form of advance directive.
D. Decision-Making Capacity – The ability to make choices
that reflect an understanding and appreciation of the nature
and consequences of oneís actions and the patient has not
been declared incapacitated by any court nor has had a
guardian appointed over his (her) person. (See pages 64-68
of this Manual).
E. Declaration – An advance directive.
F. Durable Power of Attorney for Health Care (DPOA) – An
advance directive in which an individual names someone
else (the agent, attorney in fact or proxy) to make health
care decisions in the event the individual becomes unable
to make them himself (herself). The DPOA can also include instructions about specific possible choices to be
made.
G. Living Will – A written document voluntarily executed by
the patient directing how a patient without decision-making capacity should be treated.
III. PROCEDURE INFORMING PATIENTS OF THEIR RIGHTS
AND OPTIONS
A. Emergency and Elective Admissions
1. During the admission for every patient the Admitting
Representative or Patient Financial Counselor will ask
71
2.
3.
either the patient or his (her) representative whether or
not the patient has an advance directive, i.e., a Living
Will or a Durable Power of Attorney for Health Care
(DPOA) and complete the Advance Directive Checklist form accordingly. The original of the checklist
will be attached to the admitting record. The 2nd copy
will be given to the patient. The 3rd copy will be filed
in the patientʼs financial folder.
If the patient has an advance directive upon admission:
(a) If the patient has an advance directive, the Admitting Representative or Patient Financial Counselor
should make a copy of it, stamp date it and, if
possible, have the copy authenticated (signed and
initialed by the patient), complete the Advance
Directives Checklist accordingly and attach the
advance directive and the Checklist to the admission package.
(b) The Admitting Representative or Patient Financial
Counselor may check the advance directive for
completeness:
(i) If the directive is a Living Will executed
prior to admission, it must be substantially
in the form as set forth in Georgia law and
witnessed by two (2) adult witnesses. If validity is questioned Social Services, the Office of the General Counsel or Health System
Administrator should be contacted for additional assistance.
(ii) If the directive is a Durable Power of Attorney for Health Care executed prior to admission it must be substantially in the form as
set forth in Georgia law and witnessed by
two (2) adult witnesses. If validity is questioned Social Services, the Office of the
General Counsel or Health System Administrator should be contacted for additional
assistance.
(iii) If the patient presents another form of advance directive, Social Services, The Health
System Administrator, or the Office of General Counsel should be notified.
If the patient has an advance directive, but does
not have it with them:
(a) The Admitting Representative or Patient Financial
Counselor will notify the patient or representative
that the terms of the advance directive will not be
followed until the Hospital receives a copy. The
Admitting Representative or Patient Financial
Counselor should complete the Advance Directive
Checklist accordingly and attach the original to
the patientʼs admission record.
72
4.
5.
6.
(b) The patient or the representative should be requested to provide a copy of the advance directive
to Social Services as soon as possible. Once the
advance directive is received by Social Services
it should be validated, as described in paragraph
A, 2 (a) and (b) above, a copy should be made,
dated and placed in the patientʼs medical record.
The patientʼs attending faculty physician should
be informed about the existence of the advance
directive. The original should be returned to the
patient and/or his (her) representative.
If the patient is a re-admission with an advance directive which has not changed since his (her) previous admission and presents with no copy:
(a) The Admitting Representative or Patient Financial Counselor will obtain a copy of the advance
directive from the Medical Records Department
for the current admission. Upon receipt by the Admitting Representative or Patient Financial Counselor the copy should be authenticated (signed
and initialed) by the patient, dated and attached to
the patientʼs Admission Record and made part of
the current medical record.
(b) The Admitting Representative or Patient Financial
Counselor will notify the patient or representative
that the terms of the advance directive will not be
followed until the copy is obtained and authenticated.
If the patient has decision-making capacity and
does not have an advance directive:
(a) The Admitting Representative or Patient Financial
Counselor will give the patient a copy of the Advance Directives Booklet.
(b) The Admitting Representative or Patient Financial
Counselor will complete the Advance Directives
Checklist accordingly indicating that the patient
does not have an advance directive, the fact that
the Booklet was given to the patient, and whether
or not the patient or representative desires additional information about advance directives.
(c) Comments will be entered in the function CPIU of
MediPac.
(d) The Advance Directives Counselor(s) will attach
the original of the Advance Directives Checklist
to the patientʼs Admission Record to be forwarded
to the appropriate inpatient area.
If the patient is unable to communicate and is unaccompanied:
(a) If the patient is unable to communicate and is unaccompanied, the Admitting Representative or
Patient Financial Counselor will complete the Advance Directive Checklist accordingly and attach
73
B.
it to the admission record.
(b) The Admitting Representative or Patient Financial Counselor will follow-up with the patient
about advance directives when and if the patient
regains decision-making capacity.
7. If the patient is unable to communicate and is accompanied:
(a) If the patient is unable to communicate and is accompanied, the Admitting Representative or Patient Financial Counselor will ask the representative about the existence of an advance directive.
If one does exist, the Advance Directives Checklist will be completed accordingly and the policy
regarding requesting a copy of the advance directive should be followed. See paragraph A, 3(b)
above.
(b) If the patient does not have an advance directive,
to the best of the representativeʼs knowledge, the
Advance Directive Checklist will be completed
appropriately and, in an effort to educate the community about advance directives, the representative will be provided a copy of the Advance Directive Booklet.
(c) The Admitting Representative or Patient Financial
Counselor will follow-up with the patient about
advance directives when and if the patient regains
decision-making capacity.
Advance Directive Follow-up Social Services Department
1. The Social Service Department will have additional
follow-up whenever possible with inpatients:
(a) Who have expressed a desire for more information
about advance directives; or
(b) Who, based on pre-established criteria determined
by the Hospital, should receive additional information and counseling regarding advance directives.
IV. EXECUTING ADVANCE DIRECTIVES AFTER ADMISSION
Should an adult patient desire to execute an advance directive
following admission to the hospital and/or request advance directive forms, contact Social Services, Chaplaincy Services, or
the Office of General Counsel. However, no hospital employee
or physician shall prepare, offer to prepare, or provide advance directive forms unless specifically requested to by the
patient.
A. The patient should be provided with a copy of the advance
directive form (a Living Will and/or Durable Power of Attorney for Health Care) as set forth in Code Section 31-323 and 31-36-10 of the Official Code of Georgia Annotated.
If the patient desires another form of advance directive to
be executed following admission, advise the patient to contact his/her attorney.
74
B.
C.
D.
V.
Executing Durable Power of Attorney for Healthcare:
1. Assure that all sections of the form have been read,
and that only one of the three paragraphs dealing with
the subject of life-sustaining or death-delaying treatment is checked.
2. The patientʼs attending faculty physicians must sign
as a witness in addition to two (2) witnesses over 18
years of age, in the presence of the patient and in the
presence of each other.
3. It must be signed by the patient or for the patient by
some other person in the patientʼs presence and the
patientʼs express direction.
4. It must be signed in the presence of and witnessed by
the patientʼs attending faculty physician.
Executing a Living Will.
1. Assure that the document is appropriately executed
— signed and dated.
2. The patientʼs signature must be witnessed by two competent adults at least 18 years of age and who are:
• not related to the patient by blood or marriage;
• not entitled to any portion of the patientʼs estate;
• not the attending physician of the patient or an
employee of the attending physician or an employee of the institution;
• not financially responsible for the patientʼs medical care; or
• have no present claim against any portion of the
patientʼs estate.
3. The Medical Director, any physician on the Medical
Staff who did not participate in the care of the patient, or a person on the Hospital staff who has not
participated in the care of the patient, designated by
the Medical Director and the Executive Director must
sign the living will as a third witness.
If the staff questions the decision-making capacity of the
patient to execute an advance directive, this should be discussed with the witnessing physician in sufficient time to
make a determination prior to execution of the document.
The witnessing physician is attesting to his/her good faith
judgement that the patient was of sound mind at the time
he/she executed the advance directive.
MAINTENANCE OF THE ADVANCE DIRECTIVE COPY
A. A copy of the advance directive should be made for the
Patientʼs medical record. This copy should be stamp-dated
for the current admission.
B. The original of the advance directive should be returned to
the patient.
C. If the patient has no advance directive, this fact should be
documented in the medical record on the Advance Directives Checklist.
D. The advance directive copy should always remain in the
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E.
F.
G.
front of the patientʼs record, not to be “thinned out” if the
record becomes voluminous.
Transfer patients:
1. Temporary — If the patient is temporarily out of the
hospital for a diagnostic procedure, or elsewhere, a
copy of the advance directive should be sent with the
patient.
2. Permanent — A copy of the advance directive should
be sent to the receiving facility with the patientʼs
transfer records.
Each time a patient is admitted, the advance directive copy
should be dated and signed by the patient in order to validate its currency in view of the fact that future amendments or changes may be made.
The advance directive copy shall become a permanent part
of the patientʼs medical record, permanently maintained in
accordance with the hospitalís record retention policy.
VI. NOTIFICATION
A. To Attending Physician
1. A copy of the advance directive will be placed in front
of the medical record by the Area Clerk who is furnished with a copy.
2. The advance directive is considered valid unless challenged by the agent or immediate next-of-kin.
3. The Area Clerk will place an advance directive label
on the front of the patientʼs chart which will serve as
notice to the patientʼs attending physician and staff of
an advance directive.
B. To Agent or Next-of-Kin
1. To the extent possible, the patientʼs attending physician or his/her designee is responsible for notifying
the agent or next-of-kin that the conditions to activate
the advance directive have been met.
VII. CHANGING EXISTING ADVANCE DIRECTIVE AND
OPPORTUNITY FOR REVOCATION
A. If the patient desires to change or amend his/her Durable
Power of Attorney for Healthcare during his/her admission, contact Social Services, the Chaplaincy Service, the
Office of General Counsel or the Health System Administrator, who will adhere to the following procedure:
1. A Durable Power of Attorney for Health Care may be
amended at any time by a written amendment executed in the presence of two witnesses at least 18 years
of age, and witnessed by the patientʼs attending faculty physician:
a. The amendment must be signed by the patient or
for the patient by some other person in the patientʼs presence and at the patientʼs express direction.
b. This change should be noted and dated in the
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B.
C.
D.
patientʼs medical record by the patientʼs Charge
Nurse or the nurse assigned to the patient.
c. The Charge Nurse or the nurse assigned to the patient shall notify Social Services and the patientʼs
attending physician of the changes.
d. Social Services should make all reasonable efforts
to inform the agent of this change as promptly as
possible.
Revocation of a living will or durable power of attorney
for healthcare can be in the form of:
1. Defacing, destroying, obliterating or tearing the document;
2. A written revocation, signed and dated by the patient
and/or the patientʼs agent;
3. Verbal or nonverbal expressions of the wish to revoke
in the presence of an adult witness who verifies the
expression of intent in writing within thirty (30) days
of the expression of such intent. If at all possible more
than one witness should be present, although not required.
A written revocation should be signed, dated, and placed
in the patientʼs medical records by the healthcare provider
witnessing the revocation.
All healthcare providers in direct contact with patients have
a responsibility to be sensitive to and acknowledge verbal
and nonverbal patient expressions of a wish to revoke or
change their advance directive. After acknowledging any
change or revocation, the staff should contact the patientʼs
attending physician and Social Services, Chaplaincy Service, or The Health System Administrator, in order to
change the patientʼs directive.
VIII. PROCEDURES TO ADDRESS CONFLICTS BETWEEN
PROVIDERʼS AND PATIENTʼS ETHICAL VIEWS
If a conflict arises between a providerʼs and patientʼs ethical
views, usual conflict resolution practices and procedures should
be followed. If a conflict continues after following the usual
Hospital procedures, transfer of the patientʼs care to another
provider or facility may be pursued in accordance with hospital
policy.
IX. ROLE OF ETHICS COMMITTEE
The hospitalʼs Ethics Committee will be available to address
any conflicts, issues, or concerns involving the ethical implications of advance directives.
X.
ONGOING STAFF TRAINING
In addition to initial hospital-wide orientation and training in
regard to advance directives, quarterly hospital-wide inservices
regarding advance directives will be held. Ongoing training
will be conducted for those staff members directly involved in
implementation of the policy on advance directives. Also a brief
77
discussion of advance directives should be included in new employee orientation.
LIVING WILLS
A living will is a written directive executed by a competent adult
person instructing his (her) physician to withhold or withdraw life
sustaining procedures in the event of a terminal condition, a coma
or a persistent vegetative state. Under the Georgia statute governing living wills neither the physician nor the Hospital will have civil
or criminal liability for withholding or withdrawing life sustaining
procedures from a patient who has executed a living will, if the living will has been executed appropriately and if the physician and the
Hospital act in good faith and in compliance with the law.
The statute limits the physician and the Hospital from involvement
in several aspects of the execution of the living will:
(a) No physician or hospital may require any person to execute a
living will as a condition to receiving any healthcare services.
(b) The Hospital may prepare, offer to prepare, or otherwise provide forms for a living will when requested to do so by the person desiring to execute the living will. If the patient requests
a living will form please contact Social Services at 5- 4195,
Chaplaincy Services 5-4270 or the Office of Legal Affairs at
5-5147.
Each living will must be executed in the presence of two (2) witnesses. If the patient is in a hospital or nursing home at the time the
living will is executed, in addition to the two (2) witnesses, the living
will must be signed in the presence of the Medical Director, any
physician on the medical staff who is not participating in the care of
the patient or a person on the Hospital staff who is not participating
in the care of the patient designated by the Medical Director and the
Executive Director to witness living wills.
If a living will is executed on or after March 18, 1986, it shall be
valid indefinitely unless revoked. If a living will was executed prior
to March 18, 1986, it should be reviewed with Administration or
the Office of Legal Affairs. When the time comes to implement the
patientʼs desires expressed in the living will, Administration, the Office of Legal Affairs, Social Services and/or the Medical Director
should be consulted with regard to any questions or concerns. Prior
to withholding or withdrawing life sustaining treatment, the following actions should be taken:
(a) The attending physician should determine that the patient is not
pregnant, or if pregnant that the fetus is not viable and that the
patientʼs living will specifically indicates that the living will is
to be carried out.
(b) The patientʼs attending physician and concurring physician
must provide written certification of the fact that the patient
has a terminal condition, is in a coma, or in a persistent vegetative state:
(i) A coma means a profound state of unconsciousness caused
by disease, injury, poison, or other means and for which
it has been determined that there exists no reasonable
78
LIVING WILL FORM
79
expectation of regaining consciousness. The two physicians must indicate in writing, after examination of the
patient, that the patient has been in a profound state of
unconsciousness for a period of time for the physicians to
conclude that the unconscious state will continue and that
there is no reasonable expectation that the declarant will
regain consciousness.
(ii) A persistent vegetative state means a state of severe mental impairment in which only involuntary bodily functions
are present and for which there exists no reasonable expectation of regaining significant cognitive function. To
establish the existence of a persistent vegetable state, the
two (2) physicians must examine the patient and certify in
writing that the patientʼs cognitive function has been substantially impaired and there is no reasonable expectation
that the patient will regain significant cognitive function.
(iii) A terminal condition means an incurable condition
caused by disease, illness or injury which, regardless of
the application of life-sustaining procedures, would produce death. To establish the existence of a terminal condition the two (2) physicians must certify in writing after
personally examining the patient that there is no reasonable expectation for improvement of the condition of the
patient and death of the patient from these conditions will
occur as a result of such illness or injury.
(c) The attending physician must determine that the living will is
in the exact form, or substantially the form, specified by Georgia law.
If the patient has also executed a Durable Power of Attorney for
Healthcare the living will is in-effective and inoperative as long as
there is an agent available to serve pursuant to the Durable Power of
Attorney which grants the agent authority with respect to the withdrawal of or withholding of life-sustaining or death delaying treatment.
(Also see this Manual Advance Directives.)
DURABLE POWER OF ATTORNEY FOR HEALTHCARE
Under the Georgia law an adult with decision-making capacity has
the right to control all aspects of his (her) personal care and medical
treatment, including, the right to decline medical treatment or to direct the withdrawal of treatment. However, if an individual becomes
disabled, incapacitated or incompetent his (her) right to control treatment may be denied unless the individual, as principal, delegates his
(her) decision-making power to a trusted agent. A durable power of
attorney for healthcare (“DPOA”) is an advance directive in which
a patient/principal, in writing, names someone else (as agent, attorney in fact, or proxy) to make healthcare decisions in the event the
patient/principal becomes unable to make the decisions himself (herself). The durable power of attorney for healthcare can also include
instruction about specific choices to be made.
The healthcare powers that may be delegated to an agent, include,
80
without limitation, all powers that the patient would have including
the right to be informed about, consent to, refuse or withdraw any
type of healthcare for the principal. The agency may extend beyond
the patientʼs death, if necessary to permit anatomical gifts, autopsy
or disposition of remains. The DPOA must be in writing and signed
by the patient/principal, or by some other person in the principalʼs
presence and at his (her) expressed direction, if the principal is physically unable to sign for himself (herself). The DPOA must include
the powers and protection similar to the statutory form required and
set forth in the Georgia Statute. (See sample form on page 100 of
this Manual). In order to verify the existence or the validity of a durable power of attorney, particularly with regard to withholding or
withdrawing life sustaining procedures from a patient the physician
should consult Administration, the Medical Director or the Office of
Legal Affairs.
The durable power of attorney must be attested and subscribed in
the presence of the patient/principal by two (2) or more competent
witnesses who are eighteen (18) years of age or older. If the patient
is in the Hospital or in a nursing home at the time the DPOA is executed, it must be attested and subscribed to in the presence of the
principalʼs attending faculty physician. Members of the house and
medical staffs and employees of the Hospital are prohibited from
acting as witnesses to the DPOA.
If the patient is able to understand the general nature of healthcare
procedures being consented to or refused, as determined by the attending physician based on the physicianʼs good faith judgment, the
patientʼs decision will have authority. An agent appointed under a
durable power of attorney shall not have the authority to make a particular healthcare decision different from or contrary to the patient if
the patient is able to understand the general nature of the healthcare
procedure being consented to or refused. The patient may revoke or
amend a durable power of attorney at any time without regard to the
patientʼs mental or physical condition. The DPOA may be revoked
by any one of the following methods: by being obliterated, burned,
torn or otherwise destroyed or defaced in manner indicating an intention to revoke by the patient or by some person in his presence and by
his direction; by written revocation signed and dated by the patient
or by an individual acting for or on behalf of the patient; or by an
oral or any other expression of the intent to revoke the agency in the
presence of a witness eighteen (18) years of age or older.
The DPOA should be made a part of the patientʼs medical record
and any and all changes to the durable power of attorney should be
included in the record. Whenever the patientʼs attending physician
or other staff members believe the patient is unable to understand
the general nature of a healthcare procedure which the staff deems
necessary, the attending physician shall consult with the available
agent who then shall have the power to act for the patient. As with
a living will, healthcare providers and other third parties who rely in
good faith on the acts and decisions of the agent within the scope of
the power of the DPOA may do so without fear of civil or criminal
liability to the principal, the state, or any other person.
81
GEORGIA STATUTORY SHORT FORM, page 1
82
GEORGIA STATUTORY SHORT FORM, page 2
83
GEORGIA STATUTORY SHORT FORM, page 3
84
SECTION II
CLINICS
85
CLINICS, AMBULATORY CARE
The complex of Outpatient Clinics at Grady Health System serves
the dual purpose of contributing an essential service to the community while providing the house staff physician with valuable and diversified clinical experience.
Emergency Clinics
The Emergency Care Center is located on the ground floor, Armstrong Street side; it serves as the only Level I Trauma Center for the
metropolitan Atlanta area. It is continuously staffed by a compliment
of resident physicians under the 24 hour-per-day guidance of Board
Certified Emergency Physicians.
Patients in the Emergency Care Center are seen in one of five contiguous treatment areas. Red Zone is designated as the major trauma/major surgery area; Blue Zone is designated as the major medical area. Each Zone is perfectly capable of treating any emergency
complaint. Patients with acute asthma are evaluated in a specially
designated treatment area, while patients with low acuity complaints
are evaluated in Patient Ambulatory Care express (PACe). Care for
prisoners is provided in the Detention area. In addition to the five
treatment areas, a segment of patients with chest pain are evaluated
in the Chest Pain Center under a specific treatment and risk stratification protocol.
The Psychiatric Emergency Clinic is located on 13B; Pediatric
Emergency Clinic is located on 1st floor, Hughes Spalding Childrenʼs
Hospital. The Womenʼs Urgent Care Center is located on the ground
floor of the clinic building, Pratt Street side. Each of the emergency
clinics is staffed continuously by a complement of residents under the
direction of an Active Staff physician.
Care must be taken to provide the most efficient care possible to all
patients while maintaining an atmosphere conducive to the fostering
of good patient relations. The physician must be fully aware that what
may appear to be a medically negligible condition may, in fact, be a
source of extreme concern to the patient or to the patientʼs relatives.
Whenever possible, of course, obvious nonemergent cases are to be
treated and then referred out of an emergency clinic to the appropriate
Appointment Clinic.
Primary Care Appointment Center
The Primary Care Appointment Center serves as the primary entry
point for non-appointment ambulatory patients who present to Grady
Memorial Hospital for non-emergent health care services. The Primary Care Appointment Center is located on the Ground Floor, A
area, in the main hospital building adjacent to the Clinic Building
Atrium. It is operational from 0700 until 1530, Monday through Friday, except Grady observed holidays. Due to the efforts of Medicaid
and other payers to reduce the use of unnecessary and costly emergency room visits for non-emergent problems, the Primary Care Appointment Center also provides a mechanism for patients to continue
86
their relationship with their primary care physician/provider.
Advice Nurse Center
The Advice Nurse Center seeks to assure that patients get the health
service they need, at the appropriate time and in the most appropriate
location. The program represents the development of a new point of
entry or an additional front door for Grady Health System®.
The Advice Nurse Center is located on the Ground Floor, A area,
in the main hospital building adjacent to the Clinic Building Atrium.
It it operational 24 hours a day, seven days a week, providing services that include health assessment/triage, physician/service referral,
health information, general information, after-hours calls for providers, appointment coordination, followup calls, authorization of health
services, and coordination of health care needs. The Center can be
reached at 616-0600.
Advice nurses are registered nurses who have received special
training. The software product that is used provides comprehensive
guidelines to support and complement the professional judgement of
the nurses. Primary care physicians are available around the clock to
support the advice nurses and to assist with callers when necessary.
The Advice Nurse Center seeks to help people establish a relationship
with both a primary care location within our network and a personal
primary care physician.
Endoscopy Center
The Endoscopy Center is a service of the Division of Digestive
Diseases, Department of Medicine. It is located on the 2nd floor, Darea. The hours of operation are 0800-1630, Monday through Friday,
except on Tuesday 0800-1200. The phone extensions are 5-4358 and
5-4359. The following special procedures are performed:
1. Esophagogastroduodenoscopy
2. ERCP
3. Sclerosis Banding of Esophageal Varices
4. Esophageal Dilation
5. Colonoscopy
6. Proctosigmoidoscopy
7. Liver Biopsy
8. Large Volume Parcentesis
9. Small Intestinal Biopsy
10. Gastric Analysis
11. PEG
12. Esophageal Stent Placement
All routine procedures must be scheduled through the GI Fellows
or GI Residents, by submitting a written consultation form. Emergency endoscopy procedures may be scheduled by paging the GI Fellow with individual PIC number. Outpatients are scheduled for elective procedures through consultation to the Medical GI Clinic (which
meets in the Grady Clinic Building, Ground Floor, J-Area) or upon
direct approval by a GI Fellow. A written request is mandatory. Some
87
outpatient procedures can be directly ordered by the referring physician without being seen in the GI clinic. A consult referral should still
be sent with the patientʼs pertinent medical information along with
the referring physicians PIC number and the endoscopy date assigned
for the patient.
Written consults on inpatients should be placed in the GI mail slot
in the post office. These are picked up daily Monday through Friday by 0700. A consultation request submitted without a physicianʼs
name will not be accepted.
For additional information, please refer to Gastroenterology (GI)/
Endoscopy Center in the Appointment Clinics section of the manual.
Georgia Sickle Cell Center
The Georgia Sickle Cell Center was established through funding
appropriated by the General Assembly of Georgia. The services of the
Center are available to all citizens of Georgia with sickle cell disease.
The Center is staffed by physician assistants, nurse practitioners, staff
hematologists, and residents of the Department of Medicine. In addition, the staff includes nursing staff involved in chronic care, genetic
counseling, and patient education, as well as a psychiatric nurse clinician, a social worker, a vocational rehabilitation counselor, and an
occupational therapist. Treatment is followed by protocol.
The Center is located on Ground Floor, Clinic Building and operates 24 hours a day, seven days a week providing care for patients
with acute exacerbations of sickle cell disease and related hemoglobinopathies. The Centerʼs extensions are 5-3572 and 5- 4539. Patients
less than 16 years are treated in the Pediatric Emergency Clinic. Pregnant patients should be referred to the Womenʼs Urgent Care Clinic.
Patients with burns, cuts, etc. are seen in the ECC. Center staff is
available to assist with triage decisions by calling 5-3572.
In addition to acute care, the Center also provides for health maintenance care and follow up care for adult and pediatric patients. For
further information, please refer to Sickle Cell Chronic Care Clinic in
the Appointment Clinics section of this manual.
APPOINTMENT CLINICS
The Hospital maintains outpatient Appointment Clinics corresponding to all inpatient services. Additionally, ambulatory services
include a Psychiatric Day Care Center, Drug Treatment Center, Physical and Occupational Therapy, Radiation Oncology Center, neighborhood health centers, Audiology, Speech Pathology, and an Optical
Dispensary.
AIDS Clinic - Please see Infectious Disease Clinic.
CLINIC:
SERVICE:
CLINIC CODE:
DAY/HOURS HELD:
PLACE:
ASTHMA/ALLERGY, ADULT
MEDICINE
XALR
Monday through Friday, 0800-1630
Clinic Building ILS
88
PHONE:
616-7390
LAB PREREQUISITE: None
METHOD OF REFERRAL:
Patients may be referred from any outpatient facility or ward upon
submission of a consultation sheet including a brief description of the
patientʼs problem.
Patients needing urgent referrals from in-house or ECC or UCC
may be made by consultation sheet and/or by contacting the clinic at
the above number.
Patients who have irreversible COPD or any other irreversible pulmonary problems are not followed in this clinic unless an allergic
component or reversible asthma is suspected, which if treated, could
improve the patientʼs outcome.
PROBLEMS TO WHICH SPECIALTY ASTHMA/ALLERGY
CARE WILL BE GIVEN:
1. Asthma which is unstable or uncontrolled or requires multiple
medications.
2. Emergency room visits or hospitalization of the patient for
asthma.
3. Asthma or allergic disease which interferes with a patientʼs
quality of life or causes recurrent absences from school or
work.
4. Excessive use of inhaled beta agonists.
5. Asthma which requires frequent bursts of systemic corticosteroids or daily oral corticosteroids.
6. Chronic cough, refractory to usual therapy.
7. Frequent nocturnal episodes of asthma.
8. Disease (rhinitis, urticaria, angioedema, etc.) which may be
caused by allergens or other environmental factors.
9. Diagnosis of asthma is uncertain.
10. The patient asks for a consultation.
CLINIC:
SERVICE:
CLINIC CODE:
AUDIOLOGY/SPEECH PATHOLOGY
REHAB
213 Speech Pathology
214 Audiology
DAY/HOURS HELD: Monday-Friday, 0800-1630
(sessions vary)
PLACE:
3J — Otolaryngology (ENT) Clinic
PHONE:
5-8267-Audiology
5-8265-Speech Pathology
METHOD OF REFERRAL:
A Patient may be referred for evaluation by any hospital physician. Referrals must include a consultation request form with a brief
description of the patientʼs medical problem(s), location/area, physicianʼs name and physicianʼs ID number.
89
FOLLOW-UP
The need for follow-up will be determined by the severity of illness and response to treatment.
CLINIC:
SERVICE:
CLINIC CODE:
COMPREHENSIVE BREAST CENTER
BREAST
Z001-Emory Surgical Breast
Z002- Morehouse Surgical Breast Clinic
Z003-Emory GYN Breast Clinic
Z004-FNA
Z006-Screening
DAY/HOURS HELD: Monday-0800-1200, Friday-1200-1500
Emory Surgical Breast
Tuesday-0800-1500 Screening Clinic
Wednesday-0800-1500 Screening Clinic
Tuesday-0800-1200 GYN Breast Clinic
Wednesday-1000-1200, Friday-0800-1200
Morehouse Surgical Breast Clinic
Thursday-0800-1500-Screening Clinic
PLACE:
Ground Floor New Building GK
PHONE:
5-3494
METHOD OF REFERRAL: Written Referral Only Health Care Providers/In Reach/GHS & Outreach/Community
MULTIDISCIPLINARY BREAST CONFERENCE: Mondays 1700 Ground Floor, Pathology Conference Room
FNA CLINICS
DAYS/HOURS HELD: Monday-0900-1200
Tuesday 0900-1200
Friday 0900-1200
METHOD OF REFERRAL: Referral form MRC #40-38
Note: FNAs can be performed at other times in urgent cases, or on
the wards for isolated or immobile patients. Please call Cytology, 53650, to schedule.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
CARDIAC, ADULT (EMORY)
MEDICINE
130
4 days a week — Mondays & Fridays
0800-1200
Wednesdays & Thursdays 1230-1630
2nd Floor — E Area
5-4422
METHOD OF REFERRAL:
Patients may be referred for evaluation by any hospital physician,
neighborhood health clinic, or Grady Vocational Rehabilitation. Re-
90
ferrals must include a consultation sheet with a brief description of
the patientʼs problem, the referring physicianʼs name, number and
location.
LAB PREREQUISITE: EKG and recent PA chest film.
FOLLOW-UP: As requested.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
1. ASHD-CHF, arrhythmias, severe angina, post coronary
bypass, PTCA evaluation for coronary surgery.
2. Permanent pacemaker implantations.
3. Valvular heart disease: prosthetic valves or other management
problems.
4. Hypertension ó when it complicates other CV diseases.
5. Problems in diagnoses and management of congenital heart
disease, cardiomyopathy and miscellaneous congenital and
acquired valvular diseases.
6. Problems in CV disease.
CLINIC:
SERVICE:
CARDIAC, ADULT (MOREHOUSE)
MEDICINE —
REFERRAL SERVICE ONLY
CLINIC CODE:
136
DAYS/HOURS HELD: 4 days a week — Monday 1230-1630
— Tuesday 1230-1630
— Wednesday 0900-1200
— Thursday 0900-1200
PLACE:
2nd floor — E Area
PHONE:
5-4422
METHOD OF REFERRAL: Patients may be referred for evaluation
by any hospital physician, neighborhood health clinic, or Grady Vocational Rehabilitation. Referrals must include a consultation sheet
with a brief description of the patientʼs problem, the referring physicianʼs name, number and location.
LAB PREREQUISITE: EKG and recent PA chest film.
FOLLOW-UP: Patients are given follow-up appointments at the discretion of the clinic attending. If no further follow-up is needed, patients are then dismissed from the clinic and released to their primary
care clinic.
CLINIC:
CARDIAC, BLOODPRESSURE,
ADULT (NURSE)
SERVICE:
MEDICINE
CLINIC CODE:
139
DAYS/HOURS HELD: 2 days a week — Tuesday, 0830-1100
— Friday, 1230-1530
PLACE:
2nd Floor — E Area
PHONE:
5-4424
91
METHOD OF REFERRAL: Patients may be referred by any cardiac
fellow. Patients must be cardiac clinic patients.
FOLLOW-UP: As requested.
CLINIC:
CARDIAC CONSULTATION FOR
PREOPERATIVE EVALUATION
(EMORY)
SERVICE:
MEDICINE
CLINIC CODE:
137
DAYS/HOURS HELD: Wednesdays, Thursdays, 0800-1200.
PLACE:
2nd Floor — E Area.
PHONE:
5-4422
METHOD OF REFERRAL: Patients may be referred by any hospital
or clinic physician requesting cardiac clearance for a surgical procedure to be done on an inpatient or an outpatient basis. Referral must
include a consultation sheet with a brief description of the patientʼs
problem, the date of planned surgery, the referring physicianʼs name,
number, and location.
LAB PREREQUISITE: EKG, PA chest film and SMA-7. May obtain
EKG on date of clinic visit.
FOLLOW-UP: The consultation report will include, in addition to
the clearance for surgery, the suggested preoperative orders or procedures. If clearance for surgery is not given, the referring physician
will be telephoned so that the surgery can be rescheduled.
CLINIC:
CARDIAC REHABILITATION
PROGRAM
SERVICE:
MEDICINE
DAYS/HOURS HELD: 3 days a week, Tuesday, Wednesday,
Friday
0830-1000
PLACE:
16th Floor, Room 1609
PHONE:
5-9970
The cardiac rehabilitation program includes an exercise training
program for patients with Angina Pectoris, Myocardial Infarction,
Status Post Coronary Bypass Surgery and other selected patients after
cardiac surgery or with other cardiac problems.
METHOD OF REFERRAL: Refer to Cardiac Clinic for a baseline
exercise test and specific exercise prescription. The program is supervised by a physician, exercise physiologist and a nurse.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
0830-1130, 1300-1500
PLACE:
PHONE:
COUMADIN
MEDICINE
145
4 days a week, Mon-Thur,
2nd Floor — Cardiac Clinics Area.
5-4428 or 5-6677
92
METHOD OF REFERRAL: A Coumadin Clinic referral form must
be completed by the inpatient or clinic physician for each patient referred to the Coumadin Clinic. Patients will not be enrolled unless
the completed referral form includes (pre-printed Coumadin referral
forms are available on all areas):
1. Problem for which anticoagulation therapy is prescribed.
2. Anticipated duration of therapy.
3. Prothrombin level/dosage 48 and 24 hours prior to discharge
for hospitalized patients.
4. Discharge prothrombin level and medication instructions.
5. Hematocrit within one week of discharge.
6. Discharge medications.
7. Appointment date for Medical, Cardiac Clinic or other primary
care clinic.
8. Doctorʼs name and number requesting referral.
Prior to referral from the in-patient area, the Cardiac Clinic Teaching Nurse should be requested to educate the patient about anticoagulant therapy and its management when Coumadin therapy is initiated.
The area clerk requesting an appointment for the Coumadin Clinic
should call the Coumadin Clinic at extension 5-4428. Clinic code,
area, time and appointment date will be given to the area clerk. An
appointment slip should be given to the patient on the area, together
with the patient copy of the referral form.
FOLLOW-UP: Patients are followed by a nurse. A Cardiac Clinic
physician is assigned to the Clinic for consultation regarding problems relating to anticoagulation. The patient MUST be followed in a
primary care clinic during anticoagulation therapy. Problems in management of anticoagulation (compliance, medical problems, side effects, etc.) will be addressed to the primary care physician. Dismissal
process from the clinic will require re-referral prior to re-admittance
to Coumadin Clinic (See method of referral).
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
DERMATOLOGY
GENERAL DERMATOLOGY
176, 177, 178
Monday: 0900-1200,
Wednesday and Thursday: 1300-1600,
Tuesday and Friday: 0900-1600.
Same day patients directed to the
Dermatology Clinic are evaluated
daily except Wednesday and Thursday
morning. Patients with skin disorder
requiring regular follow-up in the
Dermatology Clinic are given
appointments.
Dermatology Clinic, First Floor - A - Area.
5-4239
METHOD OF REFERRAL: Consultation sheet to Dermatology
93
Clinic clerk. Self Referral (see above).
LAB PREREQUISITE: None.
FOLLOW-UP: Patients will be sent back to referring physician: followed with referring physician; or provided primary care, depending
on particulars of individual case.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Diseases unique to the skin or diseases in which dominant problems
can best be managed in the Dermatology Clinic.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
DERMATOLOGY, PEDIATRIC
DERMATOLOGY
179
Mondays 1230-1600. Same day patients
directed to the Dermatology Clinic are
evaluated the same day. Patients with skin
disorders requiring regular follow-up in
the Dermatology Clinic are given appointments.
Dermatology Clinic, First Floor, A-Area
5-4239
METHOD OF REFERRAL: Consultation sheet to Dermatology
Clinic clerk. Self Referral (see above).
LAB PREREQUISITE: None.
FOLLOW-UP: Patients will be sent back to referring physician; followed with referring physician; or provided primary care, depending
on particulars of individual case.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Diseases unique to the skin or diseases in which dominant problems
can best be managed in the Dermatology Clinic.
CLINIC:
DIABETES DETECTION & CONTROL
CENTER
(New Patients to the Diabetes Clinic)
SERVICE:
MEDICINE
DAYS/HOURS HELD: Monday, Tuesday, Thursday and
Friday 0730-1600
PLACE:
Feebeck Hall, First Floor.
METHOD OF REFERRAL: Healthcare providers must submit a
consultation form. The consultation should give an indication of how
soon patient should be seen. Patients can be seen within 24- 48 hours
if indicated. Diabetes Screening can be arranged by calling extension
5-3730.
LAB PREREQUISITE:
94
1. If a random Plasma Glucose (PG) is obtained and the result is:
A.
> 140 mg/dl, obtain FPG.
B.
> 200 mg/dl & asymptomatic, obtain FPG.
C.
> 200 mg/dl & symptomatic, refer to DDCC.
2. If a Fasting Plasma Glucose (FBG) is obtained and the result is:
A.
> 140 mg/dl times 2 refer to DDCC.
B.
< 140 mg/dl once & > 140 mg/dl once, schedule a Glucose Tolerance Test with the Diabetes Clinic.
Numbers 1 and 2 on lab prerequisite will be changed nationwide as
diagnostic criteria 6/97.
FOLLOW-UP: If no primary clinic identified the Diabetes Clinic will
provide follow-up. Otherwise, the patient is referred back to the primary care clinic for follow-up.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
All patients with diabetes will be provided primary care unless primary care is being provided in another clinic.
CLINIC:
DIABETES CLINIC (Follow-Up Patients)
SERVICE:
MEDICINE
DAYS/HOURS HELD: 5 days, 0800-1630, except
Wednesday, 0800-1200
PLACE:
Feebeck Hall, First Floor.
PHONE:
5-3730
METHOD OF REFERRAL:
1. If a patient has not been seen before in the Diabetes Clinic, refer
to Diabetes Detection and Control Center.
2. Call extension 5-3730 and ask to speak with the primary care provider assigned to the patient. This can be determined by the front
desk, a chart note, the nurseʼs name on the primary care sticker,
or patientʼs ID card if the Diabetes Clinic is providing primary
care.
LAB PREREQUISITE: None for follow-up in the Diabetes Clinic.
FOLLOW-UP Follow-up will be determined by the patientʼs illness.
Discussion with the specific primary care provider involved is encouraged. Referring physicians should indicate their plan for followup and how our efforts can best be coordinated.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN: All
persons with Diabetes Mellitus will be provided primary care if they
are not receiving primary care in another clinic.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
DRUG DEPENDENCE UNIT (DDU)
PSYCHIATRY
651-657
Monday-Friday, 0730-1830
Saturday, Sunday and Holidays, (07151100)
95
PLACE:
PHONE:
(Medication Only — Monday-Friday, 07301030/1200-1300/1800-1830
Saturday, Sunday and holidays 0715-1015,
DDU)
Florida Hall - 60 Coca Cola Place
5-3970; 5-3971
METHOD OF REFERRAL: Referral can be made by any GHS staff
member or other agencies and facilities for a patient who resides in
Fulton and DeKalb Counties.
Inpatient: Call the DDU immediately and forward a referral by way
of a consultation upon admission and/or at the time of any identified
signs/syptoms of a substance abuse disorder.
Outpatient: Patient may walk in during clinic hours and be interviewed by a DDU staff member prior to admission. The patient must
present a valid I.D. (i.e., Georgia Drivers License or Georgia Identification Card).
LAB PREREQUISITE: None (lab work will be done by DDU staff)
FOLLOW-UP: Patients may be continued on the program for counseling and follow-up in keeping with their needs.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN: The
DDU is a voluntary outpatient treatment program for adult heroin addicts and/or individuals addicted to opioid, opiate alkaloids and their
derivatives or meet diagnosis criteria for DSM-IV Opioid Dependence. The DDU also provide patient care services that include:
1. Methadone substitution therapy for opioid dependence
patients.
2. Consultation service for inpatient at Grady memorial
Hospital with a drug related illness and dependence.
3. Referrals for other substance-related disorders.
CLINIC:
INTERNATIONAL MEDICAL
CENTER (IMC)
SERVICE:
Primary Family Care (Adult, Teen and Pediatric patients), OB/GYN, Internal Medicine,
Pediatrics, Mental Health, Tropical Medicine and Infectious Disease Clinic, Centering Program®, Bengali Clinic, Diabetes
Education Classes
CLINIC CODES:
M159 and P733 (Pediatrics)
DAYS/HOURS HELD: Monday through Friday 0800-1700
Saturday 0800-1200
PLACE:
Clinic Building at Ground Floor GK028
PHONE:
404-616-6689
FAX:
404-616-0207
Spanish Health Line: 404-616-2555
LANGUAGES:
Spanish, Bengali, English (Other languageS
may be added in the future.)
96
LAB PREREQUISITE: None
DESCRIPTION OF SERVICES PROVIDED: comprehensive, multidisciplinary, primary care outpatient center, which provides multicultural clinical services in Internal Medicine, Pediatrics, OB/GYN,
Centering Program® (group prenatal care in Spanish), Mental Health,
Bengali Clinic, and Tropical Medicine and Infectious Diseases in a
culturally and linguistically appropriate environment. Consultations
for Hispanic individuals diagnosed with diabetes. Diabetes education classes offered in Spanish. Ready, Set, Read Program and other
community resources are used to enhance community literacy and
knowledge.
METHOD OF REFERRAL: Patients who are in need of a bilingual
primary care provider may be referred from any outpatient/inpatient
service or other entity within the Grady Health System, any agency
or facility in Fulton or DeKalb counties, or by self-referrals. Appointments are encouraged, and made by either direct phone call to
the IMC or through central scheduling. Walk-ins are accepted based
on availability.
FOLLOW UP: Patients are established with an IMC bilingual Primary Care Providers (PCP) for continuity of care. When indicated,
referrals are made to GHS sub-specialties.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Health screenings, any adult and pediatric chronic or acute medical
illnesses, any minor surgical problems, healthy prenatal care, noncomplex gynecological visits including Pap Smears, well-child health
visits and immunizations. In emergency cases, we are equipped and
trained to temporarily treat and stabilize the patient prior to transport
to the emergency room.
Clinical Manager: Maria Lemons, RN
Medical Director: Flavia Mercado, MD
Department Director: Sandra Sanchez, MS
CLINIC:
TERMINATION OF PREGNANCY
INTERVIEW/COUNSELING
OB/GYN AMBULATORY SURGERY
SERVICE:
OB/GYN
RESOURCE CODE: O411/ABOR
DAYS/HOURS HELD: Tuesday, Wednesday, Thursday, Friday;
0830; Walk-Ins Accepted
LOCATION:
Room 4F027
PHONE:
5-3866
METHOD OF REFERRAL: Patient request
LAB PREREQUISITE: None
OTHER: Must reside in Fulton or DeKalb County with income less
than 200% of FPL.
97
FOLLOW-UP: Patients are scheduled for the Pre-Op Clinic as soon
as possible.
CLINIC:
STERILIZATION INTERVIEW/
COUNSELING
OB/GYN AMBULATORY SURGERY
SERVICE:
OB/GYN
RESOURCE CODE: O411/STER
DAYS/HOURS HELD: 0930-1630 Monday through Friday,
Walk-Ins Accepted
Tuesday through Friday
PLACE:
Room 4F027
PHONE:
5-3866
METHOD OF REFERRAL: Patient request
LAB PREREQUISITE: None
OTHER PREREQUISITE: Must reside in Fulton or DeKalb County;
Thirty day written consent is required.
FOLLOW-UP: Patients are scheduled for the Pre-op Clinic.
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
OB/GYN AMBULATORY SURGERY
OB/GYN/Morehouse
O410/ABOR
Thursday, 0630-1700
Area 4K Ambulatory Surgery
5-3626
METHOD OF REFERRAL: Scheduled by the OB/GYN Ambulatory
Surgery Counselors and Nurses and the Morehouse provider in the
WUCC or the FBC.
LAB PREREQUISITE: ABOR-Routine prenatal labs.
FOLLOW-UP: Return for follow-up in 3 weeks.
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
OB/GYN AMBULATORY SURGERY
OB/GYN/Emory
O413/ABOR
Monday and Thursday 0600-1700
Area 4-K, Ambulatory Surgery Unit
5-3626
METHOD OF REFERRAL: Scheduled by OB/GYN Ambulatory
Surgery Counselors and Nurses per physician order or provider in
WUCC or FBC.
LAB PREREQUISITE: ABOR-Routine prenatal labs.
FOLLOW-UP: Return for follow-up in 3 weeks.
CLINIC:
PRE-OP CLINIC
98
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
OB/GYN AMBULATORY SURGERY
OB/GYN/Morehouse
CMSM
Wednesday, 1300
Area 2K OB/GYN Clinic
5-3866
METHOD OF REFERRAL: Scheduled by OB/GYN Ambulatory
Surgery Counselors or the Morehouse Clinic.
LAB PREREQUISITE: None
OTHER PREREQUISITE: None
FOLLOW-UP: Patients are scheduled for the out-patient surgical
procedure indicated
CLINIC:
PRE-OP CLINIC —
OB/GYN AMBULATORY SURGERY
SERVICE:
OB/GYN/Emory
RESOURCE CODE: O412/ABOR, STER
DAYS/HOURS HELD: Wednesday and Friday, 1300-1700
PLACE:
Area 2-J, OB/GYN Clinic
PHONE:
5-3866; 5-4646
METHOD OF REFERRAL: OB/GYN Ambulatory Surgery Staff and
the GYN Clinic.
LAB PREREQUISITE: None
OTHER PREREQUISITE: None
FOLLOW-UP: Patients are scheduled for the outpatient surgical procedure indicated.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
OB/GYN CLINIC
OB/GYN
O415/Emory
Wednesday & Friday, 1230-1430
2G062
5-8054
METHOD OF REFERRAL: Scheduled by provider in the Urogynecology Clinic.
LAB PREREQUISITE: Urinalysis and Urine Culture.
OTHER PREREQUISITE; None
FOLLOW-UP: Patients are scheduled to return to Urogynecology
Follow-up Clinic.
99
CLINIC:
SERVICE:
RESOURCE:
DAYS/HOURS HELD:
Tuesday, 0800-1130
PLACE:
PHONE:
EMORY COLPOSCOPY
GYN, OB
COLP
Monday, 0800-1600
2K Clinic Bldg.
616-5128
METHOD OF REFERRAL: Tumor Registry, Provider
CLINIC:
PRE-OP CLINIC
MAIN OR
SERVICE:
GYN, EMORY
RESOURCE:
GYNN/PROP, SURG
DAYS/HOURS HELD: Tuesday, 1300-1600
PLACE:
2K OR/GYN Clinic
CLINIC:
SERVICE:
RESOURCE:
DAYS/HOURS HELD:
PLACE:
PHONE:
EMORY GYN BREAST
GYN
GBRS
Wednesday 1230-1600
2K Clinic Bldg.
616-4242
METHOD OF REFERRAL: Provider, Self
CLINIC:
CLINIC CODE:
SERVICE:
DAYS/HOURS HELD:
PLACE:
PHONE:
ENDOCRINE
X157
MEDICINE
Thursday, 1230-1630
Clinic Building - GJN
616-2501
METHOD OF REFERRAL: Referral consultation form describing
endocrine problem (or suspicion) required for appointment. Urgent
consultations should be discussed with endocrine consult fellow or
attending. Patients needing diabetes care should be referred to Diabetes Clinic, not Endocrine.
LAB PREREQUISITE: None.
FOLLOW-UP: Patients will usually be referred back when diagnosis
is complete and treatment stabilized.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
None.
CLINIC:
FAMILY PLANNING CLINIC/FAMILY
PLANNING WOMENʼS HEALTH CARE
SERVICE:
GYN
RESOURCE CODE: F001
DAYS/HOURS HELD: 0800-1630, Monday, Tuesday,
100
LOCATION:
PHONE:
Thursday, Friday 0930-1630, Wednesday
Closed on all major holidays.
Clinic Building, Second Floor, “J”
(404)616-3680/7523/7525
METHOD OF REFERRAL: No referral necessary.
LAB PREREQUISITE: None
FOLLOW-UP: Scheduled for return appointment or refer to appropriate clinic.
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
GENETIC COUNSELING
OB/GYN
None
Tuesday and Thursday, 0830-1430
Regional Perinatal Center-2L
(404) 616-4936 to make appointments
METHOD OF REFERRAL: Referred from New OB, CNM Clinic,
Continuity, WUCC, Family Birth Center Lindberg, Clifton Springs
or Private Facilities.
LAB PREREQUISITE; New OB Lab Data. General medical workup
in the PAC or Hospital. Call the Genetics Division secretary to obtain
specific information. When possible, intake directly from the patient
will be obtained by the secretary. In general, a detailed family history, records from referring physicians, including specific x-rays, occasionally cytogenetic or biochemical screening are desired before
the initial visit. Ask patients to prepare to answer questions relative to
family relationship, disease, etc.
FOLLOW-UP: Pedigree and results of counseling will be placed in
permanent Medical Record. Further discussion can be done with the
genetic counselor at (404) 616-7986.
CLINIC:
GASTROENTEROLOGY (GI)
ENDOSCOPY CENTER
SERVICE:
MEDICINE
CLINIC CODES:
M995 — Morehouse Med GI
M170 — Emory Med GI
DAYS/HOURS HELD: Morehouse, Tuesdays 0830-1200
Emory, Tuesdays 1300-1630
PLACE:
Ground floor J-area
PHONE:
5-4358; 5-4359
METHOD OF REFERRAL:
Outpatient: Complete referral form and retain on the area for appropriate distribution. Referrals are only accepted from primary care
physicians.
Inpatient (Emory): Complete referral form and place in mail box in
local post office. These are picked up daily between 0730 and 0830.
Inpatient (Morehouse): Complete referral form and place on front
101
of the patientʼs chart. Notify the physician covering.
Emergencies: Consults may be obtained by beeping the physician
on call. Name and call schedule available through the Grady operator.
LAB PREREQUISITE: None.
FOLLOW-UP: Patients with primary GI problems will be followed
in GI Clinic but their other care will be rendered by their primary
care M.D. Those whose GI problems need diagnosis and treatment
for a short time will be sent back to primary MDs upon completion of
work-up and treatment. Patients sent for diagnostic GI x-rays should
be followed up by the requesting physician or their primary healthcare provider. If abnormal, then refer to GI.
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
LOCATION:
PHONE:
EMORY INFERTILITY
GYN
GEND
1st, 3rd & 5th Wednesday 1300-1600
2K Clinic Bldg.
(404) 616-4242
METHOD OF REFERRAL: Provider.
LAB PREREQUISITE: None
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
EMORY URO-GYN
GYN
GURG
2nd and 4th Wednesday 1300-1600
Thursday 1300-1600
Urodynamics
Wednesday 1300-1600
LOCATION:
2G New Clinic Bldg.
PHONE:
(404) 616-4242
METHOD OF REFERRAL: Provider
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
LOCATION:
PHONE:
MOREHOUSE GYN
GYN
CMSM
M, W, Thur, F 0830-1130
2K New Clinic Bldg.
(404) 616-4242
METHOD OF REFERRAL: Provider, Self
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
LOCATION:
PHONE:
EMORY GYN CONTINUITY
GYN
OBGN
Monday, Tuesday, Thursday, Friday
2K Clinic Bldg.
(404) 616-4242
102
METHOD OF REFERRAL: Provider, Self
LAB PREREQUISITE: None
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
LOCATION:
PHONE:
MOREHOUSE DYSPLASIA
GYN
GMSM
Thursday 1300-1600
2K Clinic Bldg.
(404) 616-5128
METHOD OF REFERRAL: Provider, Tumor Registry
Call (404) 616-5128 for more information.
CLINIC:
SERVICE:
LOCATION:
PHONE:
MOREHOUSE ENDOCRINE
INFERTILITY
GYN
2K Clinic Bldg.
(404) 616-4242
METHOD OF REFERRAL: Provider,
Call (404) 616-4242 for more information.
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
EMORY LEEP
GYN
GOO1
Thursday 0800-1600
2K Clinic Bldg.
(404) 616-5128
METHOD OF REFERRAL: Provider, Tumor Registry
CLINIC:
SERVICE:
DAYS/HOURS HELD:
LOCATION:
PHONE:
MOREHOUSE LEEP
GYN
Friday, 0800-1230
2K Clinic Bldg.
(404) 616-5128
METHOD OF REFERRAL: Provider, Tumor Registry
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
MOREHOUSE BREAST AND LOCTAL
GYN
BLAC
Wednesday 1300-1600
2K Clinic Bldg.
(404) 616-5128
METHOD OF REFERRAL: Provider/Self
CLINIC:
HAND REHABILITATION ( See: Rehab
Therapy Services)
103
CLINIC:
HEMATOLOGY - Malignant and NonMalignant Hematologic Disorders
SERVICE:
MEDICINE
CLINIC CODE:
S180
DAYS/HOURS HELD: Emory - Tuesday 0800-1200
Morehouse - Thursday
0800-1200 — Hematology & Oncology
New Patients - Wednesday, 1230-1600
Follow-up - Thursday, 0830-1200
PLACE:
12C
PHONE:
5-4885
METHOD OF REFERRAL: Patients may be referred from any appointment clinic upon submission of a consultation sheet including
a brief description of the patientʼs problem and all the lab data listed
below. Notations that the lab data have been ordered or are in the
medical record will not be accepted. Patients for whom lab data are
not available or who are referred from any hospital ward, Emergency
Clinic or walk-in clinic will be accepted for appointments only upon
approval by one of the following:
EMORY
1. The Hematology fellow (ext. 5-4885)
2. Dr. Eckman (ext. 5-4885)
MOREHOUSE
1. Dr. Rose (ext. 5-7470)
2. Janese Gaddis, R.N., Scheduling Nurse (ext. 5-5970)
LAB PREREQUISITE:
1. For red cell problems: A CBC to include all red cell indices and
a white blood count and differential; a reticulocyte count and the
corrected reticulocyte production index; a description of the peripheral blood film; platelet estimate; bilirubin (total and direct),
creatinine and BUN; stool for occult blood; and serum iron studies.
2. For white cell problems: A CBC including all red cell indices, a
white blood cell count and differential; a description of the peripheral blood film; and a platelet estimate.
3. For bleeding disorders: A platelet count, prothrombin time, and
partial thromboplastin time.
4. Other malignant disorders: CBC, platelet count, Chem 6 & Chem
12.
FOLLOW-UP: Patients will be sent back to the referring physicians
with a full consultation. In those instances when it is felt that the
patientʼs referral problem requires subspecialty care, the patientʼs
physician will be notified.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Patients with symptomatic hemoglobinopathies, symptomatic, inherited or acquired disorders of hemostatis and hemotologic malignancies.
104
CLINIC:
SERVICE:
INFECTIOUS DISEASE PROGRAM
MEDICINE
DAYS/HOURS HELD: Monday-Friday 0800-1630
Acute Care/Infusions: 0800-1800
PLACE:
The Ponce Center
341 Ponce de Leon Center
Atlanta, GA 30308
PHONE:
Administrative Director – (404) 616-9776
Clinical Coordinator – (404) 616-6322
H.I.V. Education/Intake – (404) 616-9759
Medical Director – (404) 616-2494
Operator – (404) 616-2440
The Infectious Disease Program (IDP) is a comprehensive multidisciplinary facility providing outpatient primary care and case
management to persons with H.I.V./A.I.D.S, further limited to those
with a history of an A.I.D.S.-defining diagnosis and/or a CD4 count
<200. Services include: Primary medical care, womenʼs, childrenʼs
and family clinics, acute care and infusions, mental health, oral health
care, education and community outreach, case management, and various on-site community support services. On-site Ophthamology and
Dermatology consultation service available.
NOTE: For non-H.I.V. related, outpatient Infectious Disease consultations, please contact the Discharge Planning Nurse at 5-9755.
REFERRAL/INTAKES:
Outpatient Referrals: Consultations may be mailed to the H.I.V.
Education Department at P.O. 26113, and patients may present with
their consult sheets in person to the H.I.V. Education Department.
Please including a brief medical history, with proof of seropositivity,
current CD4 count, viral load and PPD status, if possible. Patients
with CD4 count of >200 should be referred to a county health dept.
or other satellite facility, unless they are being followed by another
G.H.S. subspecialty service, or they have special needs that cannot be
met in any similar facility. In such cases, seek approval from the IDP
Medical Director at 5-2493.
Inpatient Referrals: At the time of admission, please contact the
Director of Special Immunology Social Services at 5-3968. To facilitate prompt discharge planning and follow-up at the IDP, also contact
the Continuum Care Team Nurse at 5-2426 and/or the Social Worker/
Health Educator at 5-6318.
REQUIRED LABS: Confirmation of H.I.V.-A.B. seropositivity (may
require G.H.S. retest), CBC with diff., Chem-13, CD4 count, viral
load, RPR,(and Treponemal IgG if RPR is +), Hepatitis A total antibody, HBV core antibody, and HCV AB. TB clearance is required,
with a negative PPD test before discharge, a CXR report, and/or
three negative AFB sputum tests.
Patients with < 100 CD4: serum cryptococcal antigen, toxoplasmo-
105
sis titer
Patients with < 50 CD4: serum AFB
FOLLOW-UP: Patients with chronic medical problems (ie., Hypertension, diabetes) may be referred to the appropriate subspecialty
clinic to assist in their management.
PROBLEMS FOR WHICH PRIMARY CARE WILL BE GIVEN:
H.I.V./A.I.D.S.-related problems.
CLINIC:
SERVICE:
DAYS/HOURS HELD:
PLACE:
PHONE:
PRIMARY CARE CENTER
INTERNAL MEDICINE
Monday-Friday 0800-1700
Ground and 1st Floor New Clinic Building
Pods Purple, Green, Orange and Yellow
5-4396 for all questions, call-in appointments and Pod assignments.
METHOD OF REFERRAL: Patients should be instructed to call
(404) 616-4396 to obtain an appointment. Same-day and next-day
appointments are available for patients who have an urgent need.
A referral should be entered into the OAS Gold System so that the
provider is aware of the reason for the visit. Please specify MD if
desired or appropriate.
LAB PREREQUISITE: None.
FOLLOW-UP: If problem is ongoing Primary Care Center
Physicians will follow unless otherwise requested.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
All problems in Internal Medicine. Colon and gynecological cancer
screenings are available.
CLINIC:
MEDICAL ONCOLOGY — Clinic for
All Solid Tumors Except Lymphomas
SERVICE:
MEDICINE
CLINIC CODES:
S182 Medical Oncology
DAYS/HOURS HELD: Monday (Emory)0800-1200;
Wednesday (Morehouse) 1230-1600;
Thursday (Morehouse) 0830-1200, &
Friday (Emory) 0800-1200
PLACE:
Clinic-12C Office 15B
PHONE:
Clinic - 5-4618 Office - 5-4885
METHOD OF REFERRAL: Patients are seen by appointment only.
New patients appointments are made when a completed referral
(including a current address and phone number) is received and reviewed by Oncology staff. All referral/consults are reviewed for appropriateness. Pathology is required before appointments are made.
The usual turn around time for clinic appointments is 2 weeks, with
consideration for special needs.
106
LAB PREREQUISITE: Tissue Pathology
FOLLOW-UP: Fellows and Attendings provide Long-term Oncology
follow up by appointment.
OTHER: The chemo room is open daily 0800-1630. Located in the
12C clinic.
CLINIC:
NEUROLOGY CLINIC (Emory)
CLINIC CODE:
158
DAYS/HOURS HELD: Wednesday, 0800-1200
Monday, Wednesday and Thursday
1230-1600
PLACE:
11C
PHONE:
5-4567
METHOD OF REFERRAL: Referred by consultation sheet submitted to clinic. Evaluation of routine problems, such as headache or
back pain, seen in the ECC or UCC, should be referred to the Medical
Clinic.
LAB PREREQUISITE: None.
FOLLOW-UP: Patients will be sent back to the referring physicians
with a full consultation. In those instances when it is felt that the
patientʼs referral problem requires neurological care, the patientʼs
physician will be notified.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
NEUROLOGY — SEIZURE (Emory)
NEUROLOGY
161
Monday 0800-1200
11C
5-4567
METHOD OF REFERRAL: Consultation sheet submitted to Clinic.
Only patients with difficult to control seizures will be given appointments. No patients with alcohol withdrawal seizures will be given
appointments.
LAB PREREQUISITE: None.
FOLLOW-UP: Patients will be sent back to the referring physicians
with a full consultation for care in that clinic.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Only patients who have seizures that are difficult to control. No patients with alcohol withdrawal seizures.
CLINIC:
SERVICE:
CLINIC CODE:
NEUROLOGY GENERAL (Morehouse)
NEUROLOGY
M150
107
DAYS/HOURS HELD: Friday 0830-1230
PLACE:
11C
PHONE:
5-4567
METHOD OF REFERRAL: Referred by consultation sheet submitted to clinic. Evaluation of routine problems, such as headache or
back pain, seen in the ECC or UCC, should be referred to the Medical
Clinic.
LAB PREREQUISITE: None.
FOLLOW-UP: Patients will be sent back to the referring physician
with a full consultation. In those instances when it is felt that the
patientʼs referral problem requires neurological care, the patientʼs
physician will be notified.
CLINIC:
NEUROLOGY —
MEMORY ASSESSMENT (Emory)
SERVICE:
NEUROLOGY
CLINIC CODE:
152
DAYS/HOURS HELD: Tuesday, 0800-1500
PLACE:
11C
PHONE:
5-4567
METHOD OF REFERRAL: Clinic is for patients who have memory
impairment or cognitive deficits such as Alzheimerʼs Disease, cerebral vascular disease, head injury or other organic causes. Referral is
by consultation sheet to the neurology clinic.
LAB PREREQUISITE: None.
FOLLOW-UP: Patients will have a neurological and neuropsychological evaluation. In those instances when it is felt that the patientʼs
referral problem requires neurological care, that patientʼs physician
will be notified.
CLINIC:
SERVICE:
DAYS/HOURS HELD:
LOCATION:
PHONE:
EEG/EMG
NEUROLOGY
Monday-Friday 0830-1700
11E
(404) 616-4457
METHOD OF REFERRAL: Consultation from referring physician.
LAB PREREQUISITE: None
FOLLOW-UP: Patients will be sent back to the referring physician
with a full consultation. In those instances when it is felt that the
patientʼs referral problem requires neurological care, the patientʼs
physician will be notified. See also EEG/EMG Laboratory
108
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
EMORY OB ENDOCRINE
OBSTETRICS
BEND
Monday 0800-1130
2J - Clinic Bldg.
(404) 616-4242
METHOD OF REFERRAL: Provider
CLINIC:
OB CARDIO-PULMONARY
SERVICE:
OBSTETRICS
RESOURCE CODE: BCPD
DAYS/HOURS HELD: Monday, 1300-1530
PLACE:
2J Clinic Bldg.
PHONE:
(404) 616-4242
METHOD OF REFERRAL: OB Provider
LAB PREREQUISITE: Positive Pregnancy Test
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
MOREHOUSE OB
OBSTETRICS
CMSM
Monday, Wednesday - Friday, 0800-1130
2K - Clinic Bldg.
(404) 616-4242
METHOD OF REFERRAL: Self, OB Interview
LAB PREREQUISITE: Positive Pregnancy Test
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
EMORY TEEN OB
OBSTETRICS
BTAP
Tuesday and Friday, 1300-1600
2J-Clinic Bldg.
(404) 616-4242
METHOD OF REFERRAL: Self, Provider
LAB PREREQUISITE: Positive Pregnancy Test
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
MOREHOUSE TEEN OB
OBSTETRICS
BSAR
Friday, 1300-1600
2J Clinic Bldg.
(404) 616-4242
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
EMORY OB CONTINUITY
OBSTETRICS
CMSM
Mondays, Tuesdays, Thursdays, Fridays
109
PLACE:
PHONE:
0800-1600
2J-Clinic Bldg
(404) 616-4242
METHOD OF REFERRAL: OB Interview
LAB PREREQUISITE: Positive Pregnancy Test
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
PSYCHIATRIC OB
OBSTETRICS
BPSH
Tuesday, Friday, 0800-1130
2J-Clinic Bldg
(404) 616-4242
METHOD OF REFERRAL: OB Provider, NSG
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
WOMENS PRIMARY CARE
OBSTETRICS
BPRC
Wednesday 0800-1100
2J Clinic Bldg.
(404) 616-4242
METHOD OF REFERRAL: OB Provider
LAB PREREQUISITE: Positive HIV Test with positive pregnancy
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
OB NURSE MIDWIFERY
OBSTETRICS
BCNM
Friday, 0800-1130
Wednesday, 0800-1600
2J-Clinic Bldg.
(404) 616-4242
METHOD OF REFERRAL: Self Provider
LAB PREREQUISITE: Low Risk Pregnancy
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
MOREHOUSE HI-RISK OB
OBSTETRICS
BFHG
Monday 0800-1130
2K Clinic Bldg.
(404) 616-4242
METHOD OF REFERRAL: OB Provider
LAB PREREQUISITE: Positive Pregnancy Test
110
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
LOCATION:
PHONE:
OB INTERVIEW
OBSTETRICS
0443
0800-1700
2G New Clinic Bldg.
(404) 616-4121
METHOD OF REFERRAL: Self, provider, referral
LAB PREREQUISITE: Positive pregnancy test
FOLLOW-UP: Appointments are made by clinic staff to same clinic
or to the GYN Tumor Clinic.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN: Hydatidiform molar pregnancies.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
WOMENʼS URGENT CARE (WUCC)
OB/GYN
GEC
24 Hours Daily
Clinic Bldg., Fourth Floor ìKî area
(404) 616-8621/8622
METHOD OF REFERRAL: Patient request or advice nurse.
LAB PREREQUISITE: None, but positive pregnancy test necessary
for treatment of non-GYN complaints.
FOLLOW UP:
Referred to appropriate continuity clinic.
OCCUPATIONAL THERAPY ( See: Rehab Therapy Services)
CLINIC:
OPHTHALMOLOGY CLINIC
SERVICE:
OPHTHALMOLOGY
CLINIC CODES:
General Clinics
E311 New Eye — complete work-up; glasses prescription
E312 Follow-up — review of previous treatment
E316 Screening — immediate problem triage
Specialty Clinics
E313 Pediatric
E314 Pediatric
E315 Eye Muscle/Orthoptic
E317 Neuroophthalmology
E318 Continuity Clinic
E319 Retina
E320 Screening refraction - glasses prescriptions only.
E321 Glaucoma
E326 Diabetic Retina
E327 Cornea
E328 Oculo-plastics
111
E360 Procedures
E361 Photography/Perimetry
DAYS/HOURS HELD: Monday-Thursday, 0800-1630;
Friday, 1230-1630
PLACE:
3K Clinic Building
PHONE:
General Clinic-5-4671
Nurse/Doctor-5-8236/5-8293
Appointment-5-8288
Referrals
Beep Ophthalmologist on call after 1630
and weekends. (PIC #15150)
METHOD OF REFERRAL:
General Eye Clinic: Patient Walk-ins screened for appointment;
direct appointment from designated areas; consult required from
inpatient areas and for special problems, urgent consult require
phone contact, i.e. resident on call.
Specialty Eye Clinics: Appointed from General Eye Clinics after
work-up; few direct appointments from designated areas only;
consult for suspected specialty problems.
LAB PREREQUISITE: None.
FOLLOW-UP: Clinic arranges general diagnostic and specialty treatments as indicated, including surgical intervention.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
All Ophthalmology related problems.
LEVEL OF URGENCY FOR CONSULTATION:
LEVEL I: URGENT - sudden loss of vision (includes central retinal
artery occlusion/suspected retinal detachment), corneal ulcer/foreign
bodies, trauma with intraocular bleeding or suspected laceration/rupture of globe, lacerations of lids (full thickness, esp. at canaliculi),
suspected acute angle closure glaucoma, moderate to severe chemical/thermal burns, orbital cellulitis, and gonococcal conjunctivitis.
Severe iritis.
LEVEL II: AS SOON AS POSSIBLE (12-24 HOURS) - moderate
to severe infections (conjunctivitis), moderate to severe blurry vision/
diplopia of recent onset, red/moderately painful eye (e.g., traumatic
iritis), corneal abrasions/foreign bodies (i.e., rust rings), minor injuries (chemicals, welders flash). Blunt trauma causing orbital fractures/hematoma without loss of vision.
LEVEL III: INTERMEDIATE (1-3 DAYS) - blurry vision of recent onset, chronic mild to moderate redness/pain, worsening conjunctivitis (i.e., adenovirus), urgent need to start a drug with known
ocular toxicity. New onset exophthalmos.
LEVEL IV: ROUTINE (2 WEEKS PLUS) - chronic visual disturbance related to need for/change of glasses, NEW onset diabetics
(with stable serum glucose for more than three weeks).
112
SPECIAL SERVICE:
DAYS/HOURS:
PLACE:
PHONE:
OPTICAL DISPENSARY
Monday-Friday 0900-1730 (Closed 13001400)
3-J
5-4674
METHOD OF REFERRAL: New prescription from Eye Clinic for
eyeglasses, contact lens and select other visual aids. Walk-in for eyeglass frames, reading glasses, U.V. sunglasses, general optical supplies and replacement lenses not requiring a new prescription.
FOLLOW-UP: Free minor repairs and adjustments on all eyeglasses
purchased from the Dispensary.
CLINIC:
SERVICE:
CLINIC CODE:
ORAL-MAXILLOFACIAL SURGERY
SURGERY
General
S254 Emergency Referrals
Specialty
S251 General Oral
S252 General Anesthesia
S257 Special Post-Operative
DAYS/HOURS HELD: Monday, 1100-1630; Tuesdays - on-call;
Thursday, 1300-1630;
Wednesday, Friday 0800-1630
PLACE:
3E
PHONE:
5-4469; 5-4470
METHOD OF REFERRAL: Direct appointment from designated areas or Emergency Referral; consult required from inpatient areas or
for specialty cases from other areas; no walk-ins.
LAB PREREQUISITE: None
FOLLOW-UP: Continued treatment of specialty referral as indicated.
Outside agency referral for filling teeth, cleaning teeth, braces, false
teeth, or related dental specialty work not available in Oral Surgery
Clinic.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN: Examination for necessary extraction of teeth or surgical intervention
for oral-maxillofacial surgery problems or trauma.
CLINIC:
OTOLARYNGOLOGY (Ear, Nose &
Throat Clinic)
SERVICE:
SURGERY
CLINIC CODE:
S211 ENT Clinic
S212 Specialty ENT Clinic
S213 Speech Pathology
S214 Audiology
DAYS/HOURS HELD: Monday, Thursday 0830-1630;
Tuesday, Wednesday, Friday 1300-1630
113
PLACE:
PHONE:
3J
5-4679
METHOD OF REFERRAL: Direct appointments from designated
areas, consults from inpatient areas and agencies outside the GHS
network. A limited number of walk-ins will be accepted, however a
telephone consultation is required between the referring provider and
the accepting provider.
LAB PREREQUISITE: None.
FOLLOW-UP: Continued treatment of specialty problems.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Acute Hearing Loss, Laryngeal Disorders
SPECIAL ACTIVITIES:
Advanced audiology, speech pathology, and swallowing disorders
. . . ON REFERRAL.
CLINIC:
SERVICE:
CLINIC CODE:
ORTHOPEDICS
ORTHOPEDIC
K261 Adult General
K262 Amputee (2nd & 4th Fridays)
K263 Orthopedic Hand
K265 Trauma
K268 Foot & Ankle (1st and 3rd Fridays)
K270 Orthopedic Pediatric
DAYS/HOURS HELD: Mon., Wed., Thurs., Fri., 0800-1630
(sessions vary)
PLACE:
3L, Clinic Building
PHONE:
5-4473; 5-8414
METHOD OF REFERRAL: Direct appointment from designated
areas, blue consult from inpatient areas and for specialty cases; referral from Orthopedic general to specialty clinics; consultations are
screened for appointment.
FOLLOW-UP: Continued treatment or specialty referral as indicated.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Fractures, sprains, muscular-skeletal disorders and related Orthopedic problems or trauma.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
PAIN CLINIC
ANESTHESIOLOGY
Q888
Monday-Friday, 0730-1500
6-J, Clinic Building
5-5522
114
METHOD OF REFERRAL: Consult sheets are reviewed and suitable patients are seen by appointment. Consults are accepted from
Internal Medicine, Family Practice, Obstetrics and Gynecology, Neurology, Neurosurgery, and Orthopedic Spine Surgery.
LAB PREREQUISITE:
Please include all notes, labs, and imaging relevant to the problem for which consultation was requested;
for consultations due to neck or radicular arm pain, please order cervical MRI without contrast and have patient bring film and report to
appointment.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Acute and Chronic pain syndromes with a focus on axial and radicular
pain complaints. Other patients will be seen, evaluated, and treated as
appropriate. Controlled Substances will not be prescribed.
CLINIC:
SERVICE:
RESOURCE CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
RUBINʼS DEVELOPMENT CLINIC
PEDIATRIC
591
Thursdays — 0800-1100
PAC – 2nd Floor Annex HSCH
5-2406
METHOD OF REFERRAL: Referred from all sources for the evaluation of children with abnormal development.
CLINIC:
PERINATAL CENTER —
MATERNAL SECTION
SERVICE:
OB-GYN
DAYS/HOURS HELD: Monday - Friday, 0800-1630
PLACE:
2L - New Clinic Bldg.
PHONE:
5-4006
METHOD OF REFERRAL: Referred from Special Obstetric Clinics, New OB Clinic, Regular OB Clinic, Certified Nurse Midwifery
Clinic (CNM), Labor and Delivery (4K) Antepartum High Risk ward
(4B) and private physicians.
LAB PREREQUISITE: Obstetric Clinic perinatal laboratory screen.
PHYSICAL THERAPY ( See: Rehab
Therapy Services)
CLINIC:
PSYCHIATRIC ADULT
CONSULTATION LIAISON SERVICE
INPATIENT ADULTS (18 YEARS AND
SERVICE:
OLDER)
DAYS/HOURS HELD: Monday-Friday, 0830-1630
PLACE:
1300C
PHONE:
5-2880; Beeper (742-6612)
115
METHOD OF REFERRAL: Place a blue consult sheet in the “Adult
Psychiatry Box” in the post office. Consults are picked up daily at
0830 Monday-Friday. It is helpful if the consult request is made as
early as possible in the patientʼs hospitalization. Questions on the
consultation form should be specific as possible; e.g. “Does this patient need medication?” or “is this patient homicidal?” On the consultation form include the names of both the attending and resident
physicians; also include beeper numbers.
EMERGENCY EVALUATIONS: Emergency consultations may be
obtained only in the following situations:
1. Patient has suddenly become disruptive and unmanageable;
2. Patient is actively threatening homicide or suicide; or
3. There is a question of patients ability to give inform consent in an
imminent life threatening situation.
Patients may be legally held against their will and, if necessary, physical restraints may be used where life threatening situations exist if
certain protocol is followed. Any physician may sign a form 1013 of
the Georgia Health Code (available on 1300B) should circumstances
warrant.
The Psychiatry Emergency Clinic on 1300B (Ext. 5-4762) should be
contacted only in the following situation:
1. Emergencies as noted above which take place after 1630, on
weekends, or on holidays;
2. Evaluation of a suicidal patient is required on weekends when the
Consultation Service is unavailable for 24 hours or more; or
3. There is an emergency need for outpatient referral information
when a full psychiatric evaluation is not required.
LAB PREREQUISITE: None.
FOLLOW-UP: Should the referring physician require additional information on a patient, please contact the original consultant whose
name is found at the bottom of the blue sheet. Please be aware that
the consultant makes recommendations; implementations of the recommendation is the responsibility of the primary care team. Also be
aware that the consultation service consists of attending psychiatrists,
psychiatric house staff, and psychiatric clinical nurse specialists.
DISCHARGE/TRANSFERS:
Please give at least 24 hours notice. Transfers normally occur Monday-Friday prior to 4pm.
CLINIC:
PSYCHIATRIC EMERGENCY
SERVICE (PES)
SERVICE:
PSYCHIATRY
CLINIC CODE:
Y691
DAYS/HOURS HELD: 24 hours, 7 days a week walk-in
PLACE:
1300B
PHONE:
5-4762
116
METHOD OF REFERRAL: Patients may be self-referred or referred
from civilian police departments, area county health departments,
GHS Ambulatory clinics, other community mental health centers
and other community agencies. All suicide attempts treated in ECC
should be referred for psychiatric evaluation. Patient must be medically and surgically cleared and stable. The treating physician must
call the PES before sending the patient to the area.
ROUTINE EVALUATIONS:
After the patient has had a complete physical evaluation, the treating
physician should contact the PES to find out whether the patient lives
in the geographical area served by our Central Fulton Community
Mental Health Center. If the patient lives in our area, he/she should
be referred to the walk-in clinic on 1300B with a white consult sheet
between 0800-1600, Monday-Friday. If the patient is not in the central Fulton area, he/she should be referred to his/her own community
health center.
EMERGENCY EVALUATIONS:
In emergency situations after the patientʼs medical condition is stable,
the treating physician should contact the triage officer or psychiatric
resident on PES.
LAB PREREQUISITE: Those clinically indicated.
FOLLOW-UP: If the patient is a resident of the Central Fulton Community Mental Health catchment area, he/she will be referred to outpatient services within the Central Fulton Community Mental Health
Center. Otherwise, the patient will be referred to outpatient services
at the community mental health center within his/her catchment area.
At the discretion of the clinician, the patient may be followed for brief
crisis intervention therapy in the Psychiatric Emergency Service.
CLINIC:
PSYCHIATRY,
CHILD & ADOLESCENT
SERVICE:
PSYCHIATRY, OUTPATIENT
CLINIC CODE:
641
DAYS/HOURS HELD: Monday-Friday, 0800-1700
PLACE:
Piedmont Hall, 3rd Floor
PHONE:
5-2215
METHOD OF REFERRAL: Referrals may be made by parents and
relatives of children and adolescents. Referrals also received from
other areas and clinics of GHS, as well as community agencies, other
hospitals, physicians, and related agencies.
LAB PREREQUISITE: None
FOLLOW-UP: Children, adolescents, and their families will receive
psychiatric evaluations and appropriate treatment; patients may be
referred elsewhere for additional service.
117
SERVICE:
PSYCHIATRIC CONSULTATION/
LIAISON SERVICE – CHILD &
ADOLESCENT
DAYS/HOURS HELD: Monday-Friday, 0830-1630
PLACE:
Any area of Grady Health System
PHONE:
5-2215
BEEPER:
837-0359
METHOD OF REFERRAL: Page the above beeper during hours of
service. All children and adolescents admitted to the burn center are
automatically seen. If emergency evaluations are needed after hours,
weekends and holidays, the Psychiatric Emergency Clinic (1300B
– extension 5-4762) should be contacted.
LAB PREREQUISITE: Please consider drug screens and/or pregnancy tests if indicated.
FOLLOW-UP: The consultant will follow the patient during their entire inpatient stay and will continue to work with the patient and family via outpatient medical follow-up visits. Although the consultant
makes specific recommendations, implementation of these recommendations is the responsibility of the primary health care team. The
consultant will arrange appropriate psychiatric follow-up.
CLINIC:
PSYCHIATRY COMMUNITY
OUTREACH SERVICES (COS)
SERVICE:
PSYCHIATRY
CLINIC CODE:
963
DAYS/HOURS HELD: Monday-Friday, 0830-1700
PLACE:
55 Coca Cola Place, Hirsch Hall. 6th
Floor, Room #605
PHONE:
5-9999 Fax: 5-9684
METHOD OF REFERRAL: Patients with a history of mental illness and poor compliant with follow-up may be referred from the
State Hospital system and GHS psychiatric in-patient units. Persons
making the referral may call the program for specific procedures and
referral form.
LAB PREREQUISITE: None. Provided by COS team. FOLLOWUP: When appropriate referrals are made to other treatment components.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
PAGER:
ADULT DAY SERVICES
PSYCHIATRY
661
Monday-Friday, 0800-1630
Haverty Buidling, 206 Edgewood Avenue
FOCUS Intensive Day Treatment (IDT):
5-1829
(404) 283-5201
118
FAX:
5-1850
METHOD OF REFERRAL: Individuals with serious mental illness
who are in need of outpatient psychiatric stabilization (FOCUS IDT)
or psychiatric rehabilitation (ARC Psychosocial Rehabilitation) may
be referred from a mental health program or other treatment facility.
Individuals making referrals may call the program for specific procedures, documents needed, and a referral form.
Psychosocial and Therapeutic services offered, primarily on a group
basis: medication monitoring; pre-vocational and vocational/training;
socialization and recreational education; group, family and individual
therapy; crisis stabilization; psycho education and skills training.
LAB PREREQUISITE: None.
FOLLOW-UP: Provided by Adult Day Services staff or, when appropriate, referred elsewhere for follow-up services.
CLINIC:
PSYCHIATRY EXTENDED
TREATMENT CLINIC (Evening)
SERVICE:
PSYCHIATRY
CLINIC CODE:
Y624
DAYS/HOURS HELD: Thursday Only ó 1700-2000
PLACE:
1300B
PHONE:
5-4784; Hours 0800-1630
5-4762; Hours 1700-2000
METHOD OF REFERRAL: The state hospital system and GHS
psychiatric inpatient staff may directly refer to the Adult Outpatient
Clinic. For all other cases, the patients must be evaluated in the GHS
Psychiatric Emergency Clinic before being referred to any adult outpatient psychiatry clinic. The Adult Outpatient Clinics provide services only to persons living within the Central Fulton Community
Mental Health Center catchment area.
LAB PREREQUISITE: None.
FOLLOW-UP: Follow-up is given for patients from Community
Care Program, Day Hospital, other CMHCʼs.
CLINIC:
PSYCHIATRY EXTENDED
TREATMENT
SERVICE:
PSYCHIATRY
CLINIC CODE:
612
DAYS/HOURS HELD: Monday-Friday, 0830-1630
PLACE:
Florida Hall
PHONE:
5-4784
METHOD OF REFERRAL: The state hospital system and GHS
psychiatric inpatient staff may directly refer to the Adult Outpatient
Clinic. For all other cases, the patients must be evaluated in the GHS
Psychiatry Emergency Clinic before being referred to any adult out-
119
patient psychiatry clinic. The Adult Outpatient Clinics provide services only to persons living within the Central Fulton Community
Mental Health Center catchment area.
LAB PREREQUISITE: None.
FOLLOW-UP: Follow-up is given for patients from Community
Care Program, Day Treatment, other CMHCs.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
PSYCHOTHERAPY, INDIVIDUAL
PSYCHIATRY
621
Monday-Friday, 0830-1630
Florida Hall
5-4784
METHOD OF REFERRAL: The state hospital system and GHS
psychiatric inpatient staff may directly refer to the Adult Outpatient
Clinic. For all other cases, the patients must be evaluated in the GHS
Psychiatric Emergency before being referred to any adult outpatient
psychiatry clinic.
LAB PREREQUISITE: None
FOLLOW-UP: Follow-up can be provided through Central Fulton
Community Mental Health Community Care Program, Day Treatment Program, or other community mental health centers.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
PULMONARY
MEDICINE
S181 Emory
Fridays, 0830-1230
CLINIC BUILDING - GJN
616-2501
METHOD OF REFERRAL: Patients may be referred from any outpatient facility upon submission of a consultation sheet including a
brief description of the patientʼs problem and an indication of what
information is requested. Requests will be reviewed by the attending
staff of the Clinic and may be rejected if the patientʼs problem can be
better handled elsewhere or if inadequate information is provided.
Appointment slips specifically do not constitute adequate information. Inpatients may be referred to the Pulmonary Clinic for followup care through the inpatient pulmonary consultation service. Unappointed patients cannot be seen in the Pulmonary Clinic, but will be
scheduled for appointments at the earliest possible date. The service
can be contacted at the Pulmonary Division office, Extension 5-4305,
or PIC beeper in case of questions.
LAB PREREQUISITE:
(1) Patientʼs chart including history and physical examination,
(2) recent PA and lateral chest roentgenogram, and if appropri-
120
ate,
(3) EKG, Arterial blood gases, Chem 19, CBC and PPD.
FOLLOW-UP: Full consultative reports will be returned to the referring physician or clinic. Patients whose respiratory diseases require specialized management will continue to receive primary care
through the Pulmonary Clinic. Stable patients requiring routine and
standard care, diagnostic problems and limited problems will be sent
back to their referring physician for continued primary care upon
completion of work-up.
PROBLEMS FOR WHICH PRIMARY CARE WILL BE GIVEN:
Asthma, chronic bronchitis and emphysema, bronchiectasis, sarcoidosis, fibrosing alveolitis, occupational lung diseases, pulmonary hypertension, sleep apnea.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
PULMONARY
MEDICINE
S239 Morehouse
Fridays, 0830-1630
CLINIC BUILDING - GJN
616-2501
METHOD OF REFERRAL: Patients may be referred from any outpatient facility upon submission of a consultation sheet including a
brief description of the patientʼs problem and an indication of what
information is requested. Requests will be reviewed by the at- tending staff of the Clinic and may be rejected if the patientʼs problem can
be better handled elsewhere or if inadequate information is provided.
Appointment slips do not constitute adequate information. Inpatients
may be referred to the Pulmonary Clinic for follow-up care through
the inpatient pulmonary consultation service. Unappointed patients
cannot be seen in the Pulmonary Clinic, but will be scheduled for appointments at the earliest possible date. The service can be contacted
through the Pulmonary Division office, Extension 5-4305, or beeper
of the pulmonary consult service in case of questions.
LAB PREREQUISITE:
(1) Patientʼs chart including history and physical examination,
(2) recent PA and lateral chest roentgenogram, and if appropriate,
(3) EKG, Arterial blood gases, Chem 19, CBC and PPD, PFTs.
FOLLOW-UP: Full consultative reports will be returned to the referring physician or clinic. Patients whose respiratory diseases require specialized management will continue to receive primary care
through the Pulmonary Clinic. Stable patients requiring routine and
standard care, diagnostic problems and limited problems will be sent
back to their referring physician for continued primary care upon
completion of work-up.
PROBLEMS FOR WHICH PRIMARY CARE WILL BE GIVEN:
121
Asthma, chronic bronchitis and emphysema, bronchiectasis, sarcoidosis, fibrosing alveolitis, occupational lung diseases, pulmonary
hypertension, sleep apnea.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
PREADMISSION CONSULTATION
ANESTHESIOLOGY/MEDICINE
S220
Monday-Friday, 0830-1700 Anesthesia
Consults; Monday, Tuesday, Friday, 13001600 Medical Consults
6J, Clinic Building
5-2460
METHOD OF REFERRAL: Patients being scheduled for an AM
ambulatory surgical procedure or an AM admission for surgery may
be referred from any surgical subspecialty. Perioperative Data Forms
and Consent Forms should be completed on all patients referred to
this clinic for anesthesia consultations. All patients needing medical
consultation must have a completed consultation form that is specific
problem oriented. Patients seen for Medical consults are seen by appointment only.
LAB PREREQUISITE: All patients with appointments for medical
consults must have the following completed prior to their visit:
1. Standard Labs
2. EKG
3. Chest X-ray
4. Any labs pertinent to the patient problem(s).
FOLLOW-UP: Patients for whom surgery is not immediately indicated will be referred back to the surgical subspecialty with recommendations for intervention. Medical Service will schedule a limited
number of follow-up visits if indicated to manage medical conditions
which require intervention prior to surgery.
CLINIC:
SERVICE:
DAYS/HOURS HELD:
PLACE:
PHONE:
RADIATION ONCOLOGY
RADIATION ONCOLOGY
Monday-Friday, 0800-1630
Edward C. Loughlin, Jr. Radiation
Oncology Center ó 145 Edgewood
Avenue, S.E.
5-3947
METHOD OF REFERRAL: Consultations can be called directly
to the department at 5-3947 or faxed to 5-6380 and confirmed by
a Consultation/Referral form. Consultation/Referral forms must be
completed on every patient and delivered to the Radiation Oncology
box in the hospital Post Office where they will be picked up by the
department three times a day, Monday through Friday. The request
should include a brief summary of history, physical findings, stage of
disease, the patientʼs knowledge of his/her condition, what area(s) is
122
(are) recommended for treatment, and if the patient is pregnant. Also,
note whether inpatient or outpatient, and location. Patients should be
fully informed of the reason for the referral. The Consultation/Referral Form must be imprinted with the Grady card; the name and
beeper number of the referring physician must be printed legibly on
the form. If the Grady Card is not available, please print the patientʼs
name and the hospital number.
EMERGENCY EVALUATIONS:
Regular working hours — Call the department. Confirm the emergency consultation on a Consultation Form.
After hours and weekends — Contact the hospital operator for the
Radiation Oncologist on Call. Confirm the emergency consultation
by Consultation Form.
REHAB THERAPY SERVICES
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
PHYSICAL THERAPY
REHAB
T711
Monday-Friday, 0800-1630
4C-D
5-4076; 5-4077
METHOD OF REFERRAL:
Outpatient PT - Referred by written Consultation from Physician
(medical student, physician assistant, nurse practitioner not legal).
Consultation must include a diagnosis. Inpatient PT - MD order in
Physician order section of chart.
LAB PREREQUISITE: None.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
PT - Adults with physical illness/injury amenable to PT treatment
(i.e., those patients requiring evaluation, ambulatory aides, gait and
mobility training, wound care, scar management, strengthening and
ROM exercises, modalities and postural training for deficits in gross
motor skills, balance and functional mobility
HAND REHAB PT - Adult and pediatric patients with traumatic injuries of the UE and hand. See Hand Rehabilitation.
PEDIATRIC PT - Pediatric patients with neurological involvement,
LE injuries and developmental disabilities. See Pediatric Physical
Therapy.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
OCCUPATIONAL THERAPY
REHAB
T731
Monday thru Friday, 0800-1630
4C-D
5-4177
123
METHOD OF REFERRAL:
Pediatric O.T.– See Pediatric Occupational Therapy.
Outpatient Adult O.T. – Referred with consult sheet. Consult must
include a diagnosis and M.D. signature.
Inpatient Adult O.T. – MD order in physicians order section of
chart
Hand O.T. - See Hand Rehabilitation
LAB PREREQUISITE: None.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN: All
types of physical, psychosocial, and developmental disabilities amenable to OT treatment (i.e., those patients requiring evaluation/treatment/adaptive equipment/splinting for deficits in ROM, ADL, UEmotor function, cognitive-perceptual skills, sensory integration, and
work readiness).
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
HAND REHABILITATION
REHAB
T741/T742
Monday-Friday, 0800-1630
4C-D
5-4177
METHOD OF REFERRAL: Referred by consultation from physician (medical student, physician assistant and nurse practitioner not
legal). Consult must include a diagnosis.
LAB PREREQUISITE: None.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Traumatic injuries of the UE and hand in both adult and pediatric
patients.
CLINIC:
SPEECH-LANGUAGE PATHOLOGY
AND AUDIOLOGY
LOCATION:
3J, ENT Clinic
DAYS/HOURS HELD: Outpatient - Monday - Friday,
0800-1630
Inpatient Speech - Monday - Friday,
0800-1630, Saturday-Sunday on call
PHONE:
Speech 5-8266, 5-8265
Audiology 5-8267
METHOD OF REFERRAL: Inpatient-MD order in Physician order
section of chart. OutpatientñReferred by written consultation from
Physician with relevant history and patient information.
LAB PREREQUISITE: None.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
124
SPEECH-LANGUAGE PATHOLOGY: Adults with the following
dysfunction: aphasia, dysarthia, dysphagia, oral-motor impairment,
s/p laryngectomy, voice disorders, and those in need of cognitive lingusitic therpay or augmentative/alternative communication.
AUDIOLOGY: Adults with hearing or vesticular dysfunction or disabilities.
CLINIC:
SERVICE:
CLINIC CODE:
DAYS/HOURS HELD:
PLACE:
PHONE:
REHABILITATION MEDICINE
REHAB
T722
Tuesday, 0900-1200
3F
5-4074; 5-4077
METHOD OF REFERRAL: Referred by written consultation from
another service.
CLINIC:
EMG AND NERVE CONDUCTION
STUDIES
SERVICE:
REHAB
DAYS/HOURS HELD: Mon, Thurs, Friday 0900-1200
PLACE:
16A&B (moving to 4CD late 2000)
PHONE:
(404) 616-4076
METHOD OF REFERRAL: Consultation Request EMG NCV. See
also: Pediatric, Physical Therapy, Occupational Therapy, Speech
Therapy of Rehab Therapy Services.
CLINIC:
CLINIC CODE:
SERVICE:
DAYS/HOURS HELD:
PLACE:
PHONE:
RENAL (Emory)
159
MEDICINE
Wednesdays, 1230-1630
Clinic Building: GJN
404-616-2501
PATIENTS FOR REFERRAL: Patients with renal disease or uncontrolled hypertension or who are with renal transplantation should be
seen in the renal clinic.
METHOD OF REFERRAL: Please fax a GMH Emory Renal Clinical
Referral to 404-616-1836. This will be reviewed by a staff Nephrologist on the subsequent clinic date and assigned an appointment date.
Urgent and Emergent referrals should be directly discussed with the
Nephrologist on service at GMH. This may be determined through
“simon paging” (https://simonweb.eushc.org). In the “on-call calendar” section enter “nephrologists” for group name and “select all” for
location. Click on “nephrologists” to expand then on “GMH” to find
the current physicians on service.
LAB PREREQUISITE: Please refer to GMH Emory Renal Clinical
Referral Lab Guidelines.
125
GMH Emory Renal Clinic Referral Lab Guidelines:
Please document the presence on referral or, if absent, request the
patient to have the following tests prior to referring the patient to the
renal clinic:
1. Within 1 month of referral:
a. Renal profile (including phosphrous, calcium, albumin)
b. Hgb
c. Iron saturation
d. Spot urine protein and creatinine quantification
2. Within 4 months of referral:
a. Hgb A1C if diabetic
b. Intat PTH if serum creatinine is greater than 2
3. Within 8 months of referral:
a. Renal Ultrasound
The patientʼs clinical status should dictate whether or not the referral
should be delayed while the requested tests are being procured.
FOLLOW-UP: Patient referred back to physician or clinic if so requested or if visit is purely consultative.
PROBLEMS FOR WHICH CONSULTATION AND FOLLOW
UP WILL BE GIVEN:
1. Renal Parenchymal disease.
2. Nephrolithiasis.
3. Renovascular hypertension.
4. Obstructive uropathy.
5. Hypertension related renal disease.
6. Disorders of acid-base, fluid and electrolyte metabolism.
7. Transplant follow-up.
CLINIC:
CLINIC CODE:
SERVICE:
DAYS/HOURS HELD:
PLACE:
PHONE:
RENAL (Morehouse)
158
MEDICINE
Wednesday 0830-1130
Clinic Building - GJN
616-2501
METHOD OF REFERRAL: GHS Clinical Referral/Consultation
Form without prior clearance on any patient with serum creatinine
>2mg/dl or urine protein >2 grams/day. Other renal-related consultations must be approved by renal attending. Please notify Renal Office
(Ext. 5-2501) of referral. Patients on dialysis should not be referred
to clinic unless cleared by Attending.
LAB/X-RAY PREREQUISITE: UA, SMA-19, CBC, 24-hour urine
for protein and CCr., if indicated. Renal Sonogram.
FOLLOW-UP: Patient referred back to physician or clinic if so re-
126
quested or if visit is purely consultative.
PROBLEMS FOR WHICH CONSULTATION AND FOLLOW
UP WILL BE GIVEN:
1. Renal Parenchymal disease.
2. Nephrolithiasis.
3. Renovascular hypertension.
4. Obstructive uropathy.
5. Hypertension related renal disease.
6. Disorders of acid-base, fluid and electrolyte metabolism.
7. Transplant follow-up.
CLINIC:
CLINIC CODE:
SERVICE:
DAYS/HOURS HELD:
PLACE:
PHONE:
RHEUMATOLOGY/IMMUNOLOGY
X160
MEDICINE
Thursdays 1200-1630 - Lupus Clinic
Clinic Building - IL
616-7519
METHOD OF REFERRAL: Call above number for an appointment.
Patients may be referred from any appointment clinic or ward upon
submission of a Referral/Consultation sheet including a brief description of the patientʼs problem, and the list of pertinent lab data obtained or pending.
LAB/X-RAY PREREQUISITES:
1. CBC, differential, platelet count.
2. Chem. 14
3. Urianalysis, routine and microscopic, when indicated.
4. Creatine Phosphokinase (CPK), when indicated.
5. Westergren ESR, when indicated.
6. Rheumatoid factor, (RF), when indicated.
7. Antinuclear antibody, (ANA), when indicated.
FOLLOW-UP: An opinion will be given in response to the consultation request, and the patient will be referred back to the clinic initiating the request. However, if the patient has one of the diagnoses listed
below, we would like to continue to follow the patient in this clinic
on an ongoing basis.
DISEASES TO WHICH CONSULTATIONS AND FOLLOW-UPS
WILL BE GIVEN:
1. Rheumatoid Arthritis
2. Systematic Lupus Erythematosus
3. Ankylosing Spondylitis
4. Reiterʼs Syndrome/Reactive Arthritis
5. Psoriatic Arthritis
6. Scleroderma
7. Polymyositis/Dermatomyositis
8. Vasculitis
9. Polymyalgia Rheumatica and Temporal Arteritis
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10. Severe Gout or complicated Gout and Pseudogout
11. Septic Arthritis
12. Sjogrenʼs Syndrome
13. Mixed Connective Tissue Disease
14. Raynaudʼs Phenomenon
15. Sarcoidosis involving joints and bones
16. Severe Bursitis and Tendonitis.
Early Arthritis Clinic: Evaluation and management of suspected
inflammatory arthritis of recent onset.
Lupus Clinic: Evaluation and management of suspected or known
systemic lupus erythematosus.
CLINIC:
SICKLE CELL
SERVICE:
MEDICINE
CLINIC CODE:
Adult-354; Pediatric-355
DAYS/HOURS HELD: Pediatric Clinic:
Monday, Tuesday 0800-1600
Adult Clinic:
Wednesday-Thursday 0800-1400
Leg Ulcer/Hydrea Clinic:
Tuesday, Friday 0800-1600
PLACE:
GL - Clinic Building
24-HOUR PHONE:
5-3572
METHOD OF REFERRAL: The Sickle Cell Clinic is designed to
provide ongoing medical care, genetic counseling and patient education for patients with hemoglobinopathies and thalassemia syndromes. Routine appointments can be made by submitting a referral
slip to the clinic clerk at least four working days before clinic. Request for urgent appointments can be made by contacting:
Miriam Lindsey, LPN - Ext. 5-5960-Pediatrics
Hattie Way, LPN - Ext. 5-3572-Adults
Patients sent to the clinic without prior appointment will not be seen,
but will be scheduled for an appointment at a later date.
LAB PREREQUISITE: Patients referred should have a hemoglobin
electrophoresis completed in addition they should be given a lab request for Chem 13, CBC with reticulocytes, and urinalysis and be
told to report (1) hour before appointment.
FOLLOW-UP: Patients with symptomatic hemoglobinopathies and
thalassemia syndromes may be followed permanently in the Sickle
Cell Clinic for comprehensive primary care and hematology services.
PRIMARY CARE:
Patients with primary care providers may receive hematology followup care with approval.
CLINIC:
SURGICAL CLINICS
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SERVICE:
SURGERY
DAYS/HOURS HELD: Monday-Friday, 0800-1630
(Sessions vary by Clinic. Please call during
clinic hours
for specific information about any of the
clinics listed.)
PLACE:
Gen. Surgery; 12D Main Hosp., Bldg. G.
PHONE:
5-4591; 5-4592
CLINIC CODES:
S222 Emory General Surgery Team A
S223 Emory Minor Surgery
S225 Emory General Surgery/
Vascular Surgery Team B
S226 Emory Surgical Proctology
S227 Emory Trauma
S228 Emory Suture Removal
(give specific date for removal)
S229 Emory General Plastic
S230 Emory Plastic Hand
S231 Emory Minor Plastic Surgery
S232 Morehouse GI Reflux
every other Wednesday
S237 Morehouse General Surgery
Green Team
S238 Morehouse Vascular
S240 Thoracic Surgery
S241 Emory Neurosurgery
S271 Morehouse Trauma
S273 Morehouse General Surgery
Red Team
S274 Morehouse General Plastic
S275 Morehouse Proctoscopy
S276 Trauma Specialty
METHOD OF REFERRAL: Written referrals from primary care providers. Urgent referrals will be seen within a week. The clinic (Referral Center) should give the appointment. The referral must have a correct phone/address number to contact the patient. Emergency/Urgent
referrals should be delivered directly to the clinic by the referring
department. For emergency consults make physician to physician
contact.Use the two digits (6th and 7th digits) before the terminal
digit to identify Emory and Morehouse patients. New patients with
digits 00-24 are assigned to Morehouse service. Those with digits
25-99 are assigned to Emory service. Patients may choose a service
other than the assigned, if so desired. Low back pain patients who are
referred to the Neurosurgery Clinic are separated by medical record
number, using the 7th digit. New patients with odd digits are referred
to the Neurosurgery Clinic and those with even digits are referred to
the Orthopedic Clinic. For in house consultations follow the appropriate in house consultation procedure. The Surgical Clinic does not
see inpatients.
LAB PREREQUISITE: None
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CLINIC:
TEEN SERVICES/ADOLESCENT
REPRODUCTIVE HEALTH
SERVICE:
OB/GYN
RESOURCE CODE: FTSC
DAYS/HOURS HELD: Monday 1230 - Teen Postpartum Clinic
Monday 1400 - Teen Family Planning
Clinic
Tuesday 1300 - Teen Colposcopy
Wednesday 1400 - Teen Family
Planning Clinic
Wednesday 1300 - New Teen Family
Planning Patients
Thursday 1500 - Teen Male Clinic
Saturday 0830 - Teen Clinic
CLINIC CODE:
STSC
AGE:
16 years or younger for initial referral
PLACE:
Main Hospital - 5C
PHONE:
616-3513
METHOD OF REFERRAL: Patients may telephone or stop by to
get an appointment. Staff (Pediatrics, Pediatric Emergency Clinic,
Women Urgent Care, Rape Crisis, etc.) may telephone or send referral sheet for appointment. Appointments for inpatient postpartum
patients may be made directly by the inpatient staff.
FOLLOW-UP: Special follow-up is provided for all new teen clients
within one month and routinely every three months for all teen clients.
LAB PREREQUISITE: None
MEDICAL SERVICES PROVIDED: Comprehensive reproductive
health services for adolescent females including: pregnancy testing,
sexually transmitted infections screening and treatment, birth control methods, colposcopy, sports physicals, and routine gynecological
services. Comprehensive reproductive health services for adolescent
males including: sexual health check ups, sexually transmitted infections screening and treatment, testicular examinations, sports physicals.
EDUCATIONAL AND COUNSELING SERVICES PROVIDED HIV - AIDS, pubertal growth and development, postponing sexual
involvement, peer and dating relationships, violence in relationships,
sexual abuse, and parent/teen communication.
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NEIGHBORHOOD HEALTH CENTERS NETWORK
The Neighborhood Health Centers (formerly called Satellite Clinics) are an integral part of the Grady outpatient system operating
jointly with the Fulton and DeKalb County Health Departments.
They offer a wide range of ambulatory primary care and preventive
services at its nine outlying locations.
The purpose of the centers is to make primary health care more
accessible to the many Grady eligible patients.
The centers operate during usual business hours Monday through
Friday. The staff includes primary care physicians (usually Board
certified internists, family practitioners and pediatricians), nurse
practitioners and physician assistants for children and adults, medical technologists, and other medical and administrative personnel.
The Professional medical staff is provided by the Emory University
School of Medicine and Morehouse School of Medicine.
The centers offer ancillary services of laboratory, x-ray, and pharmacy, as well as nutritional and social services. Patients are referred
to Grady Hospital from the centers for subspecialty outpatient treatment or for hospitalization.
All the centers operate primarily by appointment, and patients can
usually expect to see the same physician or nurse-practitioner on subsequent visits.
A patientʼs chart at the neighborhood centers uses the same medical record number as the chart at the downtown Hospital. With 24
hours advance notice the Neighborhood Health Center can obtain the
patientʼs hospital chart; after review it is promptly returned downtown.
Appointments can be made by phone during regular hours. Followup care will be greatly improved by sending current clinical information (discharge note, lab results, etc.) to the Neighborhood Health
Center facility as promptly as possible via courier Referral/Consultation sheets should be sent as described in the policy (see Interim
Referral/Consultation Policy)
In special cases requiring rapid follow-up it may be helpful to send
clinical information with the patient or to have the referring clinician
telephone directly to a Neighborhood Health Center doctor or nurse.
If the referral is made after the Neighborhood Health Center has
closed, the patient should be instructed to call early the next morning
to make an appointment.
The referring clinician should include the patientʼs current address
and phone number so patients who fail to appear can be called.
Patients referred from the Neighborhood Health Centers to downtown Grady for consultation or admission will be accompanied by a
referral form. Findings of the consultation or disposition of the patient should be written on the referral form and returned to the appropriate center. The original becomes the clinic note in the Grady
medical record while the carbon copy becomes part of the Neighborhood Health Center file.
For more information about Neighborhood Health Center services
or referrals, call The Nurse Advice Program at (404) 616- 0600 or
(800) 447-6032
A listing of Neighborhood Health Center services, codes, hours,
131
and addresses follows.
Neighborhood
Health Center Pharmacies
Asa G. Yancey M.D. Health Center
Dekalb Grady Health Center
N. Dekalb Health Center.
N. Fulton Comm. Health Cen.
Grady Health System-East Point
Tel.
404-616-2265
404-371-1242
770-451-8881
770-645-0904
404-768-5917
Fax.
404-875-5798
404-371-9597
770-454-6037
770-594-9546
404-768-6455
GRADY HEALTH SYSTEM
NEIGHBORHOOD HEALTH CENTER DIRECTORY
Please call your designated Neighborhood Health Center for an appointment. Call Monday through Friday from 0800 until 1630.
ASA G. YANCEY SR. M.D. HEALTH CENTER
CLINIC
ASA G. YANCEY M.D. HEALTH
CENTER
(Formerly Northwest Grady Health Center)
SERVICE:
PRIMARY CARE (Adult Medicine,
Pediatric, OB on Monday - Thursday
Family Planning - Thursday only
CLINIC CODES:
010 Adult patients
011 Pediatric
017 Nutritionist
018 Obstetrics
014 Suture Removal
F001 Family Planning
DAYS/HOURS HELD: Monday-Friday 0800-1700
PLACE:
1247 Bankhead Highway
Atlanta, Georgia 30318
(near Bankhead MARTA station)
PHONE:
(404) 616-2265
FAX:
(404) 875-5268
METHOD OF REFERRAL: Any entity within the Grady Health System, any agency or facility in Fulton or DeKalb counties, and self
referrals by patients. Appointments are encouraged. Walkins are accepted, too.
LAB PREREQUISITE: Must be ordered by GHS provider.
FOLLOW-UP: Return appointments are given to Primary Care Providers (PCP). When indicated, referrals are made to GHS sub-specialties.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Any chronic or acute medical illness. Any minor surgical problems.
In emergency cases, we are equipped to temporarily treat and stabilize the patient prior to transport to the emergency room.
132
Clinical Manager: Elsie R. Stevens, RN, MS
Medical Liaison: Elizabeth Walton, MD
CLINIC:
GRADY HEALTH CENTER
EAST POINT
CLINIC CODES:
03 Adult patients
031 Pediatric patients
035 Mammography
037 Nutritionist
038 Obstetrics
DAYS/HOURS HELD: Monday-Friday 0800-1700
PLACE:
1595 W. Cleveland Ave.
East Point, Georgia 30344-2558
PHONE:
(404) 616-2886
Fax:
(404) 209-1769
METHOD OF REFERRAL:
Referred from:
— any Grady Hospital outpatient clinic, inpatient ward, or emergency room
— any other agency or facility for a patient who resides in Fulton
or DeKalb County, and self referrals.
Appointments made by either direct phone call to the clinic or arranged through the ward clerk of the referring Grady Hospital department. Walk-in patients are accepted too.
A limited number of walk-in patients will be seen each day depending on the severity of illness.
LAB PREREQUISITE: Must be ordered by GHS provider.
FOLLOW-UP:
Return appointments are given for this clinic. When indicated, consultation or referral is made to any of the Grady subspecialty clinics.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Any chronic or acute medical illnesses.
Any minor surgical problems.
In emergency cases, we are equipped to temporarily treat and stabilize the patient prior to transport to the emergency room.
Clinical Manager: Johnnie Richburg, RN
CLINIC:
CLINIC CODES:
DEKALB GRADY HEALTH CENTER
N041 Adult patients
N042 Pediatric patients
N043 Eye Clinic
N047 Nutritionist
N048 OB/GYN
N049 OB Interviewer
R-van Dekalb Grady - Mammo
DAYS/HOURS HELD: Monday-Friday 0800-1700
Tuesday 0800-1840
133
PLACE:
PHONE:
DeKalb Atlanta Human Services Center
30 Warren St., S.E.
Atlanta, Georgia 30317-2998
(at corner ofWarren St. and Hosea
Williams Drive, SE)
(404) 377-9301
(404) 616-9304
METHOD OF REFERRAL:
Referred from:
— any Grady Hospital outpatient clinic, inpatient ward, or emergency room.
— any other agency or facility for a patient who resides in Fulton
or DeKalb County, and self referrals.
Appointments made by either direct phone call to the clinic or arranged through the ward clerk of the referring Grady Hospital department. Walk-in patients are accepted, too.
LAB PREREQUISITE: Must be ordered by Grady Health System
provider.
FOLLOW-UP:
Return appointments are given for this clinic. When indicated, consultation or referral is made to any of the Grady subspecialty clinics.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Any chronic or acute medical illnesses.
Any minor surgical problems.
In emergency cases, we are equipped to temporarily treat and stabilize the patient prior to transport to the emergency room.
Clinical Manager: Alfreda Hobson, RN, BSN, MBA
CLINIC:
CLINIC CODES:
NORTH FULTON HEALTH CENTER
061 Adult and Pediatric patients
067 Nutritionist
068 Obstetrics
DAYS/HOURS HELD: Monday, Wednesday,
Thursday, Friday 0800-1700;
Tuesday 0800-1900
Pharmacy - Monday, Wednesday,
Thursday, Friday 0830-1700
Pharmacy - Tuesday 1030-1900
Obstetrics - Tuesday, Thursday & Friday
0830-1700
NURSING STAFF
AT CLINIC:
Monday-Friday 0830-1700
PLACE:
1143 Alpharetta St.
Roswell, Georgia 30075-3707
PHONE:
(404) 616-1550
134
METHOD OF REFERRAL:
Referred from:
— any Grady Hospital outpatient clinic, inpatient ward, or
— any other agency or facility for a patient who resides in
Appointments made by either direct phone call to the clinic or
emergency room.
Fulton or DeKalb County, and self referrals. arranged through the
ward clerk of the referring Grady Health System.
All walk-in patients are entitled to a screening medical exam. A
limited number of patients will be treated each day depending on the
severity of the illness..
LAB PREREQUISITE:
Must be ordered by Grady Health System Provider.
FOLLOW-UP:
Return appointments are given for this clinic. When indicated, consultation or referral is made to any of the Grady subspecialty clinics.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Any chronic or acute medical illnesses.
Any minor surgical problems.
In emergency cases, we are equipped to temporarily treat and stabilize the patient prior to transport to the emergency room. Clinical
Manager: Alfreda Hobson, RN, BSN, MBA
CLINIC:
NORTH DEKALB
HEALTH CENTER
SERVICE:
Primary Care (Adult, Pediatric and OB
services)
CLINIC CODES:
N080 Primary Care (Adult & Pediatric)
N081 Ancillary Services (Nutrition,
Obstetrics, Radiology)
DAYS/HOURS HELD: Monday - Friday 0800-1700
Tuesday-Thursday 0800-1900
PLACE:
3807 Clairmont Road
Chamblee, Georgia 30341
PHONE:
(404) 616-0700
METHOD OF REFERRAL:
Any entity within the Grady Health System, and agency or facility in
Fulton or DeKalb counties, and self referrals by patients.
LAB PREREQUISITE: All labs must be ordered by an established
GMH Provider.
HEALTH CENTER:
GRADY HEALTH CENTER SOUTH
DEKALB
HEALTH CENTER
N070 Adult patients
CODES:
N070 Pediatric patients
N070 Suture Removal
HOURS OF OPERATION: Monday-Friday 0800-2000;
135
extended hrs. Thursdays until 1900;
Saturdays 0900-1700
OB/GYN Services:
Wednesday 0800-2000
NURSING STAFF
AT CLINIC:
Monday-Friday 0800-2000
PLACE:
2626 Rainbow Way, S.E.
Decatur, Georgia 30034
PHONE:
(404) 616-1776
FAX:
(404) 241-7162
METHOD OF REFERRAL:
Referred from:
— any Grady Hospital outpatient clinic, inpatient ward, or emergency room.
— any other agency or facility for a patient who resides in Fulton
or DeKalb County, and self referrals.
Appointments made by either direct phone call to the clinic or arranged through the unit clerk of the referring Grady Hospital department.
A limited number of walk-in patients will be seen each day depending on the severity of illness.
LAB PREREQUISITE: Must be ordered by GHS provider.
FOLLOW-UP:
Return appointments are given for this clinic. When indicated, consultation or referral is made to any of the Grady subspecialty clinics.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Any chronic or acute medical illnesses.
Any minor surgical problems.
In emergency cases, we are equipped and trained to temporarily
treat and stabilize the patient prior to transport to the emergency
room.
CLINIC:
OTIS W. SMITH M.D. HEALTH
CENTER
(Formely Grady Health Center Southeast)
MHEALTH CENTER
(Formerly Grady Health Center Southwest)
CLINIC CODES:
N090 Adult Primary Care
N090 Pediatric Primary Care
N090 Obstetrics & Gynecology
DAYS/HOURS HELD: Monday-Friday 0800-1700
PLACE:
2600 Martin Luther King, Jr. Dr. SW
Atlanta, Georgia 30311
PHONE:
(404) 696-0506
FAX:
(404) 691-4152
METHOD OF REFERRAL:
Any physician may refer patients to the health center by completing
an appropriate referral form and submitting the form via mail or by
136
hand delivery. A referring physician or his designee can also speak
with a clinic nurse, nurse practitioner, or physician to complete a verbal referral. Self referrals and walk-in patients are accepted.
LAB PREREQUISITE: Must be ordered by GHS provider.
FOLLOW-UP:
When indicated, patients may be referred to the main hospital for
special diagnostic testing and/or specialty clinic appointments. All
patients needing follow-up appointments with their primary care provider will receive appointments at discharge from clinic or by mail.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Annual physical examinations and health maintenance check
Acute and/or chronic medical conditions
Healthy pregnancies
Preventive medicine & health education
CLINIC:
CLINIC CODES:
CENTER HILL HEALTH CENTER
N020 Adult Primary Care
N020 Pediatric Primary Care
DAYS/HOURS HELD: Monday-Friday 0800-1700
PLACE:
3201 Atlanta Industrial Parkway Suite 302
Atlanta, Georgia 30331
PHONE:
(404) 616-0720 or 404-699-0509
FAX:
(404) 699-0409
METHOD OF REFERRAL: Any physician can request an appointment for his/her patient by completeing the appropriate referral form
and sending it to the health center. Verbal referrals from medical providers and self referrals are also accepted.
LAB PREREQUISITE: None
FOLLOW-UP: All patients needing follow-up appointments with
their primary care provider will receive an appointment when discharged from the clinic or by mail. Some patients may be referred
to the main GHS campus for diagnostic test and/or specialty clinic
appointments.
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Annual physical examinations and health maintenance.
Acute and chronic medical conditions.
Preventive medicine and health education.
CLINIC:
SERVICE:
CLINIC CODES:
LINDBERGH WOMENʼS &
CHILRENʼS CENTER
OB/GYN & Pediatrics
H020 Womenʼs Services
H021 Pediatric Services
H022 Counseling
H023 Ultrasound
137
DAYS/HOURS HELD: Pediatric Site:
Monday - Friday 0800-1700
Women Site:
Monday - Friday 0800-1700
PLACE:
Lindbergh Plaza
2581 Piedmont Road, N.E.
Atlanta, Georgia 30324
PHONE:
(404) 842-9810
(404) 842-0046
METHOD OF REFERRAL:
Referred from:
— Any Grady Hospital outpatient clinic, inpatient ward, or
emergency room.
— Any other agency or facility for a patient who resides in Fulton
or DeKalb County. Appointments made by either direct phone call to
the clinic or arranged through the ward clerk of the referring Grady
Hospital department.
Self referral and walk-in patients are accepted.
LAB PREREQUISITE: Must be ordered by GHS provider.
FOLLOW-UP:
Return appointments are given for this clinic. When indicated, consultation or referral is made to any of the Grady subspecialty clinics.
Primary care unrelated to pregnancy or gynecology is referred
PROBLEMS TO WHICH PRIMARY CARE WILL BE GIVEN:
Any obstetric, gynecological, or pediatric patient in need of primary care or minor surgery related to obstetrics and gynecology.
Includes suture removal for pediatrics.
Primary care unrelated to pregnancy or gynecology is referred to
other sites.
In emergency cases, patients are stabilized for transport to the
emergency care center.
138
SECTION III
SUPPORT SERVICES
139
CARE MANAGEMENT
The Care Management Department represents the integration of
three distinct professional groups: Utilization Review Coordinators,
Social Workers, and Nurse Case Managers. The primary focus of this
department is continuity of care, resource management, and discharge
planning. Each of the three disciplines brings certain core competencies and skills to this effort and functions accordingly:
Utilization Review Coordinator
A. Ensures proper utilization of hospital facilities and resources.
B. Evaluates the quality of medical care on the basis of documented evidence.
C. Reviews current inpatient records.
D. Performs quantitative and qualitative analysis of medical
care.
House staff are urged to communicate with Utilization Review
Staff regarding all questions related to medical necessity for admission or continued stay. Review coordinators have been assigned to
each nursing unit
Social Worker
A. Assesses the psychosocial needs of patients and follows up
accordingly.
B. Offers counseling and guidance to patients/families having
difficulty adjusting to illness/injury.
C. Addresses issues related to concrete service needs (food,
clothing, shelter, etc) by linking with appropriate agencies.
D. Plans and coordinates transfers/discharges to extended care
facilities, hospices, residential facilities, etc. Social workers have specific responsibility for coordinating discharge
planning and working to resolve problems which might delay the process.
Case Manager
A. Coordinates interdisciplinary conferences on the inpatient
areas.
B. Provides a clinical assessment of assigned patients and
helps to coordinate a goal directed plan of care.
C. Tracks and monitors the outcome of the care delivery system.
D. Assists in developing clinical paths to document the plan of
care.
Care managers provide a leadership role with the interdisciplinary
team to achieve desired clinical, financial and resource outcomes. The
department can be contacted by calling extension 5-7705 or 5-4201
or you may contact the staff person assigned to your nursing unit.
140
Health Outcomes Center
Location:
6-C Grady Memorial Hospital
Hours of Operation:
Monday – Friday, 0800 – 1700
Department Numbers: Phone: (404) 616-7772
Fax: (404) 616-0747
Administration:
Dr. Curtis Lewis, MD, FSCVIR - Sr. VP/
CMO, Medical Affairs
Dr. Kelvin Holloway, MD - Deputy Sr. VP/
CMO, Medical Affairs
Howard Mosby, CPA - VP, Medical Affairs
Department Contacts: Ms. Cassandra Crane - Medical
Administrative Secretary
Mr. Chad VanDenBerg, MPH, CHE Director
Scope of Services
The mission of the Health Outcomes Center is to improve the quality and efficiency of care provided to patients by the Grady Health
System leading to enhanced, cost-effective health care outcomes.
The HOC serves the Chief Medical Officer and the institution through
timely evaluation and analysis of data leading to recommendation
of efforts and opportunities intended to improve the quality of care
and the efficiency of service. In addition to being an informational
resource to the institution, the HOC is primarily responsible for the
following initiatives:
Research Oversight Committee: The HOC coordinates and facilitates the oversight body responsible for reviewing and approving all
research being carried out at the Grady Health System. This includes
maintaining a database of all submitted protocols.
General Clinical Research Center: The HOC is responsible for the
administrative oversight of the GCRC.
Clinical Pathways: The HOC is responsible for facilitating the development and implementation of clinical pathways and protocols.
In addition to serving as an informational resource for the identification of particular diseases for pathways, the center serves as an informational resource to track the progress made on targeted indicators.
ICU Operations Committee: The HOC serves as the chair and
facilitator of the ICU Operations Committee. This subcommittee
of the MEC serves the institution by developing and implementing
strategies to improve the delivery of care and patient outcomes of our
critical care units. This includes the strategic decision to support and
implement a critical care decision support tool called APACHE.
Benchmarking: The HOC serves the institution by facilitating the
benchmarking of care practices and outcomes with the national experience.
Anyone interested in volunteering on a project or learning more
about the HOC should contact the department at the phone number
noted above.
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Health Outcomes Center Staff
The Health Outcomes Center routinely assesses it current staffing
configuration to ensure itʼs able to best serve the institution.
One Medical Director FTE (1 Medical Director, 2 Associate Medical Directors)
One Director
Three Research Associates
One Research Scientist
One Medical Administrative Secretary
DEPARTMENT OF MULTICULTURAL AFFAIRS (DOMA)
The mission of the Department of Multicultural Affairs is to eliminate
barriers to healthcare access and encourage culturally and linguistically appropriate services to decrease health disparities. DOMA
promotes and creates liaisons with other Grady Health System (GHS)
departments, hospitals and community organizations to better serve
the multicultural population that seeks healthcare at GHS. The department offers cultural competency trainings throughout the system,
language services and outreach in the community. DOMA provides
organizational support for cultural competence and compliance with
the CLAS standards to GHS. DOMA promotes the recruitment and
hiring of bilingual providers and staff throughout GHS.
LOCATION:
HOURS OF OPERATION:
DEPARTMENT NUMBERS:
Main office- 1518B
Monday – Friday 0830 – 1730
Phone: (404) 616-4993
Fax: (404) 616-5678
ADMINISTRATION CONTACT:
Dr. Curtis Lewis, MD. FSCVIR
S.V.P Chief Medical Officer, Medical Affairs
Dr. Kelvin Holloway, MD, Deputy Sr. VP, Medical Affairs
Dr. Leon Haley, MD, Deputy Sr. VP, Medical Affairs
Howard Mosby, CPA, VP, Medical Affairs
DEPARTMENT CONTACTS:
Ms. Thelma Hood – Secretary
Ms. Sandra Sanchez, MS – Operations Director
Dr. Flavia Mercado, MD – Medical Director
The following are the areas under the umbrella of the Department
of Multicultural Affairs: The Spanish Health Line, the International
Medical Center (IMC), Multicultural Program Services, InjuryFree Coalition for Kids (IFCK) and Language Interpretive Services
(LIS).
Spanish Health Line (404) 616-2555: This line was created to address the needs of Spanish-speaking patients that call Grady Health
System. This line provides general information about Grady Health
System and its resources in Spanish and helps individuals navigate
the health system.
The International Medical Center is a comprehensive, multidisciplinary, primary care outpatient center, which provides multicultural
clinical services in Internal Medicine, Pediatrics, OB/GYN, Center-
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ing Program (group prenatal care in Spanish), Mental Health, Bengali
Clinic, and Tropical Medicine and Infectious Diseases in a culturally and linguistically appropriate environment. Consultations for
Hispanic individuals diagnosed with diabetes. Diabetes education
classes offered in Spanish. Ready, Set, Read Program and other community resources are used to enhance community literacy and knowledge. Other multicultural clinics may be added in the future. (See
more detailed information under the Appointment Clinics section).
LOCATION:
HOURS OF OPERATION:
Clinic Building – Ground Floor GK 028
Monday – Friday 0800-1700
Saturday 0800-1200
Phone: (404) 616-6689
Fax: (404) 616-0207
Ms. Maria Lemons – Clinical Manger
CONTACT:
CONTACT PERSON:
LANGUAGES: Spanish, Bengali, English (Other languages may be
added in the future).
Multicultural Program Services promotes health-related activities within multicultural communities. The services include: cultural competency trainings, Spanish classes, outreach efforts, health
fairs and screenings, health education to multicultural patients within
Grady Health System and other organizations. The Multicultural
program coordinates and supports focus groups, surveys, studies and
research projects/grants that will improve health outcomes within the
multicultural population served at Grady Health System. The multicultural program establishes liaisons between Grady Health System
and the community; it promotes the International Medical Center,
Language Interpretive Services and GHS in general.
HOURS OF OPERATION:
CONTACT PERSON:
Monday – Friday 0800 – 1700
Ms. Bernice Tippett – Multicultural
Program Coordinator
Injury Free Coalition for Kids - Atlanta – Cuidad Los Niños- Occupant Safety Program – Keeping the Children Safe was formed to
provide health safety information to families about preventable pediatric injuries such as Car Seat Safety, playground safety, pedestrian
safety, bicycle safety and auto safety. This program commits to the
effort to reduce injury to the children of metropolitan Atlanta and
to the promotion of safe communities for children and their families by providing health care and injury prevention activities based
on local community needs. This program is funded by the Georgia
Governorʼs Office of Highway Safety.
DEPARTMENT NUMBERS:
CONTACT PERSONS:
Phone: 404-616-1403
Fax: 404-616-2326
www.injuryfree.org
Ms. Ana Everett – Program Manager
Ms. Donna Childress – Program Coordinator
Dr. Terri McFadden-Garden, Dr. Barbara Pettit
and Dr. Jana MacLeod – Principal Investigators
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Language Interpretive Services (LIS) is committed to facilitating
patient and health care provider/staff communication (written and
oral) throughout GHS during every patient encounter at GHS. It is
the policy of the Grady Health System to ensure that language does
not create barriers to equal access to services; to protect the rights of
LEP persons; and, prohibit national origin discrimination as it affects
LEP persons and/or deaf/hard of hearing. GHS does not use family
members, friends, staff or otherwise unqualified interpreters.
GHS Language Interpretive Services complies with Title VI of
the Civil Rights Act of 1964, Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) and the Office of Minority
Health (OMH) standards for Culturally and Linguistically Appropriate Services (CLAS), and other Georgia and federal laws and regulations, which mandate provision of qualified medical interpreters
and translators at all points of contact and free of charge to promote
equal access to health care for Limited English Proficient (LEP) patients.
All LIS medical interpreters must meet all of the following qualifications:
· Demonstrate proficiency in English and one target language
· Complete a medical interpreting training course
· Demonstrate knowledge of interpreter roles, standards and protocols
· Demonstrate proficiency in medical terminology in both languages
· Demonstrate awareness of the significant role that culture plays
in the medical encounter
· Demonstrate interpreting skills that support the provider-patient
relationship
· Demonstrate adherence to standard code of ethics for interpreters
· Participate in continuous education sessions in medical interpretation skills and terminology
LIS supports the languages most frequently used by the LEP population coming to Grady Health System. Currently LIS has Spanish
interpreters on staff to assist in person as well as by telephone. (Staff
interpreters of other languages will be added as the need of services
increases.)
For languages not offered by staff interpreters, including American
Sign Language (ASL), LIS coordinates with outside agencies for interpretation in person, over the phone or through video conferencing
(multiple units available in the hospital).
For written communication, LIS has an in house medical translator
available for Spanish and contract agencies for translation of other
languages. Any translated document used by Grady Health System
must be approved by LIS before distribution.
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HOURS OF OPERATION:
CONTACT NUMBERS:
CONTACT PERSONS:
24 hours a day/7 days a week
Phone: 404-616-9626
Pager: 404-871-1196 (5 p.m. to 7 a.m.)
Fax: 404-616-5701
JaNean Mitchell, Interim Supervisor
Sandra Figueroa-Reyes, Translator 404-616-1997
Language Interpretive Services Staff: Fifteen Staff Interpreters at
Grady Memorial Hospital; There are interpreters assigned to the Infectious Disease Program and some Grady Neighborhood Clinics:
North DeKalb Health Center, North Fulton Health Center, Lindbergh
Womenʼs & Childrenʼs Health Center, Otis W. Smith, M.D. Health
Center.
To request a qualified interpreter: Dial 404-616-9626 and select one
of the following options: (Assess the situation to decide if the interpretation can be handled over the telephone or if it needs an interpreter in person.)
• Press 1: for over the phone interpreter for languages other than
Spanish
• Press 3: for over the phone Spanish interpreter to relay non-medical information
• Press 4: for over the phone medical Spanish interpreter
• Press 5: to request medical interpreter in person and have the
following information available:
• Language
• Type of interpretation (Medical/Admission/Discharge/
Appointment, etc.)
• Callerʼs information:
– Name of person making call to request an interpreter
– Callerʼs title
– Name and title of the person requesting the interpreter
(if different from caller)
– Exact location of the person requesting the interpreter
– Callerʼs extension/pager and/or the extension/pager of
the person that needs the interpreter
Please make sure that you are in the agreed location when the interpreter arrives.
If after placing a request for an interpreter, he/she is no longer required, please notify the dispatcher at 404-616-9626 (option 5) immediately.
GUIDELINES ON HOW TO USE
ON-SITE MEDICAL INTERPRETERS
Prior to seeing the patient
• Give pertinent information to interpreter before entering the room
• Keep in mind that everything you say must be interpreted
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• All information will be kept confidential
Etiquette/Protocol
• Introduce yourself and the interpreter to the patient.
• Address the patient, not the interpreter
• Position yourself to maintain eye contact
• Talk to the patient using first person (“I”)
• Let the interpreter be your voice as well as the voice of the patient
The Dialogue
• Keep a comfortable pace that will allow extra time for interpretation
• Avoid highly technical medical jargon and idiomatic expressions
• Listen without interrupting
• Use diagrams and pictures to facilitate comprehension
• Ask patient several times if they have questions and confirm understanding asking the patient to repeat back important instructions
• Do not ignore the cultural insights from the patient. The interpreter
may be aware of cultural differences and may alert you if a cultural
issue arises, but should not be consider a cultural expert
Ensure the accuracy and confidentiality of the communication
• Always use a qualified interpreter by calling 404 616-9626. If
none is available or another language is needed call the Language
Line
• Do not use another patient or family member (especially a child) or
non-qualified hospital staff
• Do not ask the patients to bring their own interpreter
• LEP patients have the right to a trained interpreter, free of charge,
according to federal mandates.
Ethics
• The interpreter is bound by the Professional National Code of Ethics to be neutral, and cannot interfere, advise, or interject personal
opinions. Interpreters are professionals, and must conduct themselves appropriately.
• Do not ask the interpreter to do anything else but interpret. They
cannot sign as a witness, or carry out duties of other medical professionals however minor.
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QUALITY MANAGEMENT DEPARTMENT
ADMINISTRATION CONTACT:
Dr. Curtis Lewis, MD, FSCVIR
S.V.P. Chief Medical Officer, Medical Affairs
Dr. Kelvin Holloway, MD, SVP, Deputy Chief of Staff
Howard Mosby, CPA, Vice President
DEPARTMENT CONTACTS PERSON(S):
Ms. Thomassina Jordan,
Secretary II
Ms. Judy H. Shepard, RN, MN, Director
DEPARTMENT NUMBERS
Phone: (404) 616-7706
Fax: (404) 616-2119
_______________________________________________________
Vision
Quality and safe healthcare for all Grady Health System patients.
Mission
Quality Management is committed to providing professional expertise and appropriate data that will improve patient outcomes and exceed community standards in care delivered within
Grady Health System.
Principles of Quality Management leadership
•
•
•
•
•
•
•
•
•
•
•
•
Constructive Relationships
Mission Driven
Strategic Thinking
Passion and Vigor
Culture of Inquiry
Association-Mindedness
Ethos of Transparency
Integrity
Sustaining Resources
Results-Oriented
Continuous Learning
Forward Thinking
Adapted from the approved NAHQ Board of Directors 2006 documents. Source document; The Source: Twelve Principles of Governance That Power Exceptional Boards. Washington, D.C.: BoardSource 2005, “http//www.boardsource.org”
1. Scope of Service
The Quality Management (QM) department is under the direct supervision of the Sr.Vice President/Deputy Chief of Staff, VP of the
Medical Affairs Division and Senior Vice President, and Chief Medical Officer of the Grady Health System. The QM department process
(s) supports the strategic plan, mission, vision and core values of the
Grady Health System. We assist the GHS in complying with JCAHO, CMS, DHR, GHA/PHA and other regulatory agency standards
as appropriate. The QM department monitor and evaluate the Performance Improvement (PI) program effectiveness within the organization. Quality Management is responsible for collecting, analyzing
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and evaluating patient care delivery and processes for the some major
populations and medical staff services. The PI plan includes the
framework for how the program is structured and identifies the ongoing focus of improvements of the organization. The goal is continuously to improve the care and patient health outcomes by determining
“the degree of what is done is efficacious and appropriate for the individual patient, is available in a timely manner to patients who need it,
is effective and continuously provided, and is rendered in a safe environment and with respect to the patient.” Continuous improvements
should be sustained. The methodology used to assess and improve
organizational performance is FOCUS - PDCA, attached at the end of
this document. Essential processes are used for:
•
•
•
•
•
•
•
Planning,
Designing, and
Implementing processes
Monitoring performance through data collection,
Analyzing data,
Improving current performance, and,
Sustaining improved performance
Quality Management is largely responsible for Service specific reports on HV, HR, PP or HC patient care or processes to Medical Staff
Services and Executive meeting, Peer review quality profiles are
completed for all medical staff, provide population specific projects
for the PRO, facilitate target teams for hospital focus studies and is
a resource for continuing PI education. GHS leadership is committed
to continuous quality patient care and service delivery. The leadership empowers staff to lead improvement efforts by providing time
and resources necessary to identify opportunities to improve care, organize teams, clarify current process, understand process variation,
select a process to improve, Plan Do Check Act then implements the
improvement. We sustain gains throughout the organization.
The GHS current Performance Improvement plan is posted on the
Grady intranet. Please review the plan for the organizationʼs PI goals
and objectives, and JCAHO required performance measurement and
the PI structures.
2. QM Staffing Plan:
Director (1)
Quality Management Specialists (7)
Review Assistants (4)
Medical Administrative Secretary (1)
Secretary II (1)
3. LOCATION:
15-C and 1B 017 Grady Memorial Hospital
4. HOURS OF OPERATION:
Monday - Friday 0800 - 1700.
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Revisions: 6/98, 6/00, 8/01, 3/02, 5/05, 3/30/06, 1/3/07
UTILIZATION MANAGEMENT
Utilization Management activities are also coordinated by the Case
Management Department. The Medicare program created the first
formal requirements and guidelines for development of utilization
review driven by a concern for the rising level of healthcare expenditures. Accrediting bodies, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), American Osteopathic
Association (AOA), Utilization Review Accreditation Commission
(URAC) and National Committee for Quality Assurance (NCQA)
include requirements geared toward utilization review in their standards.
The Utilization Management program endeavors to assure appropriate allocation of hospital resources, addresses over/under utilization and inefficient resource scheduling. It is criterion based utilizing
a concurrent review process.
The functions are:
To ensure proper utilization of hospital facilities and resources.
To evaluate the quality of medical care on the basis of documented
evidence.
To review current inpatient records.
To perform quantitative and qualitative analysis of medical care.
To coordinate, with social services, discharge planning with
available community resources to ensure adequate follow-up care.
To review all patientsʼ records using established criteria, with respect to the medical necessity of admissions to the institution, the
duration of stays, and professional services furnished, including
drugs and biologicals. If additional information is needed to make
a determination, a “Utilization Alert” form will be placed in the
medical record for completion by the attending physician. Information is communicated to the Georgia Medical Care Foundation
(the Professional Review Organization contracted by the Healthcare Financing Administration to oversee the medicare/medicaid
program), by the Admission Coordinators in the Admitting Office.
House Staff are urged to communicate with the Case Management
staff regarding all questions and concerns about quality, medical necessity for admission or continued stay. Case Management or Utilization Review Coordinators have been assigned to each nursing unit.
They can be reached by calling (404) 616-7705 (ext. 5-7705).
Appeals may be filed by either Admission Coordinators (Authorization for Admission) or by Utilization Review Coordinators (Continued Stay Authorizations).
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SOCIAL SERVICES
There are numerous social workers at Grady Hospital assignedto
various units throughout the Grady Health System. Their functionsvary considerably in accordance with the particular area ofspecialty:
Main Social Service
Pediatric Social Service
Womenʼs Health Services
HIV Social Service
Crestview Social Service
extensions 5-4195
extensions 5-5724
extension 5-4192
extension 5-3968
extension 5-8120
Listed above are the major social work areas. However, there are
social workers assigned to specialized programs, such as First Steps,
Neighborhood Health Clinics, Psychiatry, Ambulatory Clinics, etc.
Limited evening, weekend and holiday coverage is offered. After
normal work hours, social work services are available in the E.C.C.
24 hours per day, 7 days per week. For emergency needs occurring
after normal work hours, contact E.C.C. social work office at extension 5-5331, or the Grady operator.
It is important that patients be referred as soon as possible followingrecognition of a problem, both to ensure that optimal benefitsof
this service may be provided, and to avoid delay in makingany arrangements necessary for proper care outside the hospital.
The following conditions and/or circumstances are delineatedto
assist the House Staff physician in determining the needor advisability of social service assistance for patients:
1. Social or economic problems are contributing to or complicating
an illness.
2. Inadequate or inappropriate facilities exist for home care; or assistance is needed to follow through with the recommended plan
of treatment.
3. Transfers to other medical facilities.
4. Unusual fear, anxiety or confusion in relation to the illness, the
treatment plan, or home care.
5. Rehabilitation or vocational guidance is needed.
6. Hospice care and/or counseling related to terminal conditions.
7. Referrals for food, clothing, shelter, disability income, or other
concrete needs.
8. Issues related to domestic violence, abuse and neglect (children,
the elderly, mentally impaired, etc.)
9. Patients in need of placements, i.e., personal care homes, shelters,
foster homes, specialized residential facilities, etc.
10. Special transportation needs.
Additionally, Social Service staff maintains a liaison with healthrelated community agencies, such as county health departments,local
prisons, neighborhood health clinics, and Family andChildren Services, to name a few.
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THE PEDIATRIC SOCIAL SERVICES DEPARTMENT,
located in Hughes Spalding Childrenʼs Hospital in Room B18H, is
openMonday through Friday from 0800-1630 hours, and may be
reached by dialing extension 5-5724. Outside normal workinghours,
the coverage is as follows:
1. Holiday coverage from 0800-1630 hours
2. Saturday coverage from 0800-1630 hours
3. Emergency coverage per digital beeper (404) 619-7975
4. Pediatric Social Services also provides Pediatric Sickle Cell social work services as well as Hispanic Services social work services
When issues relate to child abuse/neglect, Pediatric Social Services
can be consulted directly for coordination of services.
WOMENʼS SOCIAL SERVICES includes services to OB/GYNand adult sexual assault victims. The Womenʼs Social Services also
includethe Grady First Steps to Healthy Families Program provideservices to first time parents who deliver at Grady. Services includetelephone follow-up as well as home visitation. The goal is to preventchild abuse and or neglect through education. The directnumber
to Grady First Steps is 5-6264.
THE CUSTOMER SERVICE DEPARTMENT
The Customer Service Department is maintained by the GradyHealth System® to enable patients and their families to obtainsolutions to problems by acting in their behalf with administration or
any department or service, by coordinating among departmentswhen
necessary, and by recommending alternative policies and procedures
in order to improve service. As the Health Systemʼs direct representatives, Customer Service Representatives interpretthe Grady philosophy, policies, procedures, and services to patients, families and visitors. The Customer Service Department is also the authorized agent
for the receipt and resolution of patient grievances in accordance with
federal regulations, and the Health Systemʼs designated authority on
patientsʼ rights. The Customer Service Department may be reached
by phone at 5-5349 or by fax at 5-6950.
The Patient Satisfaction Survey is administered, scored and reported by the Customer Service Department. For information regarding
survey results or administering the survey in your area, please call
5-7683.
RAPE CRISIS CENTER
The Rape Crisis Center is a 24-hour service providing informationas well as crisis and long-term counseling for victims of sexual
assault and their families. The Center works in close cooperation with
the GYN/OB service which provides medical care for the adult female victims and with the Emergency Care Clinic which provides
medical care for the adult male victims. Other ongoing services include a 24-hour hotline, individual, family andgroup therapy, and
information, support and accompaniment throughout the police and
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court procedures. Our staff and volunteers are also available to do
public speaking to a variety of community and professional groups.
Women, men, and children who have been recently sexually assaulted should be referred to the appropriate Emergency Clinic for
medical care and the possible gathering of medical evidence as soon
as possible. Women should be referred to the Womenʼs Urgent Care
Clinic, Men to the Emergency Care Clinic, and Children (both males
and females under 18) to the Pediatric Emergency Clinic at Hughes
Spalding. The Rape Crisis Center will then participate in the care of
patients in the respective clinic. Counseling services are also available to victims who were assaulted previously and continue to suffer
emotional pain from the attack.
The Center is located in Grady Health Systemʼs main building and
the phone number is 616-4861. For emergency coverage situations,
please call digital beeper 404-619-7975.
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THE LONG TERM CARE DIVISION
The Long Term Care Division includes the following entities and
service programs: Crestview Health & Rehabilitation Center, and
Home Care Services, which includes the Hospice Program and
Home Health Program.
CRESTVIEW HEALTH & REHABILITATION CENTER
One the largest hospital-based nursing facilities in the nation, at
388-beds, Crestview Health & Rehabilitation Center has the distinction of the State of Georgiaʼs largest nursing home. The Facility is
accredited by the Joint Commission on Accreditation of Health Care
Organizations, and licensed by the State of Georgia Department of
Human Resources.
Crestview provides an array of services to ensure the highest quality of life possible for adult residents in its care. The Scope of Services includes: Individualized Rehabilitation Program, Skilled Nursing
Services, Pulmonary Rehabilitation, Wound Management, IV Therapy, Pain Management, Hospice Services, Respite Care, HIV Management/Services, Nutritional Support /Management, Psychosocial and
Recreational Services. Crestviewís Care Team specializes in wound
care services and assessment of high risk residents. Twenty-four hour
coverage is provided by skilled RNs and an Extended Care Service,
including, a full-time Chief of Service, physicians and physician assistants. Services are provided by an interdisciplinary team of health
care professionals in a homelike atmosphere in a compassionate and
respectful manner.
The Facility has a fifty-four (54) bed Medicare Unit. Private Pay,
Medicaid, Medicare, and other third party insurances are accepted.
Crestviewʼs management strives to maintain close relationships with
the surrounding community. Toward this end, Crestview provides academic and service relationships with participating physicians from
Emory School of Medicine and the Morehouse School of Medicine.
As resident care is integrated with education and research, residents,
staff, and students benefit from an educational and stimulating environment.
A community, in and of itself, Crestview Health & Rehabilitation Center offers residents many amenities, including: Recreational
Therapy/Activities, Resident Advocacy, Pastoral Support, Beauty and
Barber Shop, Phone, Mail and Newspaper Service, Chapel, Security,
Pharmacy, and Rehabilitation Services, including Physical Therapy,
Speech Therapy, Occupational Therapy, and Respiratory Therapy,
and Laundry Service. Set within a secure seven-acre landscaped park,
the Facility is located ten (10) minutes south of downtown Atlanta.
For admissions information, please contact the Admissions Coordinator at 5-8125.
HOME HEALTH PROGRAM
The Grady Health System maintains contracts with two (2) Home
Health agencies to provide comprehensive, cost-effective home care
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to the Grady patient population. Referrals are assigned to the contracted agencies based on a weekly rotational schedule. All requests
for home health care are by physician order, and should be coordinated by the social worker assigned to the patientís Unit/Clinic. Members of the House Staff may identify home health care needs for any
patient registered with outpatient clinics or candidates for discharge
from the hospital. A Home Health Referral Form (303-77006PD)
must be completed on all Home Health candidates. Copies of the Referral Form are available at all nursing stations and Clinic areas.
The Home Health Programʼs Scope of Services includes: intermittent skilled nursing services by registered and licensed practical
nurses; comprehensive rehabilitative therapies including Physical
Therapy, Occupational Therapy, and Speech/ Language Pathology;
personal care services provided by Home Health Aides (HHAs), and
collaboration for Durable Medical Equipment/Routine Medical Supplies required by the patientʼs plan of care.
NOTE: After 1630 hours, and on weekends, all requests for home
health care must be completed by the physician using the Home
Health Referral Form. The completed Form must be routed to the
Social Service Office located in the Emergency Care Center (ECC)
area.
HOSPICE PROGRAM
The Grady Hospice Program provides high quality palliative and
supportive care for the terminally ill, their families and significant
others in a respectful, compassionate and competent manner. The
Programʼs premise is that although nothing can be done clinically, to
extend a patientʼs life, there is always something that can be done to
improve upon oneʼs quality of life. The Hospice Program is accredited by the Joint Commission on Accreditation of Health Care Organizations, and licensed by the State of Georgia Department of Human
Resources. Hospice Care may be provided either in the patientʼs own
home or at Crestview Health and Rehabilitation Center. Care is holistic and is provided by an interdisciplinary team including physicians,
nurses, social workers, chaplains, home health aides, and volunteers.
Candidates can be admitted into the Hospice Program, if they meet
the following criteria: have an incurable, progressive illness with a
life expectancy of six (6) months or less; all curative treatments (such
as radiation, chemotherapy or surgery) have been completed; the patient agrees with the Hospice philosophy; and a primary care person
is available in the home to assist with routine care needs.
Referrals for Hospice Care should be made through the Hospice
Office at extension 5-3496.
The Hospice Program Mission places emphasis on educating the
Grady Community in the art and science of Care for the Terminally Ill
and Their Families. Discussion about, and requests for, educational
presentations may be directed to extension 5-3496.
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DRUG INFORMATION CENTER (DIC)
The mission of the Drug Information Center is to provide concise,
timely, and accurate responses to drug information inquiries received
from Grady Health System patients and healthcare professionals. The
Drug Information Center is staffed by clinical pharmacists and is
available to answer inquiries encompassing all aspects of drug therapy and drug use policies within Grady Health System. These areas
may include indications for use, drug administration, adverse effects,
availability, compatibility/stability, dosage, identification of foreign
or herbal drugs, drug interactions and safety during pregnancy or lactation.
DIC DAYS/HOURS:
PHONE:
ON CALL PAGER:
FACSIMILE:
Monday through Friday 0800 to 1600.
Please refer questions to the on-call pager
during non-business hours.
(24-hour on-call service available)
(404) 616-7725
(during normal operating hours)
(404) 283-0587
(outside of normal operating hours)
(404) 616-2227
CLINICAL STAFF PHARMACISTS
Clincial Staff Pharmacists are decentralized clinical pharmacists
who review the pharmacotherapy of patients on selected nursing
units and clinic areas in order to improve the selection and monitoring of medications. They ensure appropriate dosing of medications,
monitor for drug interactions, adverse drug reactions, medication errors, and are a resource for drug information. In addition to these
clinical services, the Department of Pharmacy and Drug Information
utilizes Clinical Pharmacists and Clinical Pharmacist Specialists to
provide services in the areas of Infectious Diseases, Metabolic Support, Primary Care, Internal Medicine, Drug Information / Medication Use Evaluation, Neonatology, Oncology, Pharmacokinetics,
Emergency Medicine, and Critical Care. The clinical pharmacy staff
work throughout Grady Health System to identify, prevent, and resolve drug-related problems. All clinical pharmacists working in
inpatient areas are certified in ACLS and are members of the code
response team. Please refer to the formulary book for the name and
pager number of the clinical pharmacist covering an area or service,
or page the pharmacy resident at 404-283-0587 for consults.
DRUGS AND SUPPLIES
A list of drug supplies available for use from the Grady Health
System inpatient and prescription pharmacies (Drug Formulary) is
included in a separate manual entitled the Grady Health System Pharmacy and Clinical Laboratory Manual. The Pharmacy and Therapeutics Committee, a multidisciplinary committee of the medical staff,
155
selected the drugs on this formulary based on their efficacy, safety,
and cost.
It is expected that this formulary will be followed rigorously in
prescribing for all patients. Approved changes to the formulary are
distributed monthly to chiefs of service and chief residents. Specific
questions regarding formulary medications should be referred to the
nearest pharmacy location, the Drug Information Center, or the clinical pharmacist on-call (404-293- 0587). The Drug Information Center may be contacted at (404) 616-7725.
The Department of Pharmacy and Drug Information at Grady Memorial Hospital provides 24 hour pharmacy services for hospitalized
and ambulatory patients. In addition, the Department operates eight
off-site pharmacies throughout the metro Atlanta area. The Pharmacy
provides pharmaceutical care through a unique blend of centralized
and decentralized programs with unit dose and intravenous admixture services. Telephone numbers and locations of several pharmacy
sites are listed below. Information regarding the Infectious Disease
Program Pharmacy and the Neighborhood Health Center Pharmacies
may be located in this manual on the pages for these respective programs.
PHARMACY TELEPHONE NUMBERS
Inpatient Pharmacy Areas
Telephone
Main Inpatient Pharmacy — Order Entry
(404) 616-4118
Main Inpatient Pharmacy — IV Admixture
(404) 616-4119
Neonatal ICU Pharmacy Satellite
(404) 616-7353
Inpatient Pharmacy Supervisor
(404) 616-2061
(404) 616-2063
Prescription Pharmacy Areas Telephone
Main Prescription Pharmacy
(404) 616-4115
Senior Care Pharmacy
(404) 616-5079
Facsimile
(404) 616-0655
(404) 616-0655
(404) 616-2017
(404) 616-2227
Facsimile
(404) 616-8651
(404) 616-8663
Pharmacy Purchasing/Admin. Telephone
Facsimile
Administrative Office
(404) 616-3817 (404) 616-6070
Storeroom
(404) 616-3471 (404) 616-9897
Clinical Pharmacy Services
Clinical On Call Pager
Drug Information Center
Telephone
Facsimile
(404) 283-0587 (404) 616-2228
(404) 616-7725 (404) 616-2227
INVENTORY, DISTRIBUTION & RECEIVING
Supply Distribution is responsible for establishing and maintaining
“on hand” sufficient amounts of medical/surgical supplies to meet the
daily demands imposed on the Grady Health System. This process
enables the Grady Health System staff to provide proper patient care
to both inpatients and outpatients.
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GENERAL INFORMATION
Location of Supply Distribution: BH035, in the Clinic Building
Basement Level
Hours of Operation:
24 Hours per day, 7 days per
week including Holidays
For information, please call extension: 5-3984 or 5-3985
INCOMING REQUISITIONS
PURPOSE: Incoming requisitions are utilized by hospital personnel to request hospital stocked medical/surgical supplies utilized to
provide patient care and also office supplies for daily general office/
record keeping functions.
POLICY: All requests for supplies stocked in Supply Distribution
must be put on a requisition form (stock #30377329) with all information completed.
PROCEDURE: Items needed from the storeroom should be requested via a Supply Distribution requisition form (stock #30377329).
This form should include the following data:
1. The correct catalog stock number, catalog description, requesting department, service unit number, quantity ordered
and the unit of issue as shown in the catalog, all written in
the appropriate spaces.
2. All items should be listed in stock number sequence. Account classification can be obtained by referring to the index listing of the stock catalog.
3. Room number and extension(s) must be provided for all
office areas.
4. All requests must have an approval signature.
5. Requisitions that are not properly filled out will be returned
to the originator, without action.
EMERGENCY REQUISITIONS
POLICY: Nursing area personnel can promptly/accurately receive
hospital stock items should an emergency/crisis occur and supplies
are not readily available in the area. All emergency requests for stock
items must be presented to Supply Distribution personnel on a white
Supply Distribution requisition form # 30377329.
PROCEDURES:
1. Requests will be hand carried to Supply Distribution in
(BH035).
2. The request for medical-surgical supplies only and for only
3 items or less.
a. Supply Distribution personnel will honor this
requisition without questions and will proceed
to fill it immediately.
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CENTRAL STERILE SUPPLY
The Central Sterile department is responsible for the procurement,
distribution, maintenance, and steam and gas sterilization of all the
instrument trays and case cart instruments for the perioperative services, OB/GYN services, ECC, and clinic areas of the Grady Health
System. We also serve as a hospital wide equipment support area for
specific O.R. disposable supplies and other equipment, such as, specialty beds, intravenous delivery devices, feeding devices, pneumatic
devices and hypothermia units.
General Information:
Location of Central Supply: HB028, in the clinic building
(basement level).
Hours of operations:
24 hours per day, 7 days per week
including holidays.
CLINICAL ENGINEERING DEPARTMENT
The Clinical Engineering Department is responsible for promoting
compliance with the management of all patient care/clinical equipment (regardless of ownership), used in any facility operated by Fulton-DeKalb Hospital Authority. Patient care/clinical equipment includes equipment used in the treatment; diagnosis and/or monitoring
of patients. You may report clinical equipment problems to 5-3939.
PLANT OPERATIONS DEPARTMENT
The Plant Operations Department is responsible for promoting
compliance with the management of non-clinical equipment (regardless of ownership), used in any facility operated by the Fulton-DeKalb
Hospital Authority. Non-clinical equipment includes all equipment
and/or utilities used to maintain operations and maintenance of the
patient care environment. You may report these problems or safety
hazards to 5-3960.
INFORMATION SERVICES
I. Organizational Units
A. Client Services
This area of Information Services (IS) provides consulting
and support services for the department level computer applications, especially those which involve multiple departments. Client services projects range from minor systems
modifications to the selection and implementation of new
systems.
B.
Network Services This area of Information Services (IS)
maintains all telecommunications and computer network
resources, including the central telephone switching system
and the multiple local area networks, network applications,
and most frequently telephone service.
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C.
Production Services This area of Information Services
(IS) maintains the mainframe (data center/operations) and
mid-range environments. Production services maintains
the physical computer facility, monitors production quality for IS systems and frequently come in contact with you
through such activities as data entry and distribution of system reports.
D.
Support Services
This area of Information Services (IS) may be generally
viewed as the “customer service” area of IS. This area
provides support for hardware problems, software problems, and user systems education, they are responsible for
multiple functions such as the management of IS related
purchases and vendor maintenance. This area also organizes and conducts a full selection of classroom computer
based terminal training for all major applications in use at
Grady Health System and also provides a variety of popular personal computer training classes. This area provides
a central “Help Desk”, for IS related product for service
problem documentation, tracking and resolution through
coordination of appropriate resources. Support Services
also provides documentation and coordination of resources
to ensure your service requests are completed.
II. Reference Information
A.
Training
This group will support users with training classes that include hands-on training and practice sessions. This group
will help educate and orientate computer users to various
information systems used within Grady Health System.
This group will also be responsible for password security
for both the THERESA and Medipac systems. To schedule
a class please call the Help Desk at ext. 5- 1715.
B.
Help Desk
Contact this group at ext. 5-1715 for hardware, software,
classes, login name and ISRF questions and concerns.
C.
Service Requests
ISRFʼs are your avenue for requesting computer, data
and telecommunications information and services from
IS. All ISRFʼs must be submitted to IS Support Services
at Box 26045, 100 Edgewood Avenue, Suite 1700. Faxes
and copies are not accepted. The ISRF is a three-part form
available from Central Stores/Supply. This form must be
submitted to Support Services (SS) before any request or
portion thereof is processed.
The ISRF is entered into a “change management” system
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and assigned to the appropriate department within Information Services (IS) within 24 hours of receipt by SS. Prioritization and individual assignment is handled by the IS
Department Head that receives the request.
Requests for status information should be directed to the
individual assigned to your request. If you do not know,
or have not been contacted by someone and you require
status information, you may contact the SS Help Desk at
extension 5-1715. The Help Desk will determine the IS department where your request is located and provide you the
appropriate number to call regarding detailed status information. To ensure your request is handled in the most timely manner possible, please include the following steps:
Requirements for proper completion of the ISRF:
1. Your Name, Department, 10 digit cost center number,
5 digit account number, Office extension (phone number), internal post office box number, date initiated, VP
signature, and a statement of change requested (justification).
2. A request to Purchase form will be required to cover all
installation and monthly service charges when equipment or services must be obtained from outside vendors. When internal billing is required, a copy of the
ISRF will be sent to the Accounts Payable Department
indication transfer of funds from your cost center.
SAFETY
The Grady Health System has prepared an Environment of Care
policy and procedure Manual, also known as the Safety Manual.
These manuals, currently red in color, are available in every department and should be reviewed for appropriate responses to various
situations that may arise.
There are certain emergency responses that are communicated
throughout the building via the overhead paging system and/or
through the fire alarm audible alerts. When any of the following
codes are announced, your role is very simple: Follow the direction
of the Clinical Manager or senior hospital official on duty in your
current area.
FIRE:
Whenever the fire alarm system is activated (either through smoke
detectors or a manual pull station) you will hear audible bells and
see the strobe lights flashing. This indicates that the smoke or fire
situation is on your floor, the floor immediately above you, or the
floor immediately below you. Do not depend solely on the operatorʼs
overhead announcement to identify the specific alarm area. Respond
immediately by asking the Clinical manager or other charge person
in the area how you can assist in the situation. The code term for a
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smoke/fire situation at GHS is “Dr. G. Red”.
TORNADO:
When the Safety Officer and/or the senior hospital official on duty
determines that weather conditions indicate the possibility of a tornado, you will hear an overhead page “Code Gray”. If you are in a
patient care area at this time, you should be prepared to follow the
instructions of the Clinical Manager who will supervise the execution
of the Tornado Plan for the area. If the weather situation progresses
to a tornado warning, you will hear an overhead page “Code Black”.
You will then be expected to immediately assist the department/unit
staff in relocating patients, visitors, and employees into the designated safe havens specifically noted within the departmentʼs tornado
plan. You are advised not to leave the building during this time. When
the “Code Black-all clear” is announced, assist the staff in returning
all patients to their assigned rooms.
BOMB THREATS:
The Security staff will take over the situation and you should follow their directions. If you find a strange package or container in your
area, do not touch or attempt to move it. Notify Security immediately
at 911#. If at anytime you receive a threatening call informing you of
a potential explosion at Grady, prolong the conversation as much as
possible and attempt to gain as much information as the caller will
provide. Notify Security as soon as possible by dialing 911#.
EXTERNAL/INTERNAL DISASTERS:
The overhead page to notify staff to activate their response to external and/or internal disasters is “Code D”. Report to the Clinical
Manager or senior hospital official in charge of your current location
and offer your assistance. If your assistance is not needed, you may
continue your regular duties unless otherwise instructed.
Remember that the Environment of Care policy and Procedure
Manual (The Safety Manual) is available in all departments if you
wish to review the full hospital response to these emergency situations. The Safety Manager can be reached at ext. 5-5357 if you have
any safety-related concerns you wish to report.”
EMERGENCY RESPONSE TO CARDIAC ARREST
It is the responsibility of GHS to provide initial basic life support
to all individuals who experience cardiac or respiratory arrest. CPR
is contraindicated only in those patients with a valid Do Not Resuscitate order documented per GHS policy on the physicianʼs Order
Sheet. CPR will be administered in accordance with current ACLS
guidelines. ACLS training and certification is expected of all house
staff physicians and encouraged for nursing and respiratory care
personnel.
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Immediate assistance in cases of cardiac arrest can be obtained in
the hospital by dialing telephone extension 5-5555. The overhead
page to summon assistance is “Doctor 99”. Announcement of a code
(Dr. 99):
In response to the 5-5555 call, Communications Department will:
• Sound the “attention getter” code alarm (3 rising tones) on the
overhead loudspeaker system and announce twice, Dr. 99, and
location by floor with the corridor letter (e.g. Alpha, Bravo,
Charlie, etc.). (Exception: Some units may not announce codes
over the speaker system, but instead handle their own codes;
e.g., the Medical ICU, Coronary Care Unit, Surgical ICU,
Neurosurgical ICU, Burn Unit, OB/GYN, Neonatal ICU, OR/
PACU, and ECC at Grady, the Pediatric ECC, and the Pediatric
ICU at Hughes Spalding Childrenʼs Hospital.)
The person who first discovers or witnesses the cardiac arrest and
the second person on the scene become the initial members of the
resuscitation team and carry out CPR until they are relieved. Morehouse and Emory physicians will run the codes on their own patients;
the other institutionʼs physicians may be excused.
In response to the overhead page and/or the pager signal, all essential equipment for full CPR will be brought by the staff to the site of
any cardiopulmonary arrest at GHS. All personnel not participating
in the Code 99 resuscitation should continue with their responsibilities. Only required personnel, along with those personnel requested
by the resuscitating team should be in attendance.
EMERGENCY POWER
The Hospital has emergency power generators for use in the event
of an electrical power failure in the community. This generator operates life saving equipment for the patients and provides electricity
for needed hospital services. All elevators are part of the emergency
power system. Operating rooms, delivery rooms, emergency areas,
and the blood bank are served by this emergency power. Red or lighted electrical sockets denote emergency electrical power.
LABORATORY SERVICES
The Clinical Laboratory is a limited resource which must be utilized efficiently. It is essential, therefore, that each member of the
House Staff be totally familiar with the requirements and operating
schedules of the laboratory. Orders for emergency tests must be limited to true emergencies and not related to ordering for convenience or
intensity of interest. For a detailed description of laboratory services,
refer to the Pharmacy and Clinical Laboratory Manual.
MEDICAL STAFF SERVICES DEPARTMENT
LOCATION:
HOURS OF OPERATION:
Grady Memorial Hospital 1B026,
1st Floor, Main Hospital
Monday - Friday 0800 - 1730
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DEPARTMENT NUMBERS: Phone: (404) 616-4262
Fax: (404) 616-3066
ADMINISTRATIVE CONTACTS:
Dr. Curtis Lewis, MD, FSCVIR
Sr. VP/Chief Medical Officer,
Medical Affairs
Dr. Kelvin Holloway, MD, Deputy Sr.
VP/CMO Medical Affairs
Howard Mosby, CPA, VP Medical
Affairs
DEPARTMENT CONTACT PERSON (S):
Ms. Renata M. Jennings,
CPCS, CPMSM, Manager
Ms. M. Darylene Rood-Allen,
Credentials Assistant
SCOPE OF SERVICE
The department of Medical Staff Services is under the direct supervision of the Deputy Director, Medical Affairs, AVP and Senior
Vice President for Medical Affairs of the Grady Health System. As
physician and allied health professional advocates, it is the mission
of the medical staff services department to accomplishment the goals
of the organized medical staff in both an efficient and an effective
manner. By means of established processes and ongoing compliance
with regulatory and accreditation standards, the Medical Staff Services Department ensures quality healthcare to the patients of Grady
Health System through risk management and performance improvement. Serving as liaison, the Medical Staff Services Department promotes a cooperative relationship between the medical staff and Grady
Health system in accomplishment of their goals and strategic plans.
MEDICAL STAFF SERVICES STAFF:
Director (1)
Credentials Coordinators (4)
Peer Review Coordinators (2)
Credential Assistants (2)
MEDICAL RECORDS
The preparation and maintenance of medical records are of the utmost importance in providing optimal care for patients, and supplying
valuable documentation for quality assurance activities and investigation as well as documentation for reimbursement and audits for
third-party payers. Accordingly, it is the policy of the Grady Health
System to insist upon extreme care in the preparation and preservation of these records.
The Medical Record Department is located on the first floor of the
hospital, room E-138. It is fully staffed Monday through Friday from
0800 until 1630. Coverage is provided after hours and on weekends.
The department is open 24 hours a day, seven days a week.
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There is a Satellite Office (Room B206) established to assist physicians to complete medical records of recently discharged patients in a
timely manner. Staff is available in this office from 0700-2030, M-F;
0800-1630 on Saturdays and Sundays. Physicians are encouraged to
give one-hour notice before arrival to complete medical records.
The OB-Subsection is located in Room 4G006. Office hours are
0800-1700, Monday-Friday (extension 5-3922). Obstetrics and Gynecology records are stored here.
Pediatric medical records are housed in Hughes Spalding Childrenʼs
Hospital and is located in room B50H. Office hours are Monday thru
Friday, 0700 – 1700 with extended hours 0700 – 1900 on Tuesdays
and Thursdays. Physicians are asked to call extension 5-5777 to make
arrangements to complete records after office hours.
General Rules
(1) Medical records are the property of the hospital and may be removed from the hospitals jurisdiction and safekeeping only in accordance with a court order, subpoena or statute, or to be microfilmed.
(2) Medical records may be removed from the Medical Record Department for outpatient clinic reference or ward admission purposes
only. When such is the case, the physician should request an area
Clerk to secure the medical record for him/her. The record will be
checked out to the Area in care of the requester and picked up by an
Area Clerk or requester. Records must be returned within 24 hours.
(3) Medical records requested for reasons other than patient care
must be reviewed in the department.
(4) Only Medical Records personnel are allowed to remove charts
from the files; however, records will be pulled promptly upon request
and general questions will be answered when referred to telephone
extension 5-4280.
(5) All records are filed by Medical Record Number. This number
may be obtained by accessing the SMS Invision System. If the number cannot be found, call the Card Index Section (5-4293) giving the
patientʼs name, date of birth, and social security number if available.
(6) Medical Records of discharged patients will be picked up on
the night shift by 1 a.m.
Release of Medical Record Information
All requests for release of medical record information must be
placed with the Correspondence Section of the Medical Record Department. Medical Record information should not be released by any
other department or individual except in the case where a patient is
transferred to another institution and a copy of the record must be
sent with the patient. In emergency cases, information will be released to a relating physician from another facility via telephone or
fax. If a copy of the entire medical record is needed, a signed authorization by the patient must be submitted In accordance to JCAHO and
HIPPA regulations, at no time shall patient records be removed from
the hospitalʼs patient care unit, clinic or medical records department
for case studies or review.
Medical information is released in response to authorization signed
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by patients, subpoenas, requests for production of documents and
court orders. However, medical staff who receive subpoenas for records or a deposition must consult with the Department of Legal Affairs before responding.
Requests for medical information are processed within 15-20 business days for activity in the last two years, and up to 30 days for
activity >2 years and microfilmed information. Walk-in requests are
discouraged.
Preparation of Medical Records
In accordance with JCAHO, medical records must be completed
within 30 days of the patientʼs discharge. All reports must be dictated
and signed before that deadline.
The following policies and guidelines are to be followed in the
preparation and handling of all medical records at the hospital:
Internal policies regarding medical record documentation are guided by state and federal requirements and other regulatory entities.
(1) Each medical report must contain adequate documentation to
justify and support diagnoses, procedures, ancillary tests, and the
medical necessity for each encounter.
(2) For each admission, the official medical history and physical
examination will be recorded and must be recorded by a physician
within 24 hours. The history and physical examination must be signed
by the provider and countersigned by the attending physician.
(3) All entries made in the medical record must be made in blue,
black or red ink; the use of pencils, “magic markers,” etc., is not
permitted. All entries must be LEGIBLE, DATED, AND SIGNED.
All signatures must include title, rank, and Grady Number (if applicable). CORRECTIONS MAY BE MADE BY DRAWING A SINGLE LINE THROUGH THE ERROR, MAKING ACORRECTION
IN INK, THEN SIGNING AND DATING THECHANGE. Under no
circumstances may erasures be made.
(4) A provisional (admitting) diagnosis must be written on every
patient at the time of admission.
(5) Consultations imply both examination of the patient and analysis of the patientʼs medical record. A consultation note, therefore,
must be entered on the record and signed and dated by the consulting
physician. (See selection under Consultative.)
(6) Consent forms for treatment and special consents for surgery
must be completed and signed by the patient.
(7) All treatment and invasive procedures must be documented in
the medical record.
(8) Except in cases of grave emergency, patients must receive
complete diagnostic work-ups before surgery and all findings fully
recorded in the chart. When a patient goes to Surgery all orders are
automatically canceled and new orders must be written postoperatively.
(9) Operative notes must be dictated immediately after surgery and
must contain both a description of the findings and a detailed account
of the procedure and technique used and the tissues removed or altered (see the following section under “Dictation”).
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(10) All Final Diagnoses and Procedures based on the nomenclature in the International Classification of Diseases (ICD-9-CM
Codes) must be recorded in the Discharge Summary. No abbreviations may be used. The diagnoses and procedure will be coded by
Medical Record personnel using the ICD-9-CM and CPT4 codes
where appropriate.
(11) Standing orders must appear on the medical record and must
be modified as appropriate for each patient and signed by the responsible physician. All orders written by medical students and PA must
be countersigned by a House Officer or attending staff, before such
an order is carried out.
(12) Verbal orders must be signed, dated and timed by the physician who gave those orders or by a responsible team member.
(13) In all instances, the physician must sign and date the clinical
entries which he or she makes. Attendings are responsible for countersigning Histories and Physicals, and Short Stay Summaries.
(14) When a patient moves from observation status to full admit,
the change must be documented in the physicianʼs orders.
(15) The final Autopsy Protocol should be completed within 60
days after the autopsy was performed.
(16) Prenatal history and physical examination results must be recorded for every obstetrical patient.
(17) A History and Physical, should be annotated with an INTERVAL NOTE for patients readmitted within 30 days.
(18) The SHORT STAY FORM may be used for patients with certain treatment and diagnostic problems of a minor nature, which require less than 48 hoursʼ hospitalization. The physician is responsible
for checking with the Chief of his service to determine when this
form may be used on that service. A dictated discharge summary is
NOT required when you use a Short Stay form. If the patient remains
in the hospital for longer than 48 hours, a complete dictated discharge
summary must be recorded for that patient.
(19) All progress notes must be signed and dated by the resident or
Attending Physician.
(20) Records of discharged patients must be completed at the time
of discharge. Records will be picked up by Medical Record staff on
the evening shift of the day of discharge.
(21) The designated Attending Physician will be ultimately responsible for the completion of the Medical Record.
(22) Rubber Stamps for countersigning records must be approved
by Medical Records and Administration. A statement of the use of the
stamp must be filed in the Executive Directorʼs Office and the stamp
may be used only by the person whose signature the stamp bears.
(23) Orders must be written by licensed physicians having the authority to order medications and treat patients. Document all restraint
orders on the Restraint and Seclusion Order Form only. Do not write
Restraint Orders on the yellow MD order form.
(a) Each episode of restraint or seclusion must be timed limited, per restraint policy.
(b) Justification for restraint or seclusion orders and the type
of restraint desired must be documented. (24) Problem list
should be updated with each outpatient encounter.
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TRANSCRIPTION/DICTATION
Transcription is located on the first floor (Rm E138) in the main
Medical Records Department. Hours of operation are from 0700
– 1800, Mon-Fri. To report problems with dictation system:
Call ext. 5-4279 or 5-4280 (after hours)
Operative Reports and Discharge Summaries must be dictated.
Operative Reports should be dictated immediately after a surgical case, no later than the 24 hrs after surgery. Any physician whose
operative reports are not dictated within 24hrs post-procedure will be
suspended from the OR until they have been completed.
Discharge Summaries or Death Summaries must be dictated upon
the patientʼs discharge or expiration.
Dictation Equipment is located on all ward areas, 6th floor operating room lounge, in Oral Surgery Clinic, the Main Medical
Record Department (room E138), OB Medical Record Subsection
(room 4G006), HSCH Medical Record Department (B50H), Medical
Record Satellite Offices (rooms B206 and E294). In addition, every
telephone with in the hospital can be used for dictation by dialing
5-5270.
All dictation using either the Lanier Dictating Unit or a regular
touch-tone telephone is automatically relayed to the Medical
Record Department, Transcription Area. Upon transcription, this
information can be retrieved on the THERESA (the data repository
for transcribed documents) by authorized persons throughout the hospital. Instruction cards for operating the dictation equipment may be
obtained from the Transcription Area, 5-4279 and Record Completion Area (5-2317).
GRADY HEALTH SYSTEM DICTATION INSTRUCTIONS
Using the Lanier VW OS:
1. Pick up handset.
2. Enter the first 5 digits of your physician ID#.
3. Enter the 2 digit work type or touch the key labeled with the appropriate work type:
01 - Operative Report
02 - Discharge Summary
03 - Endoscopy
06 - Psychiatric Discharge Summary
4. Enter the 8-digit patient MR#.
5. If dictating an operative report, please indicate the Attending Physician present at the time of the procedure. If dictating a clinical
referral, please indicate the name of the referring MD and clinic.
6. Please indicate patientʼs name and date of birth.
* A tone will sound and a prompt will inform you that you are ready
to begin dictation.
* Touch the “D” button on either side of the handset to begin dicta-
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*
*
*
tion. (The “D” button must be depressed to record dictation).
Touch the “R” button on the back of the handset to rewind/review.
To Fast Forward: Press key labeled Fast Forward.
Touch the “L” button on the back of the handset to listen.
TO COMPLETE DICTATION:
*
*
Touch the “End Report” button.
Hang up handset.
TO DICTATE MULTIPLE REPORTS:
*
At the end of the first dictation touch “End Report”. Then enter
the work type and patient MR# for the next report. Follow this
step after each report.
TO REVIEW/EDIT:
* Pick up handset.
* Enter physician ID#, work type, patient MR#.
* Touch the key labeled review/edit.
* Fast forward or rewind to the point in which you want to edit.
* Edit your dictation then touch “End Report.
TO INSERT:
*
Fast forward or rewind to the point in which you want to insert
dictation into your text.
* Touch the “Insert” key and depress the “D” button to begin inserting dictation into the text.
* After you have finished inserting, touch the “Insert” key again to
close the insertion mode.
OPEN REPORT: (This allows the dictator to hold a report open until
he/she is able to complete the dictation).
* Touch the “Open Report” key. (An “O” will appear on the LCD
display).
TO RETRIEVE AN “OPEN” REPORT:
*
*
*
*
*
*
Enter Physician ID#.
Touch “Review Open Report”.
Enter work type, MR# of the open report.
Touch Enter.
Complete Dictation.
Touch “Open Report” when completed.
TO DICTATE PRIORITY REPORTS:
*
Touch the “Priority” button at any point during the recording of
dictation.
* Call the Transcription Dept. to check on priority status. (5-4279)
USING TOUCH TONE TELEPHONES:
1. Dial the Access Number: In-house: 5-5270;
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Outside: 404-616-5270
2. Enter your 5-digit physician ID#.
3. Enter the 2-digit work type.
4. Enter the 8-digit patient MR#.
* You will hear a verbal prompt letting you know that you are
ready to begin dictation.
* Touch “2” to begin dictation.
* Touch “4” to pause.
* Touch “3” to short rewind.
* Touch “1” to listen.
* Touch “7” to fast forward.
* Touch “6” to go to end of dictation.
* Touch “8” to go to the beginning of dictation.
* Touch “5” to end report.
* Touch “9” to disconnect from the system. (You must disconnect
from the recorder before you hang up the telephone).
TO REVIEW/EDIT:
*
*
*
Dial into the system.
Touch “#” then “3” to enter the review/edit mode.
Enter the user ID#, work type and MR# for the dictation in which
you wish to edit.
TO INSERT:
*
*
*
*
Fast forward or rewind to the point in which you want to insert
dictation into your text.
Touch “#” then “6” and dictate the insertion.
After you have finished inserting, touch “3” to exit the insertion
mode.
The recorder will rewind a few seconds and play back the insert
passage.
OPEN REPORT: (This allows the physician to hold a report open
until he/she is able to complete the report).
*
Touch “O” to place the dictation in “Open Report” status.
TO RETRIEVE OPEN REPORT:
*
*
*
*
*
*
*
Dial into the system.
Touch “#” then “4” to enter the review open report status.
Enter the work type and MR# for the open report you wish to
retrieve.
Complete the dictation.
Touch “O” to close the file.
Touch “5” to end report.
Touch “9” to disconnect from the system.
TO DICTATE PRIORITY REPORTS:
*
*
Touch “#” then “9” at any point during the dictation.
Call the Transcription Dept. to check on the priority status.
(5-4279)
169
Please dictate in the order of the format
OPERATIVE REPORT FORMAT
DICTATING SURGEONʼS NAME/ID#
PATIENTʼS NAME
MEDICAL RECORD NO.
AREA/SERVICE
DATE OF OPERATION
DATE OF DICTATION
PREOPERATIVE DIAGNOSIS:
POST OPERATIVE DIAGNOSIS:
OPERATIVE PROCEDURE:
ATTENDING SURGEON: (only if present in Operating Room and
is performing or assisting with the procedure).
RESIDENT SURGEON:
1ST ASSISTANT
2ND ASSISTANT
ANESTHESIA:
ESTIMATED BLOOD LOSS:
REPLACEMENT:
COMPLICATIONS:
INSTRUMENT COUNT:
INDICATIONS: (Brief Statement of incident)
FINDINGS:
TECHNIQUE:
Restate Dictating Surgeonʼs Name/ID#
Restate Patientʼs Name/MR#
**********************************
SURGICAL DISCHARGE SUMMARY FORMAT
DICTATING PHYSICIANʼS NAME & ID#
PATIENTʼS NAME & MR#
SERVICE
ADMISSION DATE
DISCHARGE DATE
ADMISSION DIAGNOSIS
DISCHARGE DIAGNOSIS
HISTORY OF PRESENT ILLNESS
HOSPITAL COURSE
DISCHARGE MEDICATIONS
DISCHARGE INSTRUCTIONS
********************************
MEDICAL DISCHARGE SUMMARY FORMAT
DICTATING PHYSICIANʼS NAME & ID#
PATIENTʼS NAME & MR#
SERVICE
ADMISSION DATE
DISCHARGE DATE
PROBLEM LIST
HISTORY OF PRESENT ILLNESS
HOSPITAL COURSE
DISCHARGE MEDICATIONS
DISCHARGE INSTRUCTIONS
170
************************************
GENERAL INFORMATION:
PHYSICIAN ID ENTRY:
Your 5 digit physician ID# must be registered in the dictation
system in order to dictate If dictating for another physician, please
indicate the name of the physician you are dictating for. Call the
Transcription Dept. to register your ID#. (5-4279)
WORK TYPES:
01 Operative Report
02 Medical Discharge Summary
03 Endoscopy Report
04 Pediatric Clinical Report
05 Surgical Discharge Summary
06 Psychiatric Discharge Summary
07 Flourescein Angiogram Reports
08 OB/GYN Discharge Summary
09 Radiation/Oncology Medical Summary
12 OMS Clinical Consult
13 GI Clinical Consult
14 Ortho Clinical Consult
16 Cardiac Clinical Consult
17 ENT Clinical Consult
18 Diabetes Clinical Consult
19 Ophthalmology Clinical Consult
21 Dermatology Clinical Consult
22 Neurology Clinical Consult
23 Memory Assessment Clinical Consult
24 Urology Clinical Consult
25 General Surgery Clinical Consult
26 Rheumatology Clinical Consult
27 Renal Clinical Consult
28 Pulmonary Clinical Consult
29 Asthma Clinical Consult
31 Endocrine Clinical Consult
32 Lupus Clinical Consult
33 Medical Clinical Consult
34 Geriatric Clinical Consult
35 NDL Clinical Consult
36 Toxicology Clinical Consult
37 International Clinical Consult
38 Crestview Clinical Consult
39 HSCH Cardiac Clinical Consult
41 HSCH GI Clinical Consult
42 Breast Clinical Consult
43 Plastics Clinical Consult
44 Cancer Center Clinical Consult
45 Trauma Clinical Consults
*Note: This is not a complete roll-out of clinical consult work
types.
171
DICTATION TIPS:
* Dictate your name and ID# at the beginning and at the end of
dictation.
* Dictate the patient name and medical record number at the beginning and at the end of dictation.
* Dictate name of Service.
* Speak clearly and concisely.
* Spell new or unusual medical terms/drugs.
* Dictate in an environment with minimal background noise.
* Please refrain from using a cellular phone to dictate.
At the end of a Residentʼs tour of duty at Grady he/she may request
in writing a copy of all the reports he/she has dictated three weeks
prior to the scheduled time of leaving. This request is to be given to
the Transcription Manager.
After dictations have been transcribed, reports will be sent to the
Record Completion Area, where reports will be filed under the respective providerʼs name for signature. The dictating physician is to
sign reports in the satellite office (Rm B-206).
Research and Educational Studies
Physicians and other researchers wishing to utilize medical records
for research or studies must complete the RESEARCH PROJECT
DATE FORM, obtained from the Medical Record Department. This
form should then be submitted to the Manager, Research and Studies
(5-6114). The form must be completed with all signatures affixed.
Assistance will then be given in the selection of code numbers for
the study; appropriate records will be pulled and placed in the Research/Study Area file identified by the individualʼs physicianʼs or
researcherʼs name. These records will be retained for two weeks in
the Research/Study Area within Main Medical Records (E138).
Researchers will have access to these records 24 hours a day, 7
days a week.
It is suggested that requests be made two weeks in advance for
records to be used for research purposes, since study schedules are often heavy, and records pulled in the same order in which requests are
received. Records will be refiled by Medical Records personnel upon
notification that they are no longer needed. IT IS EMPHASIZED
THAT RECORDS FOR RESEARCH WILL BE REVIEWED IN
THE MEDICAL RECORDS DEPARTMENT ONLY. NO GRADY
RECORDS MAY BE TAKEN FROM THE HOSPITAL. IT IS ALSO
EMPHASIZED THAT RECORDS FOR RESEARCH PURPOSES
WILL NOT BE REQUESTED THROUGH WARD OR CLINIC
PERSONNEL AND THAT RECORDS FOR RESEARCH WILL
NOT BE SENT TO THE CLINIC OR WARD AREAS FOR STUDY
PURPOSES.
172
RESEARCH PROJECT DATA FORM
Deficient Records
All incomplete records picked up by Medical Record personnel
will be held in the respective Satellite offices for completion by the
responsible physician.
Type
Pediatric Records
OB/GYN
All Others
Location
HSCH
GMH Room 4G006
GMH Room B206
Ext.
(5-5777)
(5-3922)
(52317)
The Record Completion Area will generate and distribute daily and
weekly reports to the appropriate Chiefs of Service, Medical Affairs,
and Administration regarding individual physician completion activity, and statistics of incomplete and delinquent records.
PHYSICIANS ARE EXPECTED TO VISIT THE RECORD
COMPLETION AREA IN THE MEDICAL RECORD DEPARTMENT TO COMPLETE MEDICAL RECORDS AS FREQUENTLY
173
AS POSSIBLE.
The completion of medical records and autopsy protocols as required by the Hospital is essential not only to the functioning of the
Hospital but also should be considered part of a physicianʼs medical
training, which will not be considered complete until all medical record deficiencies have been reconciled.
To facilitate completion of medical records physicians should:
- Ask for assistance from Record Completion Staff; all records
may not be filed behind his/her name since one chart may assigned to
more than one physician.
- Call at least one hour ahead to ensure that all medical records are
located and pulled.
CASE SUMMARY FORM
174
Prospective Payment System
Billing for Medicare patients is done under the Prospective Payment System (PPS) which is based on a classification system known
as Diagnosis Related Group (DRG).
With PPS, hospitals are reimbursed at the same rate for all patients
who fall into the same DRG (based on diagnoses procedures listed on
the CASE SUMMARY FORM) regardless of actual costs incurred.
HCFA has also assigned Blue Cross/Blue Shield as the fiscal intermediary to audit a random selection of these records on a regular basis. Blue Cross, Peer Review Organization(PRO), DHR, Champus and
several commercial insurance companies also audit medical records
for claims submitted. Audits usually focus on adequate documentation to justify admission/readmission, quality of care issues, etc.
If medical records are not accurate and complete when the patient
is discharged, assignment of a DRG (which is done in the Medical
Record Department) may be difficult or incorrect. Consequently billing will be delayed or based on incomplete information, will result
in cash flow problems. HENCE A COMPLETE AND WELL DOCUMENTED MEDICAL RECORD ENSURES MAXIMUM REIMBURSEMENT FOR SERVICES RENDERED.
All procedures (diagnostic and invasive) must have an order written on the Physicians Progress Notes - Order Form. This is in addition to documentation in the medical records that such procedures
are done and that the results are addressed. Reimbursement to the
hospital for a procedure, such as a lumbar puncture, may be denied
if the specific order is missing. The physician is responsible for completing these items on the Case Summary sheet AT THE TIME OF
DISCHARGE:
(1) Principal Diagnosis. The condition established after study to be
chiefly responsible for occasioning the admission to the hospital.
(2) Secondary Diagnoses. Conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment
received and/or length of stay.
(3) Principal Procedure. Performed for definitive treatment rather
than for diagnostic or exploratory purposes, or was necessary to
take care of a complication.
(4) Secondary Procedures. Other therapeutic and diagnostic procedures performed during a patient stay.
(5) A DICTATED AND SIGNED DISCHARGE SUMMARY AND/
OR OPERATIVE REPORT ARE ALSO REQUIRED FOR
HCFA, DMA AND OTHER THIRD PARTY REVIEWS
PEER REVIEW ORGANIZATION
Georgia Medical Care Foundation is under contract with the Federal Government to act as the Stateʼs Peer Review Organization. The
175
PROʼs chief function is to review records of Medicare beneficiaries
to insure that admission to the hospital was medically necessary, that
there is adequate documentation to support the diagnoses and procedures listed, that DRG assignment was correct and that billing was
appropriate.
Additionally, the PRO reviews for quality of care issues such as:
medical stability of patient at discharge; deaths; no social infections;
trauma suffered in the hospital; and major adverse drug reactions or
medication errors with serious potential for harm.
The PRO also reviews Hospital Issuance of Non Coverage Notices
(HINN) that are given to patients who no longer need acute care.
PRO also investigates any and all complaints made by patients.
For assistance with completion of medical records, or questions
concerning DRGs, please contact the PRO/Insurance Manager at
55113 or Data Quality Manager at 54298.
ABBREVIATIONS
Policy
It is the policy of Grady Health System to follow guidelines established by the Joint Commission on Accreditation of Hospitals in the
use of abbreviations for writing hospital forms, medical records or
other instructions related to patient care.
With reference to medical records, however, abbreviations may not
be used in writing final diagnoses and operations on the Case Summary of the Medical Record (neither green face sheet nor separate
discharge summary sheet).
Only abbreviations approved by the Grady Health System should
be used in the patients record. All abbreviations must be spelled out
at least once in a given document with the abbreviation listed alongside.
All abbreviations must be defined on hospital forms.
Chemical symbols are approved.
The use of abbreviations is discouraged. The following list of abbreviations, signs and symbols are in common use and are recognized
for writing orders and other instructions related to patient care. The
list is representative of abbreviations currently in use by the Medical
Staff and Allied Health Profession Staff.
AAROM
A-P
A-P & Lat
A-V
a.c.
a.k.
A2
AB
abd.
ABd
ABG
acid phos
Active Assisted Range of Motion
anteroposterior
anteroposterior and lateral
arteriovenous
before meals (ante cibum)
above knee
Aortic second sound
abortion
abdomen
Abduction
arterial blood gases
acid phosphatase
176
ad lib
ADA
ADd
ADH
ADL
adm.
AF
AFB
afeb.
AGA
AGN
AI
AIDS
AJ
AKA
alb
alk pʼtase
ALL
AM
AMA
AMI
AML
amnio
amt
Anesth.
ant.
approx
appt.
ARD
ARDS
AROM
arom
art
ARV
AS
ASA
ASAP
ASCAD
ASCVD
ASD
ASH
ASHD
AV
AVF
AVM
AVR
AWOL
AX Node Diss
AZT
Ba
BEE
BK
as desired, Ad Lib
American Diabetic Association
adduction
antidiuretic hormone
activities of daily living
admission
atrial fibrillation
acid-fast bacilli
afebrile
appropriate for gestational age
acute glomerulonephritis
aortic insufficiency
Acquired immuno-deficiency syndrome
ankle jerk
above knee amputation
albumin
alkaline phosphatase, alk phos
acute lymphoblastic leukemia
morning
against medical advice
acute myocardial infarction
acute myelogenous leukemia
amniocentesis
amount
Anesthesia
anterior
approximate(ly)
appointment
acute respiratory distress
Adult respiratory distress syndrome
artificial rupture of membranes
active range of motion
arterial
AIDS-related virus
aortic stenosis
aspirin
as soon as possible
atherosclerotic coronary artery disease
arteriosclerotic cardiovascular disease
atrial septal defect
asymmetric septal hypertrophy
arteriosclerotic heart disease
atrial ventricular
arteriovenous fistula
arteriovenous malformation
aortic valve replacement
away without leave
axillary node dissection
Azidothymidine (Retrovir drug)
Barium
Basal Energy Expenditure
below knee
177
baso
BDC
bid
bilat
bilat OM
bili
BKA
BM
BP
BPD
BPH
Br Bx
BRP
BS
BSA
BSE
BUN
Bx
CS
...
C&S
C
c/o
CA
CABG
CAD
CAHD
cal.
C.A.P.D.
Caps
Card Cath
CAT
cath
CBC
CBG
CC
cc
CCU
C/D
CEA
CHD
CHF
CHI
chol
CI
C1
CIN
CIS
Cl.
CLL
CM
cm.
basophile
burn dressing change
twice a day (bis in die)
bilateral
bilateral otitis media
bilirubin
below knee amputation
bowel movement
blood pressure
bronchopulmonary dysplasia
benign prostatic hypertrophy
breast biopsy
bathroom privileges
blood sugar
body surface area
Breast Self-examination
blood urea nitrogen
biopsy
cervical spine
with
culture and sensitivity
centigrade
complains of
carcinoma
coronary artery bypass graft
coronary artery disease
coronary atherosclerotic heart disease
calorie
Continuous Ambulatory Peritoneal Dialysis
capsules
cardiac catheterization
computerized axial tomography
catheter
complete blood count
Capillary Blood Gas
chief complaint
cubic centimeter
Coronary care unit
Cup/Disc
carcino-embryonic antigen
congenital heart disease
congestive heart failure
closed head injury
cholesterol
cardiac index
Cyclogyl 1%
cervical inraepithelial neoplasia
carcinoma in situ
Liq clear liquids
chronic lymphocytic leukemia
cardiomyopathy
centimeter
178
CML
CMV
CNS
CO
COE
comp.
conc.
Conf.
Conj.
cont.
COPD
CPAP
CPC
CPK
CPR
creat.
C SECT
CSF
CT
CVA
CVL
CVL-2
CVL-3
CV
CVP
CX
CXR
D&C
D&E
D/C
d/c
D/DW
D5LR
D5W
DDS
Derm
DF/PF
DIC
diff.
DJD
DKA
DM
DNR
DOA
DOB
DOE
DP
DPR
DPT
DRG
DT
DTR
chroni myelogenous leukemia
cytomegalovirus
central nervous system
cardiac output
Court Order Evaluation
compound
concentrated
confrontations
conjunction
continued
chronic obstructive pulmonary disease
continuous positive airway pressure
clinicopathological conference
creatinine phosphokinase
cardiopulmonary resuscitation
creatinine
cesarean section
cerebrospinal fluid
Computerized Tomography
cerebrovascular accident
Central venous line
Double lumen central venous line
Triple lumen central venous line
cardiovascular
central venous pressure
cervix
chest x-ray
dilation and curettage
dilation and evacuation
discharge
discontinue
dextrose/distilled water
5% Dextrose and Lactated Ringers
5% Dextrose and Sterile Water
dentist
Dermatology
dorsiflexion/plantarflexion
disseminated intravascular coagulation
differential
degenerative joint disease
diabetic ketoacidosis
diabetes mellitus
do not resuscitate
dead on arrival
date of birth
dyspnea on exertion
dorsalis pedis
Discharge Planning Record
Diphtheria, Pertussis, Tetanus vaccine
Diagnostic Related Group
delirium tremors
deep tendon reflexes
179
DUI
Dx
e.g.
ECC
ECHO
ECMO
EDC
EEG
EENT
EGA
EKG, ECG
Elect.
EMG
ENT
EOM
eos
EPAP
Epis
ML Epis
LML Epis
RML
ER
ERCP
driving under influence
diagnosis
for example
Emergency Care Center
virus enterocytopathogenic human virus
extracorporeal membrane oxygenation
estimated date of confinement
electroencephalogram
eyes, ears, nose, throat
estimated gestational age
electrocardiogram
electrophoresis
electromyogram, electromyography
ears, nose, throat
extraocular movement
eosinophils
expiratory positive airway pressure
episiotomy
midline episiotomy
left mediolateral episiotomy
right mediolateral episiotomy
emergency room
endoscopic retrograde
cholangiopancreatography
end stage renal disease
ethanol
ethanol
etiology
examine under anesthesia
Emory University Hospital
Evaluation
exploratory laparotomy
expiration, expiratory
ESRD
ETOH
ET
etio
EUA
EUH
EVAL
Exp. Lap.
expir
Extremities:
LLE
left lower extremity
LUE
left upper extremity
RLE
right lower extremity
RUE
right upper extremity
F Fahrenheit
F/U
follow-up
FB
foreign body
FBG
fasting blood glucose
FBS
fasting blood sugar
FCHD
Fulton County Health Department
Fetal Position and Presentation:
LFA (RFA)
left frontoanterior (right)
LFP (RFP)
left frontoposterior (right)
LFT (RFT)
left frontotransverse (right)
LMA (RMA)
left mentoanterior (right)
LMP (RMP)
left mentoposterior (right)
LMT (RMT)
left mentotransverse (right)
LOA
left occipitoanterior
180
LOP
LOT
LSA (RSA)
LSP (RSP)
OA
OP
ROA
ROP
FFP
F.H.
FHT
FIBS
FIO2
fld
flex.
FM
FP
FSH
FTT
FUB
FUO
Fx
G6PD
GB
GC
GEN, gen
GER
GI
Gm
Gm–
GMH
GMHI
gr
GRAV.I
GRH
GSW
GTT
gtt/gtts
GU
GYN
h
H&P
H.O.
HA
HAF
HBIG
HBP
HB SCREEN
HBSAG
HC
HCO3
Hct
left occipitoposterior
left occipitotransverse
left sacroanterior (right)
left sacroposterior (right)
occipitoanterior
occipitoposterior
right occipitotransverse
right occipitoposterior
fresh frozen plasma
family history
fetal heart tones
Fibrillations
Fractional inspired oxygen
fluid
flexion
fetal monitoring
family planning
follicle stimulating hormone
failure to thrive
functional uterine bleeding
fever unknown origin
fracture
glucose-6-phosphate dehydrogenase
gallbladder
gonorrhea
general
gastroesophogeal reflux
gastrointestinal
gram
gram negative
Grady Memorial Hospital
Georgia Regional Hospital
grain
primigravida, secundigravida, etc.
Georgia Regional Hospital
gunshot wound
glucose tolerance test
drop or drops
genitourinary
Gynecology
hour
history of physical
house officer
headache
hyperalimentation
hepatitis B immune globulin
high blood pressure
hepatitis B screen
hepatitis B surface antigen
head circumference
bicarbonate
hematocrit
181
HCVD
HDL
hemo
Hep. Lock
HIV
Hgb
H.O.
horiz.
hpf per
HTLV-ÎII
ht.
Hx
I.B.W.
I&O
I&D
ICU
IDDM
Ig
IGA
IGE
IGG
IGM
IHSS
IM
IMV
Inc. AB
Inev. AB
Ind. Coombs
INH
inspir
inv/ev
IOP
IPPB
IQ
irreg.
ITP
IUD
IUFGR
IUP
IV
IVC
IVH
IVP
Kg
KUB
KVO
L&D
lab
LAC
LAD
lat
lb.
hypertensive cardiovascular disease
high density lipids
hemodialysis
Heparin Lock
human immunodeficiency virus
hemaglobin
House Officer
horizontal
high powered field
human lymphotrophic T-cell Virus III
height
history
Ideal Body Weight
intake and output
incision and drainage
intensive care unit
Insulin Dependent Diabetic Mellitus
immunoglobulin
immune globulins A
immune globulins E
immune globulins G
immune globulins M
idiopathic hypertrophic subaortic stenosis
intramuscular
intermittent mandatory ventilation
incomplete abortion
inevitable abortion
indirect coombs
isoniazid
inspiration, inspiratory
inversion/eversion
introcular pressure
intermittent positive pressure breathing
intelligence quotient
irregular
idiopathic thrombocytopenic purpura
intrauterine device
intrauterine fetal growth retardation
intrauterine pregnancy
intravenously
intravenous cholangiography
intraventricular hemorrhage
intravenous pyelogram
kilogram
kidney, ureter, bladder
keep vein open
labor and delivery
laboratory
laceration
left anterior descending coronary artery
lateral
pound
182
LBW
LBQC
LCA
LDH l
LGA
LH
liq.
LLL
LUL
RLL
RML
RUL
L.O.C.
LLQ
LUQ
RLQ
RUQ
LMD
LMP
LOA
LOM
LOS
LP
LPN
LV
LVEDP
LVH
lymphs
lytes
M.Insuf.
M.D.
MAC
MAP
Max A
M.C.A.
mcg.
MCH
MCHC
MCV
Med
mEq.mEq/L
mg
mg%
mg/dl
MI
M1
min
Min A
ml
mm
mod
low birth weight
large based quad cane
left coronary artery
actic dehydrogenase
large for gestational age
luteinizing hormone
liquid
left lower lobe — lung
left upper lobe
right lower lobe
right middle lobe
right upper lobe
level of consciousness
left lower quadrant — abdomen
left upper quadrant
right lower quadrant
right upper quadrant
local medical doctor
last menstrual period
Leave of Absence
left otitis media
Length of Stay
lumbar puncture
licensed practical nurse
left ventricle
left ventricular end diastolic pressure
left ventricular hypertrophy
lymphocytes
electrolytes
mitral insufficiency
Doctor of Medicine
monitored anesthesia care
mean arterial pressure
Maximal assistance
middle cerebral artery
microgram
mean corpuscular hemoglobin
mean corpuscular hemoglobin
concentration
mean corpuscular volume
medicine
milliequivalents, per liter
milligram
milligrams per hundred
milligrams per deciliter
myocardial infarction
Mydriacyl 1%
minute
Minimal Assistance
milliliter
millimeter
moderate
183
MOM
mono
MR
MRF
MS
ms
MVA
MVR
N
N&V
N/A
NAD
NB
neg
Neuro
NG
NEC
N.K.A.
NKDA
NPH
NPO
NSR
NST
NSVD
NTG
NV
O.D.
O.S.
O2 cap.
O2 sat.
OB
Obs
oint.
OCT
OG
OGTT
OOB
Op
OPC
Ophth
OR
Ortho
OT
OU
oz
P.A.
p.c.
p.o.
P2
PA
PAC
milk of magnesia
monocyte
mitral regurgitation
maternal risk factor
multiple sclerosis
mitral stenosis
motor vehicle accident
mitral valve replacement
nitrogen
nausea and vomiting
not applicable
no acute distress
newborn
negative
Neurology
nasogastric
necrotizing enterocolitis
no known allergies
no known drug allergies
NPH insulin (Neutral Protamine Zinc
Hagedorn)
nothing by mouth
normal sinus rhythm
non-stress test
normal spontaneous vaginal delivery
nitroglycerine
not visualized
right eye
left eye
oxygen capacity
oxygen saturation
obstetrics, obstetrical
observation
ointment
oxytocin challenge test
orogastric
Oral Glucose Tolerance Test
out of bed
operation
outpatient clinic
ophthalmology
operating room
Orthopaedic
Occupational Therapy
both eyes
ounce
Physician Assistant
after meals
by mouth
pulmonic second heart sound
pulmonary artery
premature atrial contraction
184
PAD
PAP
PARA I, II
PAS
PAT
Path
P.E.C.
PCO2
PCV
pd
PDA
PFC
PE
Ped.
PEEP
Pelvic Measurements:
A-P D
Ant or Post
Sag D DC
IS
OC
TI
Trans D
PERLA
pH
PI
PID
PIE
PIH
PIP
PKU
PM
PND
PO2
PO
POC
POD
polys
poplit.
pos
post-op.
post.
PP
PPD
PPPG
PR
PRBC
pre-op
prep
prn
PROM
Pulmonary Artery Diastolic Pressure
Papanicolaous (smear)
primipara, secundipara, etc.
Pulmonary Artery Systolic Pressure
Paroxsymal Atrial Tachycardia
Pathology
Pediatrics Emergency Clinic
carbon dioxide concentration
packed cell volume
peritoneal dialysis
patient ductus arteriosis
persistent fetal circulation
physical examination
Pediatric
positive end expiratory pressure
anteroposterior diameter
anterior or posterior sagittal diameter
diagonal conjugate
bispinous, interspinous diameter
obstetrical conjugate
intertuberous
transverse diameter
pupils equal, reactive to light and
accommodation
hydrogenion concentration
Present Illness
pelvic inflammatory disease
pulmonary interstitial emphysema
pregnancy induced hypertension
peak inspiratory pressure
phenylketonuria
evening
paroxysmal nocturnal dyspnea
oxygen, partial pressure
by mouth
product of conception
post-op day
polymorphyonuclear leukocytes
popliteal
positive
post operative
posterior
post partum
purified protein derivative
post prandial plasma glucose
per rectum
packed red blood cells
pre-operative
prepare for, preparation
as often as necessary (pro re nata)
premature rupture of membranes
185
pt
PT
PTA
PTT
Pulse ox
PVC
PVR
q
q2h
qh
qid
qns, QS
qs
qt
R
R/O
RA
RAD
RBC
RCA
RDS
Rh
RLL
RLQ
RML
RN r
ROA
rom
ROM
ROP
ROS
RR
RT
S
S/P
SAH
SAH1
SAT
SBE
SCC
sed rate
SFS
SGA
SGOT
SH
SIADH
SLE
SLR
sm
SMA-18
SO
SOAP
patient
Physical Therapy
prior to admission
partial thromboplastin time
Pulse oximetry
premature ventricular contraction
pulmonary vascular resistance
every
every two hours
every hour
four times a day
quantity not sufficient
quantity sufficient
quart
right
rule out
rheumatoid arthritis
Reactive airway disease
red blood cells
right coronary artery
respiratory distress syndrome
Rhesus blood factor
right lower lobe - lung
right lower quadrant — abdomen
right middle lobe — lung
egistered nurse
Right Occiput Anterior
range of motion
rupture of membranes
Right Occiput Posterior
review of systems
respiratory rate
Respiratory Therapy
subjective
status post
systemic arterial hypertension
subarachnoid hemorrhage
saturation
subacute bacterial endocarditis
Sickle Cell Crisis
sedimentation rate
Standards Flow Sheets
small for gestational age
serum glutamic oxaloacetic transaminase
Social History
syndrome of inappropriate antidiuretic
systemic lupus erthematosus
straight leg raise
small
Simultaneous multiple analyser-18
significant other
subjective, objective, assessment, plans
186
SOB
sol
sp. gr.
spec.
SROM
staph
STAT
STD
stillb.
Strab.
strep
subcu
Surg
Sx
sympat
T&A
T3
T4
tab
TAB
TAH
TB
tbsp
temp
THR
TI
TIA
TIBC
tid
TLC
TM
TPR
Tr
trach
TS
TSH
tsp
TTP
TUR
TV
TVH
TVR
u/o
UA
UAC
UCC
U.B.W.
UGI
unilat.
URI
Urol
U/S
shortness of breath
solution
specific gravity
specimen
spontaneous rupture of membranes
staphylococcus
immediately
sexually transmitted disease
stillborn
Strabismus
streptococcus
subcutaneous
Surgery
symptoms
sympathetic
tonsillectomy and adenoidectomy
triodothyronine
total serum thyroxine
tablet
therapeutic abortion
total abdominal hysterectomy
tuberculosis
tablespoon
temperature
total hip replacement
tricuspid insufficiency
transient ischemic attack
total iron binding capacity
three times a day
total lung capacity
tympanic membrance
temperature, pulse, respiration
trace
tracheostomy
tricuspid stenosis
thyroid stimulating hormone
teaspoon
thrombotic thrombocytopenia purpura
transurethral resection
tidal Volume
total vaginal hysterectomy
tricuspid valve replacement
urine output
urinalysis
umbilical arterial catheter
Urgent Care Center
Usual Body Weight
upper gastrointestinal tract
unilateral
upper respiratory infection
Urology
ultrasound
187
UTI
U.U.N.
UVC
V Tach
V fib
VA
vag
VD
VDRL
vent.
VF
via
VIP
VIP1
vit
Vit.
VLBW
VMA
V.O.
vol
VS
VTX
W/C
w/u
WB
WBC
WDWN
WFL
WIC
WNL
wt, WT
WUCC
/
@
‚
·
∆, ∆ʼd
1°, 2°, 3°
<
=
≠
>
+
–
≈
S
urinary tract infection
Urine Urea Nitrogen
umbilical venous catheter
ventricular trachycardia
ventricular fibrillation
visual acuity
vagina
venereal disease
serology for syphilis
ventilator
visual field
by way of
person requiring special attention for
any reason
voluntary interruption of pregnancy
vitreous
vitamin
very low birth weight
vanyl mandelic acid
verbal order
volume
vital signs
vertex
wheelchair
workup
whole blood
white blood cell
well developed, well nourished
within functional limits
Womenʼs, Infantsʼ, Childrensʼ
Food Program
within normal limits
weight
Womenʼs Urgent Care Center
extension
at
depressed, decreased, lower
dram
elevated, increased, upper
female
male
ounce
change(d), difference
first, second, and third degree
is less than
equals (may not be used for parallel)
is not equal to
is greater than
positive
negative
approximately equal to
without
188
PROBLEM-ORIENTED MEDICAL RECORD
The traditional or source oriented medical record contains information inserted according to the source from whence the information
derives: there are sections for physicians, nurses, laboratory, and xray. In contrast, the Problem-Oriented Medical Record places information according to the problem to which it is related. Information
is thus linked to problems and not to source. The Problem List is the
key to all information in the POMR, since it contains the problem
title, number, date problem entered in record and, if appropriate, date
problem resolved. The Problem List thus serves as an index or table
of contents to the record.
There are four components to the Problem-Oriented Medical
Record:
1. Data Base
This component includes:
a. Patient profile: information about how the patient spends his
usual days, his life style, travel and occupational history, and
other information that will assist the practitioner to understand the patient as a person.
b. History; chief complaint, present illness, and review of systems.
c. Physical examination.
d. Laboratory examination.
2.
Problem List
The Problem List is constructed after the Data Base has been
collected and is the first page of the Medical Record. ACCORDING
TO THE JCAHO, A PROBLEM LIST IS REQUIRED BY THE
THIRD CLINIC VISIT AND SHOULD CONTAIN DIAGNOSES,
PROCEDURES, ALLERGIES AND MEDICATIONS. A problem
is defined as anything that requires diagnosis, management, or that
interferes with the quality of life as perceived by the patient. Problems can come from any of several categories: anatomic, physiologic,
symptomatic, etiologic, demographic, social, psychiatric, etc. The
terminology or formulation of the problem will vary according to
the quantity and quality of the information collected up to that point,
plus the experience and ability of the physician. For example “chest
pain” may be the problem formulation. The problem may be stated in
this fashion because (1) the practitioner is inexperienced and did not
recognize the history was classical for angina, or (2) the practitioner
is experienced but concluded he did not have enough evidence at the
time the problem list was formulated to say any more than “chest
pain.” This example illustrates the concept that problems are not necessarily diagnoses: they may or may not be.
Each problem that is not at the highest level of resolution at the
time the problem list is formulated has an arrow placed after it, indicating this particular problem must be “solved.” Consider the following example:
a. Chest pain
189
b. Diabetes Mellitus
Chest pain needs to be resolved to angina pectoris, pericarditis, or
whatever, whereas diabetes mellitus is already at the highest level of
resolution.
See the example of a Problem List. The Date Problem Entered
indicates that the complete initial statement concerning that problem
can be found in that chart on that date. Date Problem Solved indicates there is a Progress Note in the chart on that date giving the
evidence that enables the practitioner to state the problem at a higher
level of resolution. Thus anyone using the chart knows immediately
where the notes may be found, since the chart material is arranged in
a chronological sequence. Each problem is assigned a number that always stays with that particular cluster of data, even though the problem formulation may change as new data is available.
3. Initial Plans
Plans are written for each problem. These Initial Plans have the
following components:
Problem Number and Title:
a.
Diagnostic: listed here are the rule-outs. The most likely
or most important one comes first, followed by others in
decreasing order of likelihood or priority. Following each
rule-put, and thus clearly linked to a specific rule-out, are
detailed plans for gathering more information. These plans
are also listed in order of priority or likelihood.
b.
Therapeutic:
(1) Plans for specific drugs or therapy, including exact
dosage.
(2) Parameters to be followed in order to determine response to therapy.
(3) Plans for discovering or monitoring side effects of
therapy.
c.
Patient Education: What the patient and/or his family will
be told about the problem.
4. Progress Notes (Follow-up)
There are three types of Progress Notes:
a.
Narrative Progress Notes. Each of these has the following
format:
Problem Number and Title
Subjective:
information told by patient
Objective:
information such a physical
findings and laboratory data
Assessment:
the practitionerʼs interpretation of
the subjective and objective data
Plans:
each has three components, just
as the initial plans do:
a. Diagnostic
b. Therapeutic
c. Patient Education
Each note will not necessarily have all the above components.
190
b. Flow sheets. Each one is numbered and titled for the particular problem(s) to which it pertains. Flow sheets serve to illustrate interrelationships that might otherwise not be perceived
among various parameters. They also form a highly efficient
way to record data, saving the practitioner much time.
c. Summary statements, such as interval, discharge, and death
notes are written in a problem-oriented fashion with subjective, objective, assessment, and plan components.
PATIENT CONDITION DESCRIPTIONS
It is the responsibility of the physician to determine the condition
of patients. When a patient is admitted, note on the order sheet the patientʼs condition. To facilitate standardization throughout the Hospital
in describing such conditions, the following terms are to be used:
UNDER
EVALUATION
Patient awaiting completed physician
assessment.
GOOD
Vital signs are stable and within normal
limits. Patient is conscious and comfortable.
Indicators are excellent.
FAIR
Vital signs are stable and within normal
limits. Patient is conscious, but may be
uncomfortable. Indicators are favorable.
SERIOUS
Vital signs are stable and within normal
limits. Patient is acutely ill. Indicators are
questionable.
Vital signs are unstable and not within
normal limits. Patient may be unconscious.
Indicators are unfavorable.
CRITICAL
Clinicals find the “critical but stable” term useful when discussing
cases amongst themselves because it helps them differentiate patients
who are expected to recover from those whose prognosis is worse.
But a critical condition means that at least some vital signs are unstable, so this is inherently contradictory. The term “stable” should
not be used as a condition. Futhermore, this term should not be used
in combination with other conditions, which by definition, often indicate a patient is unstable. When a patient is placed on the critical
list, a specific notation to this effect is to be written on the chart; similarly, an order is to be entered on the chart removing the patient from
the critical list should his condition so warrant. Further, the attending
physician responsible for placing the patient on the critical list should
immediately notify the patientʼs family when the patient is classified
as critical. A notation is then to be made in the chart identifying which
member of the family has been contacted. The possibility of a misunderstanding with the family is thus minimized.
191
PATIENT DIETS
Food Service offices are open from 0800 to 1700 daily. Meal service hours for patients are as follows:
Breakfast
0645 to 0845
Lunch
1100 to 1255
Dinner
1615 to 1815
Operational hours for the department are 0500 to 2000 daily.
A diet order must be written by the physician before meals will
be served. Diet orders must be received by 0530 for breakfast, 1000
for lunch, and 1500 for dinner. Diet changes are entered into the
order entry system. Diet changes, with the exception of NPO to food
and changes from regular diets to therapeutic diets, will be made at
the following meal.
The official Diet Manual used at Grady Health System (reviewed
by the Medical Staff and Clinical Nutrition Services) is available for
reference to House Officers at each nursing station. Members of the
House Staff are urged to consider this manual a valuable aid in enhancing their knowledge of sound nutritional principles.
Questions which do not appear to be answered in the manual
should be referred to the appropriate Floor Dietitian or to the Director
of Clinical Nutrition Services, extension 5-4301 or may be reached
by using the in-house pocket paging system 280-0407.
Food is made available to clinic areas by pre-established agreement with the Food Service Department. Unless otherwise specified
all regular diets will receive sack type meals at lunch and supper.
Hot meals may be made available during cafeteria hours for selected
patients. Individual requisitions are required with appropriate identifying information. Please contact charge nurse in the specific clinic
to order meals. Food is made available for patients who have been
waiting in the clinic area for an extreme period of time.
DISCHARGE DIET INSTRUCTIONS
Discharge planning should include an assessment for the need of
diet education. If you anticipate that a patient will need instructions
on a modified diet or tube feeding, please consult Clinical Nutrition
Services as soon as possible after the patientʼs admission.
Discharge diet instructions should be ordered at least 24 hours
prior to the patientʼs discharge. A minimum 72 hours notice is required for patients who will be sent home on tube feeding in order to
appropriately instruct the caretaker. The social worker assigned to
that patient should also be notified so that needed arrangements can
be made. Patients on special diets are visited routinely in the Hospital
by the dietitians within five days of admission. If indicated patients
will be instructed by the dietitian on most diets without an order unless special circumstances contraindicate the instructions. If a Floor
Dietitian is not available, call the department, extension 5-4301.
On Saturdays, the dietitian on duty may be reached by using the
192
in-house pocket paging system, 280-0407. A dietitian is in-house on
weekends and holidays.
SUPPLEMENTS AND TUBE FEEDINGS
Orders for supplemental feedings should be included in the diet
orders. Supplemental feedings and snacks will be delivered to the
nursing unit and distributed by nursing personnel.
Patients requiring supplements are routinely assessed by the floor
dietitians who can help in recommending appropriate supplements.
Tube feeding orders should specify hourly rate. Commercial tube
feeds are delivered to the Nourishment Room on each floor daily
Monday through Friday.
Tube feeding formulas available in the Hospital are obtained
through a contract service, therefore contact area dietitian for the
brand name of formulas that is presently used. Because it is well tolerated, an Iostonic formula is appropriate for most patients receiving
tube feedings. These formulas are also lactose free.
Special modular formulas are available for modified diets. Dietitians will formulate them and the formulas will be prepared by the
Department of Nutrition. For a complete list of formulas and their
composition, contact area dietitian.
Patients who are to be discharged on tube feedings will be instructed by the floor dietitian. A minimum of 72 hours notice should
be given so that effective teaching can occur. Social Service should
also be contacted well in advance of discharge, so that appropriate
arrangements can be made.
ADULT ENTERAL NUTRITION PROTOCOL
PURPOSE :
To provide nutritional support to patients who are unable to meet
metabolic demands through oral intake.
SUPPLIES:
1. Order standard adult isotonic formula.
Specify rate.
2. Order house feeding tube – a small bore tube is available through
Central Stores. A 36” tube available for nasogastric feedings and
43” tube for duodenal or jejunal feedings.
3. Order feeding bags; available through Central Stores.
4. Use a feeding pump whenever possible to provide formula at a
consistent rate. If pump is not available, use gravity drip. Feeding pumps are available through patient Unit Managers.
METHOD:
1. Continuous drip feeding should be used initially then intermittent
if tolerated.
2. Keep head of bed elevated at least 30 (degrees). Stop feeding if
193
patient must be maintained in other than the 30 (degrees) elevated
position. If the patient must lay flat, feeding tube should be beyond the pylorus into the duodenum or jejunum using a 43-inch
tube.
3. Before initiating feeding, check for correct tube placement by
CXR or KUB for placement into duodenum or jejunum. Confirm
placement within 4 hours after insertion. For nasogastric feeding,
the tip of tube should be below the gastro-esophageal junction.
Intermittently (at least q8 hours) placement should be checked
by aspiration of G.I. contents. Tube placement should be checked
whenever a feeding is begun or epecially on neuro patients and
after procedures that may dislodge feeding tubes such as pulmonary suction.
4. After tube placement is confirmed, mark tube at anterior nasal
opening for future position confirmation.
5. Check for residual q4 hours using a 60cc syringe. Return residual to stomach. If the residual is greater than 100cc, discontinue
feeding and notify the physician.
6. Check for positive bowel sounds. Check for abdominal or other
signs of G.I. problems q shift (see below*).
7. Check rate q4 hours. Hang no more than a four hour supply at one
time.
8. Change bag every 24 hours. Date bag. Rinse with water every
shift.
9. Flush tubing with a minimum of 30 mls of sterile water using a
60 ml syringe. DO NOT USE OTHER FLUIDS cranberry juice,
cola etc. When re-connecting, flush again with water. Additional
water in feeding bag MUST be run bolus.
10. Enteric coated and slow release medications should NOT be given
through the feeding tube. The feeding tube – MUST be flushed
with water BEFORE AND AFTER the addition of all medication. All medications including liquid elixirs must be diluted
with water before being administered through the feeding tube.
Whenever possible liquid medications should be used. Contact
pharmacy for questions.
ADMINISTRATION:
Start isotonic formulas FULL strength at 25cc q8 hours until
60ml/hr rate is attained.
The patient will be assessed by R.D. at which time final rate recommendations will be made. Please notify the R.D. within 24 hours
of tube feeding initiation for nutrition assessment and recommendations.
If other than standard isotonic formulas are ordered, initiate per
M.D. orders.
DO NOT ATTEMPT TO
CATCH-UP TUBE FEEDING
If a patient has been at home or in a nursing home on a tube feeding
and tolerating it, tube feeding may be initiated at rate and concentra-
194
tion that patient was on prior to admission.
Total daily fluid requirements should be estimated by physician or
dietitian and adequate fluid should be provided to each individual patient in addition to the tube feeding. Most isotonic formulas contain
only 85% free water.
Physicians, nurses, dietitians and others caring for the patient receiving tube feedings should be aware of the following problems with
enteral feeding and monitor the patient for the same:
• Bowel sounds – if not present, or if hypoactive, check residuals.
• Diarrhea – may be caused by bacterial contamination, osmolar
overload, malnutrition, low serum albumin, concurrent drug therapy, or villi atrophy due to prolonged NPO.
• Vomiting – if vomiting occurs, tube feeding should be stopped.
Notify M.D.
• Nausea – reduce infusion rate to previously ordered infusion
rate.
• Abdominal cramps/abdominal distention – stop infusion for 2
hours; recheck, if still distended call M.D.
• Constipation – may occur, provision of adequate fluid and/or fiber may alleviate constipation.
• Fluid and Electrolyte disturbances – may occur but can be managed if frequently monitored. (See below for monitoring)
All complications or problems should be documented in the medical record.
MONITOR:
1. SMA-19 prior to initiating feedings, then weekly, SMA-7 QOD
until feeding stabilized. Check prealbumin upon initiation then
every Monday.
2. Accuchecks q6 hours in diabetic patients until blood sugar is stabilized on final rate of infusion then as per M.D. orders.
3. Admission weights, then EVERY MONDAY AND THURSDAY.
4. Accurate I&O on daily basis. Tube feedings must be differentiated from p.o. or IV fluids. Document both strength and volume
delivered. Must differentiate between formula and water.
5. Weekly nitrogen balance studies – each Monday (24 hour urine
collection for UUN on Sunday). If patient is on p.o. foods as
well, accurate calorie count must be kept during urine collection
period.
For questions or problems, which arise, contact your area dietitian
or beep 280-0407.
RADIO-IODINE THERAPY
All radio-iodine patients who are being treated, as in-patients
should be served on disposable dishes and plastic ware. This is due
to the fact that radio-iodine is picked up by the salivary glands thus
make eating utensils, etc. radioactive. After their use, dishes and plastic ware are disposed in plastic bags by Nuclear Medicine.
195
PROCEDURE FOR INFANT FORMULA
Ordering disposable (Ready- To- Use) Formula.
A. Requests for Ready-To-Use Formula should be made on a requisition form and sent to Central Stores by 0900 hours.
B. Delivery Special Formula
1. Special Formula will be ordered from the Formula Lab in the
production kitchen (1E110), phone: 5-6926.
2. Orders for Special Formula should be hand carried or faxed to
the Production Kitchen by 0900 hours each day.
3. Formula will be delivered on the lunch/ food cart.
4. Orders for the Special Formula should include.
a. area ordering formula
b. name of baby
c. hospital number
d. type of formula
e. amount of formula in each feeding
f. number of feedings
g. calorie strength of feeding, i.e., 20 cal/ fl.oz.
Note: 20 calories per fluid ounce is full strength.
5. Special formula
a. Pregestermil
b. Alimentum
c. Nutramigen
d. Neocate
e. Neocare
Please contact pediatric and neonatal dietitian for other available
specialized formulas.
Any other information about above formulas or any additional
Special Formulas needed may be obtained by contacting the area dietitian.
Pediatric Dietitian Beeper: 404-415-9087
Neonatal Dietitian Beeper: 404-833-9357
196
PATIENT SAFETY DEPARTMENT
LOCATION:
Main Hospital 1B017
HOURS OF OPERATION: Monday-Friday 0800-1700
DEPARTMENT NUMBERS: Phone: (404) 616-4268
Fax: (404) 616-2119
ADMINISTRATIVE CONTACTS:
Dr. Curtis Lewis, MD, FSCVIR
Sr. VP/Chief Medical Officer, Medical
Affairs
Dr. Kelvin Holloway, MD, Deputy Sr.
VP/CMO Medical Affairs
Howard Mosby, CPA, VP Medical
Affairs
DEPARTMENT CONTACTS:
Fran Baker RN, BSN, MBA Patient
Safety Officer
Pamela Tolbert RN, BSN Patient Safety Specialist
Mission: The GHS Safety Management Plan will foster an organizational patient safety culture that is Patient Centered, Leadership
driven, and resource committed to direct patient safety priorities, interventions and systems. Implementation of the patient safety plan
will steer and provide ongoing assessments and identification of risk,
safety and quality issues. The patient safety program will recommend and provide risk-reduction strategies, prevention techniques,
educational opportunities and proactive processes that are measurable and conducive to a successful safety program. Our mission is
to eliminate, prevent and reduce medical error in our institution. Our
organization will empower our patients, providers, staff and families
to expect a healthcare delivery system that is committed to patient
safety as our #1 priority.
PATIENT TRANSPORT SERVICES
The Guest Services Department provides transportation services
for all admissions, discharges, and transfers. In-house transportation services are provided seven (7) days a week for twenty-four (24)
hours a day. Please call 3-4130 for assistance. Transportation services
are also provided by the Volunteer Services desk to outpatients going
to appointment clinics Monday through Friday from 0800-1700 daily
as staffing conditions permit. Volunteer Services assistance may be
requested at extension 5-4037.
197
INTRAHOSPITAL TRANSPORT OF ADULT PATIENTS TO &
FROM SPECIAL CARE AREAS
The goal of this policy is to ensure consistent care of critically
ill patients being transported to and from special care areas within
Grady Memorial Hospital. The patientʼs condition at the time of
transport shall govern the level of transport support, including appropriate personnel, monitoring and supportive equipment, and medications. In cases where patients do not fit neatly into one of the following categories, the determination of required transport personnel,
equipment, and medication required will be made in a collaborative
fashion among the special care area nurse, respiratory therapist (RT),
house officer and attending as appropriate. In such cases, the final
determination shall be made by the responsible attending.
DEFINITIONS:
Special Care Areas: Emergency Care Center (ECC), Intensive Care
Units (ICUs), Operating Room (OR), Post Anesthesia Care Unit
(PACU), Telemetry, and Step Down Units (SDUs).
General Care Areas: General medical and surgical floors, ancillary
service areas (eg. physical therapy, occupational therapy), and the
outpatient clinics.
Diagnostic Areas: Diagnostic Radiology (angiography, nuclear medicine, magnetic resonance Imaging, computerized tomography scanning, special procedures, and Cardiac Catheterization Lab.
Registered Nurse and Designee: A designee may be an emergency
medical technologist, paramedic, physicianʼs assistant or anesthetist.
CATEGORY I - MINIMUM TRANSPORT SUPPORT
PATIENT CONDITION
A. Such patients are on cardiac monitoring and must have
stable vital signs (VSs) and be on no intravenous (IV) antiarrhythmics pressors, or inotropes, except for dopamine used
in doses for renal perfusion only.
B. Such patients must be breathing spontaneously with or
without a tracheostomy or endotracheal tube (ETT), but not
be on mechanical ventilation, and have FiO2 requirements ≤
0.6.
C. Such patients must not be sedated.
TRANSPORT PERSONNEL
These patients require two staff members for transport, one of
whom must be a nurse (or designee), the latter who shall remain
with the patient until the patient is returned to the originating special care area, unless there is a nurse available at the receiving area
198
to care for the patient. A RT may accompany a patient with a tracheostomy or ETT.
TRANSPORT EQUIPMENT
Cardiac monitor, pulse oximeter (required for FiO2 > 0.4), appropriate medication, including oxygen (as indicated), ventilation
bag/mask and artificial airways (if needed), and infusion pumps
(as indicated).
CATEGORY II - MODERATE TRANSPORT SUPPORT
PATIENT CONDITION
A. Such patients are on cardiac monitoring and must have stable
VSs and be on on pressors or inotropes, except for dopamine used
in doses for renal perfusion only. Such patients may be IV antiarrythmics.
B. Such patients may be breathing spontaneously with or without a
tracheostomy or ETT with FiO2 requirements > 0.6, or on mechanical ventilation on a set rate with FiO2 requiremments °‹ 0.6 and °‹
10cm PEEP. Such patients may not be on pressure control ventilation (PCV), inverse-I-E ratio ventilation (IRV), or high-frequency
jet ventilation (HFJV).
C. Such patients may be lightly sedated, but not heavily sedated
or paralyzed.
TRANSPORT PERSONNEL
These patients require a nurse (or designee) to accompany on
transport. If the patient is on mechanical ventilation, then a RT will
also accompany the patient. A physician shall accompany on transport unless the patientʼs most senior resident, fellow, or attending
documents that physician accompaniment is not needed. The nurse
and RT (if required) shall remain with the patient until the patient
is returned to the special care area of origination, or when they are
relieved by corresponding personel of their level.
TRANSPORT EQUIPMENT
Cardiac monitor, pulse oximeter (required for FiO2 > 0.4), appropriate medication, including oxygen (as indicated), ventilation
bag/mask, artificial airways, and mechanical ventilator (if needed),
and infusion pumps (as indicated).
CATEGORY III - MAXIMUM TRANSPORT SUPPORT
PATIENT CONDITION
A. Such patients have unstable VSs that require IV pressors, intropes, or antiarrythmics, or a combination thereof.
B. Such patients are on mechanical ventilation on a set rate and
have FiO2 requirements > 0.6 and/or > 10 cm PEEP, or on PCV,
IRV, or HFJV.
199
C. Such patients may or may not be sedated or paralyzed.
TRANSPORT PERSONNEL
These patients require a nurse (or designee), a RT, and a physician
to accompany on transport, who shall remain with the patient until
the patient is returned to the special care area of origination, or
when they are relieved by corresponding personnel of their level.
TRANSPORT EQUIPMENT
Cardiac monitor, pulse oximeter (required for FiO2 > 0.4), invasive
monitoring equipment as appropriate to provide required level of
monitoring, infusion pumps and appropriate medication as indicated, ventilation bag/mask, intubation kit, and mechanical ventilator
(required for PCV, IRV, or HFJV, or on > 10cm PEEP).
SPECIAL CONSIDERATIONS
• ECC patients who are deemed admittable to a general care area
may be considered for transport with just Transport personnel
and may not require a nurse or physician in attendance.
• An anesthesia team will transport patients from the special care
areas to the OR. In such cases, an anesthesiology resident or an
anesthetist may replace one or more members of the transport
team. The attending anesthesiologist shall determine the level
of their involvement in the transport of these patients.
• In the case of transporting category II or III surgical patients,
one of the accompanying physicians must be surgical ≥ PGY
II.
• It is the responsibility of the transporting staff to return all
medical euipment (with the exception of infusion pumps) to
the department or area of origination.
DOCUMENTATION
The patientʼs condition, including but not limited to VSs, appropriate observations, monitoring data, medications given, equipment
used in transport, and events that occur during the time away from
the originating special care area, shall be documented in the medical record.
REFERENCE
Guidelines Committee, American College of Critical Care Medicine, Society of Critical Care Medicine and the Transfer Guidelines Task Force; American Association of Critical Care Nurses.
American Journal of Critical Care 2(3): 189, 1993.
INFECTION CONTROL
Preventing the spread of infections within the Hospital is an important part of caring for our patients. A Policy and Procedures Manual
for Infection Control (yellow three-ring binder with red letters) is
available on each patient care and patient support area. This manual
contains general policies for control of infections within the Health
200
System, and also department-specific policies for the specialty areas.
(Sections are included on proper isolation precautions, management
of intravascular devices and other implements associated with risk of
infection, and procedures for managing communicable diseases.) All
are urged to consult this manual when questions arise.
Members of the Epidemiology Department are available for consultation or questions related to the prevention and control of hospitalacquired infections and the management of communicable diseases
within the GHS and the Epidemiology Department can be reached at
Ext.5-3598, Monday through Friday, 0830-1700 hours. If assistance
is needed emergently, please access the following beepers: Henry
Blumberg, M.D., Hospital Epidemiologist (PIC pager #15029),
Susan Ray, M.D., Associate Hospital Epidemiologist (pager #404837- 8946), Carlos DiazGranados, M.D., Assistant Hospital Epidemiologist (pager #404-278-8774), or Nancy White, Director (pager
#404-319-6664). An additional resource is the physician on call for
the Division of Infectious Diseases, Department of Medicine (obtain
physicianʼs name and pager # from the GHS communication switchboard). Also, a call schedule for telephone consultation with the Infection Control Epidemiologist(s) on weekends and holidays is available in the Microbiology Laboratory, Ext. 5-4847 and the Hospital
Operator.
STANDARD PRECAUTIONS
All healthcare workers (HCWs) at Grady Health System will be responsible for adhering to the Standard Precautions. It is not possible
to identify on initial contact all patients infected with transmissible
agents. In order to prevent transmission of infectious agents, it is
expected that all HCWs will use appropriate barrier precautions to
avoid direct contact with all blood or body fluids from any patient.
Appropriate barriers are available in every patient care area to prevent exposures to blood and body fluids. Standard Precautions are
used to reduce transmission of organisms from one patient to another,
which occurs primarily via hands of personnel, and to protect healthcare workers from organisms harbored by patients.
I. Hand Hygiene
HAND HYGIENE IS THE MOST CRITICAL ELEMENT IN
INFECTION CONTROL
Cleanse hands with soap and water or the waterless alcohol antiseptic product:
• before and after each patient contact;
• immediately after gloves are removed; and
• immediately if contaminated with blood or body fluids
II. Needle and Small Sharp Disposal
To prevent needlestick injuries, needles should not be recapped,
purposely bent, sheared, removed from syringes or otherwise
manipulated by hand. In special circumstances, a needle may need
to be recapped to prevent an injury. If recapping is absolutely necessary, the HCW is to use the one-handed method. Many needle-
201
less/safer needle devices are available to ensure HCW safety. Please
utilize the safer sharps devices as appropriate.
III. Resuscitation Barriers
Mouth to mouth resuscitation without a barrier is not recommended.
Resuscitation barrier/devices are conveniently on each emergency
code cart.
IV. Laboratory Specimens
Specimens of blood or other potentially infectious material are to be
placed in a container which prevents leakage during the collection,
handling, processing, storage, transport and shipping of the specimen. Zip-lock bags with a biohazard symbol are available on the patient care units.
V. Spills
Cleaning up spills of blood and body fluids is everyoneʼs responsibility. Individuals cleaning up spills of blood, body fluids and unknown
substances will wear disposable gloves and use equipment to prevent
skin injury/contamination. To clean up a spill, pick up the spill and
then use the hospital-approved germicide (e.g., Wexcide or an aseptic- wipe).
VI. Waste Disposal
Most trash generated from patient care areas can be disposed of in
regular trash bags. Infectious waste containers lined with a red bag
are located in each patient area to receive disposable containers filled
with body fluids or substances that cannot be safely decanted into
the municipal sewer system. This includes blood products, blood
administration sets, closed chest drainage systems, suction canisters
and any other container with bulk body fluids that can not be safely
drained. Canisters containing liquid blood or body fluids are to be solidified with a chemical product (i.e., Isolyzer) prior to being placed
in the infectious waste container. Other contaminated items that are
saturated and could potentially release blood or other body fluids in
a liquid or semi-liquid state, if compressed, and items that are caked
with dried blood or other body fluids that are capable of releasing the
material during handling procedures are also to be placed in an infectious waste container.
EXPANDED PRECAUTIONS
Transmission Based
Purpose
Transmission based Expanded Precautions, along with Standard
Precautions are designed to prevent the transmission of infections
to healthcare workers (HCWs), patients, volunteers and visitors
within the Grady Health System. Interruption of the spread of infection is directed primarily at transmission. To accomplish this, the
precautions implemented in the GHS focus on diseases transmitted
by body fluids, secretions, and excretions and the spread of serious
and epidemiologically important microorganisms transmitted via the
airborne, droplet, contact, and combined routes. SEE “EXPANDED
PRECAUTIONS TO PREVENT TRANSMISSION OF INFECTIOUS AGENTS” I.C. POLICY NO. 60, GHS INFECTION
CONTROL MANUAL FOR DISEASES NOT COVERED IN
202
THIS HANDBOOK.
Summary of Adult Tuberculosis Isolation Policy Requiring
Negative Pressure Room
ISOLATION
CRITERIA
LENGTH OF
ISOLATION
ActivePulmonary Duration of hospitalizaTB
tion if less than 4 weeks;
if >4 weeks must have
clinical response, drug
susceptibility data and
three negative AFB sputum smears.
Rule out TB - any Until three negative AFB
patient who has sputum smears.
sputum
collected
for AFB or pulmonary TB is indicated
in the differential
diagnosis.
HIV positive patient Until three negative AFB
admitted with an sputum smears.
abnormal CXR unless TB disease has
beenruled out with 3
negative AFB specimens within the past
14 days of or Tuberculosis symptoms
(i.e., cough, night
sweat, weight loss,
etc.) are present.
203
COMMENT
Prior to discharge, the patient must have a
progress note on
the chart from the
conty TB liaison
and the TB social
worker confirming the discharge
address.
Report any patient started on
TB medications
to Epidemiology
5-3598.
I. Airborne (Respiratory) Isolation Precautions (e.g., mycobacterium tuberculosis)
A. Airborne (Respiratory) Isolation for tuberculosis in the adult
patient Requires A Negative Pressure Room
The room door and all windows must remain tightly closed at all
times.
1. A “STOP SIGN” and an “Airborne Precautions” sign are to be
placed on the patientʼs door.
2. An N-95 MASK MUST BE WORN TO ENTER the patientʼs
room.
3. Patients should be sent only for tests and procedures that are medically essential.
4. If the patient leaves his/her room (e.g., to go radiology for a procedure), the patient is to wear a surgical (3M 1800) mask.
5. Patients discharged on TB medications based on a clinical diagnosis without laboratory confirmation (i.e.,negative smears/
cultures) must be reported by the physician or primary nurse
to Epidemiology 5-5398.
6. Prior to discharge, any patient with suspected/confirmed multiple
drug resistant (MDR) tuberculosis must have an Infectious Disease or Pulmonary Medicine consult.
7. HIV infected patients with extra-pulmonary TB:
• must concurrently have pulmonary TB ruled out;
• are to be placed in airborne (respiratory) isolation until pulmonary TB is excluded; and
• may have airborne (respiratory) precautions discontinued
after three AFB sputum smears are negative.
B. Pediatric TB Patients - Respiratory (Airborne) Isolation Issues
1. Children of all ages with MTB are to be evaluated for infectiousness using the same parameters as for adults.
2. The parent(s)/guardian(s) may be the source of tuberculosis for
pediatric patients and may be infectious. Upon admission, the
pediatrician will order a chest x-ray with wet reading for the
parent(s)/guardian(s) of a child with a high index of suspicion for
MTB.
a. If the parent/guardianʼs chest x-ray is normal, there will be no
restriction to their visitation.
b. If the parent/guardianʼs chest x-ray is abnormal, isolation
should be continued and the parent/guardian(s) will be instructed not to visit until cleared (i.e., three negative AFB sputum smears) by their private physician or the county health
department in their county of residence.
c. Follow-up and instructions to parent(s)/guardian(s) are to be
documented in the medical records.
d. If family members are non-compliant with visitor restrictions,
they will be instructed not to visit the hospital until appropriate follow-up by the county health department is verified.
3. Airborne (Respiratory) Isolation of the pediatric patient can be
204
discontinued when three negative AFB sputum smears or equivalent (i.e., gastric aspirate, bronchial washing) have been documented.
4. Epidemiology is to be notified (5-3598) of any pediatric patient
with suspected or confirmed Tuberculosis.
DISCHARGE PLANNING FOR PATIENTS WITH DIAGNOSIS OF CONFIRMED OR PRESUMED TUBERCULOSIS
STANDARD: All patients with known or presumed infectious tuberculosis (TB) will be discharged from Grady Memorial Hospital
with adequate planning for their own care and with appropriate measures to protect the community from TB.
1. All patients with known or suspected TB must be discharged
on four-drug anti-tuberculosis regimen, unless:
– the patient has known or suspected drug-resistant TB (get ID
or pulmonary consult)
– the patientʼs organism is known susceptible to all drugs (3drug regimen is OK)
– the patient has a contraindication to any of the four usual
agents (adjust regimen)
2. All patients with known or suspected TB must have their
discharge endorsed in the chart by Social Service and the
County Health Liaison prior to discharge.
3. All patients with known or suspected TB must meet appropriate criteria for discharge, according to the chart below:
Site and Patient Characteristics
I. Another Acute Care Hospital
Criteria
Transfer anytime when stable
II. Alternative Housing Program
Transfer when medically
(GA Dept. of Human Resources) ready for discharge
III. Prison with Appropriate
Isolation Facilities
Transfer when medically
ready for discharge unless
MDR-TB suspected
IV. Home, --When Patient Is Medically Ready for Discharge, AND
the Following Criteria are Met:
(see chart)
205
IV. Home, --When Patient Is Medically Ready for Discharge, AND
the Following Criteria are Met:
Patient Characteristics
Discharge
Destination
Criteria
(See Next Page)
Known or Suspected MDR-TB
Stable Home
Needs A, B, C, D, and H
.................................................................
Unstable Home
Cannot discharge to these
or Prison
sites
Cavitary or Moderate Infiltrate
AND/OR Positive Initial
Respiratory
AFB Smear
Alternative Housing Program Contact Epidemiology
Stable Home
Needs A, B, C, and G or
A, B, C, and H
Unstable Home
Needs C, E, F and G or C,
E. F and I
Minimal or No Infiltrate AND
Initial Respiratory Smears (>=3)
Were All Negative
Stable Home
Needs A, B, and C
.................................................................
Unstable Home
Needs C, E, and F
Non-respiratory TB-Closed Site
Of Infection (Pleural, etc.)
Stable Home
Needs A, B, and C
.................................................................
Unstable Home
Needs C, E, and F
Non-respiratory TB-Open Site
Of Infection (Skin, etc.)
Stable Home
Needs A, B, C, and D
.................................................................
Unstable Home
Needs C, D, E, and F
Positive Smear Now, But
Previous Positive
Culture For Non-TB
Mycobacteria
Collected Within 60 Days
Stable Home
Needs A, B, C, D, and H
.................................................................
Unstable Home
Needs C, D, E, and F
Situations Other Than Those
Above
Stable Home
Needs A, B, C, and D
.................................................................
Unstable Home
Needs C, D, E, and F
Key to Letters Defining Criteria
A. Social service and the county health liaison have documented
stable/appropriate home environment.
B. Arrangement is made and documented in the chart for follow-up
visit by appropriate county health department, clinic, or other appropriate health care provide, as soon as possible and no longer
than 10 week days after discharge. Patient (and/or family and/or
significant other, as appropriate) are informed of arrangement.
C. Patient (and/or family and/or significant other, as appropriate) has
206
D.
E.
F.
G.
H.
I.
received discharge teaching about the disease (and about isolation, if appropriate)
Pulmonary consult or infectious disease consult or hospital epidemiologist endorses in chart that disposition is appropriate.
Social service and the county health liaison document unstable
home environment.
Patient has arrangement made and documented in the chart for
follow-up visit by appropriate county health department, clinic,
or other appropriate health care provider, as soon as possible and
no longer than 5 week days after discharge. Patient and/or family/significant other are informed of arrangement.
After 3 negative AFB smears
With good clinical response to initial anti-TB therapy of at least
5 days; there will be no new persons exposed to the patient in the
home who have not been in long-term contact with the patient
prior to the hospitalization; patient (family or significant others,
as applicable) agree to and are assessed as likely to comply with
isolation of the patient at home until the patient is seen by county
health department.
Coordinator, Alternative Housing Program, has arranged appropriate single room housing per documentation of County TB liaison.
Current Phone Numbers :
Social Service: Non-HIV Adults
HIV Adults with TB
Fulton County TB Clinic Liaison
Dekalb County TB Clinic Liaison
5-7280
5-3968
404-730-1450
5-9192
ID Consult
Pulmonary Consult
Epidemiology TB Control Coordinator 5-5323 or 5-3598
Pager: (404) 833-3946
Pager: (404) 282-3208
Pager: (404) 743-3008
Office: (404) 508-7857
Pager: (404) 966-5646
Pager: pic (call operator)
Pager: pic (call operator)
***PLEASE NOTE: Patients discharged on the 4 drug anti-tuberculosis regimen whose sputums (or other specimens) were
AFB smear negative and/or culture negative must be reported to
Epidemiology at 5-3598. This will ensure appropriate documentation and patient follow-up by the appropriate county health department. Patients with laboratory-confirmed TB will automatically be reported by Epidemiology.
II Other Diseases/Illnesses (e.g. Chicken Pox, Measles, Smallpox)
Requiring Airborne (Respiratory) Isolation Precautions in a Negative
Pressure Room:
All HCWs and visitors entering the patientʼs room will wear a surgical mask (i.e., 3M 1800, light blue cone shaped) unless otherwise
stated. This mask is to be discarded immediately upon leaving the
room.
207
DISEASE/
ILLNESS
LENGTH OF
ISOLATION
COMMENT
Measles
(Rubeola)
For 4 days after start of
rash, except in immunocompromised patients with
whom isolation should be
maintained for duration of
illness
Call Epidemiology
to report
5-3598 or 5-3789.
Chicken Pox
(Varicella)
Until all lesions are crusted.
• Persons who have had chicken
pox (natural immunity from
wild type virus) can enter the
room without a mask.
• HCWs who have received varicella vaccine are to wear a surgical mask when entering the room
of patients with chickenpox.
• Non-immune HCWs (including
those whohave not yet received the
vaccine, and those who are unable
to take the vaccine due to medical
contraindications) are excluded
from working with patients with
clinical chicken pox or shingles.
• Exposed susceptible patients who
require hospitalization will be isolated beginning 10 days after the
first day of exposure until 21 days
after last day of exposure. If susceptible patients receive varicella
zoster immune globulin (VZIG)
within 96 hrs post exposure, the
isolation period begins on day #
10 and is extended to day # 28.
Smallpox
(Variola)
Onset of rash untl the scab
separates from all lesions
(approximately 3 weeks)
•Immediately call Epidemiology
and the Infectious Deseases consult service.
•HCWs are to don N-95 mask
(3M-1860)
•Patient should have a surgical
mask (3M1800) placed over their
nose and mouth or cover head and
face with towels during transport.
Patient's body is to be completely
covered with sheets or blankets.
208
III. Droplet Isolation Prections
Negative pressure room is not required. All healthcare workers and
visitors entering the room will wear surgical mask (i.e., 3M 1800
light blue cone shaped mask). The mask is to be discarded immediately after leaving the patientʼs room.
(See chart on next page.)
IV. Enhanced Contact Isolation Precautions
STRICT HANDWASHING MUST BE ADHERED TO AT ALL
TIMES. All HCWs and visitors will wear gloves and gowns when
entering the patientʼs room. All PPEs (personal protective equipment) must be discarded after each use and before leaving the
patientʼs room. Strict handwashing is to occur prior to exiting
room.
Any equipment articles taken into the room must remain in the
room until disinfected with the hospital-approved germicide. Once
equipment has been cleaned, it is to be removed immediately from
the room.
The Following Diseases/Illnesses Require Enhanced Contact Isolation Precautions:
DISEASE/
ILLNESS
LENGTH OF
ISOLATION
Sarcoptes scabeii
(Norwegian Scabies) or
disseminated scaa
Until resolution of skin
lesions. Check with the
Epidemiology Department.
Patients with antibiotic
resistant organisms for
example:
• Vancomycin-resistant
Enterococcus (VRE)
Duration of hospital stay
(ICU or ward)
• Clinical isolate or
Epidemiology Surveillance culture
• Methicillin-resistant
Staphylococcus aureus
(MRSA)
• Imipenem -resistant
Acinetobacter
(Clinical isolate of
Epidemiology surveillance culture)
Duration of Intensive
Care Unit Stay (Isolation
to be discontinued when
patient is transferred
from the ICU, unless
otherwise directed by
Epidemiology).
209
COMMENT
GOOD HANDWASHING IS
ESSENTIAL FOR ALL
HCWs. Transmission to other
patients is most likely due to
HCWs hand carriage from
infected
excretions, common
non-critical patient care
equipment, and environmental
contamination.
See specific policy #60 GMH
Infection Control Manual.
DISEASE/
ILLNESS
Bacterial Meningitis
(Neisseria meningitidis
or Haemophilus
influenzae known or
suspected)
LENGTH OF
ISOLATION
COMMENT
For 24 hours after start of ef- Prophylaxis is needed for
household contacts and
fective antibiotic therapy.
may be needed for daycare
contacts.
HCWs who have had intimate
respiratory contact
(e.g., mouth to mouth, intubation, suctioning, etc.)
are to be referred to
Epidemiology (Ext. 5-3598)
for recommendation
re: prophylaxis.
Bronchiolitis, Croup & Duration of illness.
respiratory illnesses
(etiology unknown
in infants & young
children, most
likely adenovirus, influenza, or parainfluenza)
Transmission is most likely
due or inoculation of respiratory secretions to eyes
& mucous membranes.
Eye protection recommended
for suctioning.
Careful handwashing.
Diphtheria, pharyngeal
Until afebrile and two sets of Promptly report to
cultures (nose & throat) are Epidemiology 5-3598 or 53789.
obtained 24 hours apart
which are negative for
Corynebacterium diphtheria.
Epiglottitis, Haemophilus
influenzae
For 24 hours after start of
effective antibiotic therapy.
Meningococcal Sepsis For 24 hours after start of
effective antibiotic therapy.
or Pneumonia
Same as bacterial meningitis
Mumps (infectious par- Active Disease - For 9 days
after onset of swelling.
otitis)
Call Epidemiology to report
5-3598 or 5-3789.
Parvovirus B19
(Fifth Disease)
Duration of hospital stay
With onset of rash, communifor immunocompromised
cability unlikely and respiratopatients (i.e., HIV positive,
ry precautions not necessary.
Sickle Cell). For patients in
transient aplastic crisis maintain isolation for 7 days.
For 7 days after start of
Pertussis (Whooping
cough) including “Rule effective therapy.
Out Pertussis”
Promptly report to
Epidemiology 5-3598 or
5-3789.
For 3 days after start of
effective therapy.
Promptly report to
Epidemiology 5-3598 or
5-3789.
Plague, Pneumonic
Pneumonia, Haemophi- For 24 hours after start of
lus influenzae in infants effective therapy.
and children any age,
and Mycoplasma (primary atypical) pneumonia
Rubella (German Mea- Active Disease-For 7 days Promptly report to
sles)
Epidemiology 5-3598 or
after onset of rash.
5-3789.
210
ADMITTING CRITERIA FOR 9A:
SPECIAL IMMUNOLOGY SERVICES/MEDICINE
Retyped by Epidemiology 03/2006
Updated 01/1997, 02/1999
A total of 11 beds on 9A are now General Medicine beds used by
EUSM Team 5. For this reason, it is no longer necessary for a patient
to be HIV+ to be admitted to 9A. However, for a patient to be admitted or transferred to the SIS team the patient must be aware that
he/she has HIV infection.
1. EXCLUSIONARY CONDITIONS
A. Airborne Infection Respiratory Isolation (AIRI): Abnormal
CXR, Pneumonia, PCP, Varicella (chicken pox), zoster (shingles), R/O Tuberculosis (suspected or active), or a productive
cough (even with a normal CXR).
B. Community Acquired Pneumonia of unknown etiology but not
thought to be TB and RI has not been ordered (the most frequent cause of TB exposure to 9A).
C. Patients currently on anti-tuberculosis therapy: regardless of
AFB smear status.
D. Patients with other contagious diseases: Measles, Mumps.
E. Patients admitted for surgery or who need an ICU bed.
F. Patients with a history of TB in the last two years.
2. DIRECT ADMISSIONS
Patients may be directly admitted only by attending MD from the
IDC, the ECC, the Morehouse IDC or the ICU. These patients
must meet the criteria listed above. Patients admitted from Morehouse will be cared for by Morehouse teams.
3. TRANSFERS
All transfers require approval by the SIS I.D. Fellow or Faculty.
Morehouse patients transferred to 9A will continue to be followed
by Morehouse teams. The following rules apply to all transfers.
1. All patients initially admitted to respiratory isolation (except
solely for varicella/zoster) must have 3 documented negative
sputum spears for AFB within 14 days prior to transfer.
2. Patients not admitted to respiratory isolation must have a normal CXR within 72 hours prior to transfer.
3. The transferring resident is responsible for ensuring that the
top portion of the SIS Intake Assessment sheet is complete.
The SIS I.D. fellow or resident must verify the CXR and sputum AFB smear results. (CXR results: 5-4544, AFB results
22w, a return -- --lab computer).
4. RE-ADMISSIONS
Patients recently discharged from the SIS service who need readmission must have a normal CXR within 72 hours, or 3 negative
sputum AFB smears within 14 days prior to re-admission.
211
VANCOMYCIN-RESISTANT ENTEROCOCCUS
Vancomycin-resistant Enterococcus (VRE) is a resistant bacterial microorganism, which has been recognized with increasing frequency
in hospitalized patients over the past decade. In some U.S. hospitals
more than 15% of enterococcal infections are due to VRE.
•
VRE infections are challenging to treat due to resistance to
multiple antibiotics. Enterococcus is a pathogen which inherently may be difficult to treat even when not resistant to vancomycin, ampicillin, and aminoglycosides. With the development
of VRE, therapy is now even more complicated. Newly approved
antibiotics for VRE include Linezolid and Synercid (quinupristin/dalfopristin) and should be used only in consultation with the
Infectious Diseases service.
•
Enterococci are part of the normal flora of the gastrointestinal
and female genital tracts. Patients may become colonized with
VRE and then serve as a source for transmission to other patients.
Studies have demonstrated that VRE can spread by direct patientto-patient contact or indirectly via transient carriage on hands of
personnel or contaminated environmental surfaces and patientcare equipment.
•
CDC guidelines make recommendations for the prevention and
control VRE. Infection control and prevention efforts require cooperation among all hospital personnel and focus on 4 areas:
1) education of hospital staff
2) early detection and prompt reporting of vancomycinresistance
in enterococci
3) implementation of appropriate infection-control measures
(e.g., contact isolation) to prevent person-to-person transmission of VRE, and
4) prudent vancomycin use by clinicians (see guidelines for vancomycin use below).
•
Most hospitals and nursing homes in Atlanta have isolated
VRE from their patients.
•
At Grady Memorial Hospital: VRE was first recovered from clinical isolates in late January 1995 and has been recovered from patients both in ICUs and on the wards. Infection control efforts and
judicious use of vancomycin have proven effective in preventing
nosocomial transmission of VRE at Grady.
RECOMMENDATIONS:
• Contact isolation of colonized or infected patients with VRE
is required while the patient is hospitalized (either in an ICU
or on any in-patient ward).
•
Healthcare workers must wear a gown and gloves when caring for
212
patients in contact isolation. Good hand hygiene is essential to
prevent transmission to other patients.
•
Specific patient monitoring equipment (BP cuff, thermometer,
etc.) should be dedicated to each patient in contact isolation.
•
Special attention should be paid to the care, cleaning, and disinfection of environmental surfaces in rooms of VRE colonized or
infected patients.
•
Surveillance cultures for VRE will be done periodically by the
Epidemiology Department of high-risk areas/patients to assess
prevalence of colonization.
•
Consult the Infectious Diseases (ID) Service for treatment of patients with VRE infection (e.g., bacteremia).
Guidelines for Appropriate Vancomycin Use
1) Oral vancomycin should NOT be used for the initial treatment of
C. difficile/pseudomembranous colitis; use metronidazole (Flagyl).
2) For documented infections, IV vancomycin should be used only
when the organism is not sensitive to alternative antibiotics or the
patient has a documented, severe allergy to beta-lactam antibiotics.
3) For empiric therapy, IV vancomycin should be used only when
there is high suspicion of methicillin-resistant Staphylococcus
aureus (MRSA) or coagulase-negative Staphylococcus infection
pending culture and sensitivity results or for suspected pneumococcal meningitis. If cultures are negative for these pathogens at
72 hours, then vancomycin should generally be discontinued (if
vancomycin is still indicated, please contact the ID service for
approval for empiric therapy > 72 hours).
4) Vancomycin should NOT be routinely used for peri-operative
prophylaxis.
CARE AND MAINTENANCE OF INTRAVASCULAR
DEVICES
Intravascular devices are frequently needed for vascular access in
order to provide appropriate care for patients. The degree of risk of
site or bloodstream infection varies with the device (e.g,. higher with
central than peripheral lines), its use and its length of stay. However,
the risk of infection increases with time in place for all devices. The
policy provides direction to reduce the risk of intravascular devicerelated infections.
213
Policy
Health care workers (HCWs) who initiate, manipulate or manage intravascular devices and lines should be familiar with the specifics (the
Infection Control policy #140, “Care and Maintenance of IV Devices”) of this policy. Those that have the responsibility of supervising
HCWs should monitor the adherence to the IV policy in a regular and
consistent manner. Critical points of the policy include:
A. Documentation of each intravascular device must be present in
the medical record and/or on a designated form. The documentation will include insertion date, site of insertion, type of device
used and site care dates.
B. Maximum duration for which specific catheters may be left in
place:
• peripheral IV: change q 72 h
• Central venous catheters including peripherally inserted central catheters and hemiodialysis catheters: do not routinely
replace catheters if continued need for IV access and lack of
complications (i.e., fever, inflammation, etc.)
C. Site prep:
• Choraprep (chlorhexidine 2% with isopropyl alcohol 70%)
currently provided in some insertion kits and is the recommended prep some insertion kits and is the recommended
prep
D. Dressings for devices:
• sterile and occlusive (transparent or gauze)
• changed M - W - F whenever dislodged, soiled, wet or
inspection of site is required
E. Health care workers prep for insertion:
• peripheral IV: gloves;
• peripheral arterial lines: sterile gloves, sterile drapes;
• central IV: sterile gown, sterile gloves, mask and large
sterile drape
BLOOD CULTURE COLLECTION
PERIPHERAL VENIPUNCTURE (OR ARTERIAL PUNCTURE)
IS PREFERRED FOR OBTAINING BLOOD FOR CULTURE.
• Blood cultures should NOT be collected from central lines already in place, or through other preexisting catheters when
possible because of the high likelihood of contamination
(Blood cultures may be drawn on hemodialysis patients while
on dialysis).
• Blood cultures should NOT be drawn through femoral blood
when possible, because of the high level of microbial colonization in this area and the potential for contamination of the sample.
If site is physically soiled, wash site with antimicrobial hand soap
and rinse with water prior to site prep.
• Each set of cultures should be drawn from a separate blood
draw. A minimum of two sets of blood cultures should be obtained.
214
•
•
•
•
•
Always use Standard (Universal) Precautions: Wash hands. Put
on non-sterile gloves.
Cleanse the venipuncture site with Chloraprep ( 2% chlorhexidine
with 70% isoprophyl alcohol). Then swab in a circular fashion
with 10% providone alcohol or chloroprep. Allow the prepped
area to completely dry. Do not touch or blow on the site prior to
the phlebotomy.
Obtain blood culture prep kit and blood culture bottles with safety
device. Follow enclosed directions.
Disinfect the top of the blood culture bottle or tube with alcohol
and allow to dry.
Do not change syringe needle before injecting blood into culture bottles. Use a new needle and syringe if vein, or artery is
initially missed.
REPORTABLE CONDITIONS AND DISEASES
It is the policy of the Grady Health System to report certain communicable and occupational diseases to the County Health Departments.
The transmission of such information is considered a vital measure in
the safeguarding of public health, and all members of the House Staff
must be acutely and constantly aware of their responsibilities in this
area. When the patient is suspected of having, or is confirmed to have,
any of the diseases listed below, the physician making the diagnosis
should report the case to the Epidemiology Department (Ext. 5-3598)
which will then assume responsibility for reporting the case to the
appropriate health department. Meridian voice mail is available on
Ext. 5-3598 when no one is present to receive your call, so that cases
may be reported at any time of day or night. Please give your name,
the name, hospital number and diagnosis of the patient, and the area
on which the patient is located.
All occupational diseases, defined as “any illness suffered by a
patient as a result of the nature of his/her occupation or process of
work,” must also be reported to the Fulton County Health Department at 730-1390, or to the DeKalb County Health Department at
508-7857. An entry should be placed in the patientʼs chart noting that
this report has been made.
Any questions which may arise concerning the infectious diseases on this list should be referred to members of the Epidemiology
Department (Ext. 5-3598), to members of the Division of Infectious
Diseases, Department of Medicine (Ext. 5- 3600), or to members of
the Pediatric Division of Infectious Diseases (Ext. 5-4997), or to the
Hospital Epidemiologist (Ext. 5- 6146) as appropriate.
AIDS (Report directly to surveillance unit in Atlanta using form
CDC 50.42)**
Animal bites*
Anthrax - Microbiology**
Arboviral Infections (including fever)*
Aseptic Meningitis*
Botulism*
Brucellosis - Microbiology**
215
Campylobacteriosis - Microbiology**
Cholera - Microbiology**
Creutzfeldt-Jacob Disease (CJD) (suspected) among persons >
55 years old
Cryptosporidiosis
Cyclosporiasis
Diphtheria - Microbiology**
E. coli O157:H7/H.U.S., invasive - Microbiology**
Ehrlichiosis
Giardiasis - Parasitology**
Haemophilus Influenza Disease-Microbiology**
Hantavirus
Hemolytic uremic syndrome
Hepatitis A, B, C - Epidemiology**
HIV without personal identifiers
Infant mortality (including SIDS)
Latent Tuberculosis Infections (LTBl) in Children
Aged < 5 Years
Lead blood level> 10ugi/dl
Legionnaires Disease -Microbiology**
Leptospirosis*
Listeriosis, invasive - Microbiology**
Lyme Disease *
Malaria - Epidemiology**
Maternal Deaths (pregnant within previous 90 days)
Measles (Rubeola) - Epidemiology**
Meningitis (specify agent)
Meningococcal Disease, invasive - Microbiology
Mumps - Epidemiology**
Pertussis - Epidemiology**
Plague
Poliomyelitis*
Psittacosis*
Q fever
Rabies (Human and Animal)
Rocky Mountain Spotted Fever - Epidemiology
Rubella (including congenital) - Epidemiology
Salmonellosis - Microbiology****
Sexually Transmissible Diseases - Chancroid, Chlamydial
(Females), Gonorrhea, Herpes Type II,
Syphilis, Lymphogranuloma venereum - Microbiology**
Shigellosis - Microbiology**
Staph aureus with vanconycin mic > 4 mcg/ml
Streptococcal disease, invasive
Tetanus*
Toxic Shock Syndrome (TSS)*
Tuberculosis - Microbiology Epidemiology**
Tularemia
Typhoid Fever - Epidemiology**
Vibrio infections
Yersiniosis
216
In November 2002 and January 2003, the Georgia Department of Human Resources Board approved several new additions and changes to
the list of notifiable conditions in Georgia:
• Birth Defects. The following conditions (ICD-9 codes) will be
reportable: congenital anomalies (740-759.9), genetic and metabolic
conditions (240-279), sickle cell anemia and other hemoglobinopathies (282-282.9) fetal alcohol syndrome (760.7), and cerebral palsy
(343). Birth defects must be directed to public health within 7 days
after diagnosis in a child less than 6 years old.
• Hearing Impairment in Newborn and Young Children. (Suspected and confirmed cases) of hearing loss in newborns must be reported to public health through the Children First Program within 7
days of screening or to assist.
DEPARTMENT OF RADIOLOGY
Outpatient Radiology Ordering Guidelines
Guidelines:
1. Request for outpatient radiological services should be on the Outpatient Radiology Order Form.
2. Request for mammography services should be on the Mammography Order Form.
3. No outpatient orders should be entered into Invision OAS Gold.
4. A member of the medical or house staff performs radiological
examinations only upon written request.
5. The requisition must be completed in its entirety and legible.
6. The requisition must be signed and dated by the physician responsible for the patientʼs care.
7. Prior to an appointment being scheduled, the order must meet established criteria (i.e., valid diagnosis and history (no rule-outs).
8. The patientʼs name and Medical Record# must be indicated by the
patientʼs label or in writing.
9. The original copy of the requisition is filed in the medical record.
10. The remaining NCR copies of the requisition are given to the patient to bring to their scheduled appointment.
Scheduled Services:
1. Central Scheduling schedules the following services: Ultrasound,
CAT Scan, MRI, Nuclear Medicine, PET CT and Diagnostic
(Barium Enema, UGI, KUB, IVP, Barium Swallow, Urethrocystography / Voiding Cystogram, Hysterosalpingogram).
2. Orders should be faxed to Central Scheduling at (404) 616-5090.
3. The original copy of the requisition is filed in the medical record.
4. The patient should be instructed to bring the remaining NCR copies of the requisition to Radiology.
5. Patients should not be instructed to go to Radiology to schedule
their appointment.
217
Mammography Services:
1. Patients with symptoms should have a diagnostic mammogram.
Complete the “Diagnostic Mammogram” section.
2. Patients with no symptoms should have a screening mammogram.
Complete the “Screening Mammogram” section.
3. The original copy of the requisition is filed in the medical record.
4. The patient should be instructed to bring the remaining NCR copies of the requisition to Radiology.
5. Patients should not be instructed to go to Radiology to schedule
their appointment.
Walk-In Services:
1. Plain film x-rays are not scheduled. Orders should not be faxed to
Central Scheduling.
2. The patient should present to Outpatient Radiology Registration
located on the 3rd floor (3G068 / 3G081).
3. The original copy of the requisition is filed in the medical record.
4. The patient should be instructed to bring the remaining NCR copies of the requisition to Radiology.
Urgent Services:
1. Central Scheduling will work with the department to schedule patients whose condition requires that the study be performed prior
to the next available appointment date.
2. Indicate on the requisition how soon the patient needs to be seen.
3. Orders should be faxed to Central Scheduling at (404) 616-5090.
4. The original copy of the requisition is filed in the medical record.
5. The patient should be instructed to bring the remaining NCR copies of the requisition to Radiology.
6. Patients should not be instructed to go to Radiology to schedule
their appointment.
7. If an order is STAT contact the department directly at the following telephone extensions:
Ultrasound: ............................................... 5-4519
Breast Imaging (Screening): .................... 5-4526
Diagnostic Mammogram: ........................ 4-9190
MRI: ......................................................... 5-6762
CAT Scan: ................................................. 4-9097
Nuclear Medicine: .................................... 5-4602
Special Procedures: .................................. 5-7005
Neuro CT: ...................................5-4515 / 5-7002
Body CT: ....................................5-4515 / 5-7002
Oncology CT: ........................................... 4-9097
PET CT: ................................................... 4-9216
Oncology Ultrasound: .............................. 4-9001
Interventional Radiology Services:
1. The department at 5-7005 schedules the following services:
Vascular Angiography
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Neuro Angiography
Myelogram
Lumbar Puncture
CT Drainage Biopsy
2. Order should be faxed to (404) 616-3645. Orders for Myelograms
and Lumbar punctures should be faxed to (404) 616-6337.
3. Neuro Angiography studies require consultation with a Neuro Radiology Fellow located in the Neuro Reading Room (3F017) at
5-7055.
4. The original copy of the requisition is filed in the medical record.
5. The patient should be instructed to bring the remaining NCR copies of the requisition to Radiology.
Patients should not be instructed to go to Radiology to schedule their
appointment.
CT/Ultrasound Drainage/Biopsy
1. Body CT: Contact Erica Campbell @ pic #15391—fax orders to
5-5755
2. Neuro: Contact Angela Houston @ pic # 14071—fax orders to
The Department of Radiology consist of several major divisions:
General Diagnostic (skeletal, chest, GI and fluoroscopy), Emergency
Radiology, Ultrasonography, Computerized Tomography, Angiography, Breast Imaging, Magnetic Resonance Imaging, Nuclear Medicine and PET-CT.
Imaging procedures are performed only on written request by a
member of the medical or house staff, who is responsible for completing the radiology requisition. Emergency requisitions, which
cannot be completed by a physician, may be completed by a nurse or
ward clinic clerk in his/her absence, but must be backed up by written
order of the physician responsible for the patientʼs care. Requisitions
signed by medical students, P.Aʼs or P.A. students must include the requesting physicianʼs name, I.D. number, and pager number. The requisition must be complete in its entirety. The patientʼs name, hospital
number and referring area must be indicated by the printed labels or
in writing. Adequate history, the name, ID number and telephone or
pager number of the referring physician, name and ID number of attending physician, and the specific question to be answered (reason
for examination) are essential and must be included on the requisition.
On routine ward requests, the date the examination is required should
be indicated. The requisitions are to be forwarded to the area in the
Department where the examination will be performed. Examinations
may also be scheduled by phone. Emergency requests should be discussed with a staff radiologist or radiology resident by the referring
physician. When there is any doubt as to the proper examination
or sequence of examinations, a radiologist should be consulted. For
emergency coverage or information, please see subspecialty sections.
For routine requests after normal working hours, the patient will go
to Emergency Radiology for appropriate instructions.
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Routine requests for portable examinations are handled in the same
manner as other routine requests. Emergency requests can be made
by phone. A.M. portable request should be requested to (General
)Diagnostic Radiology not later than 12midnight. Please keep in
mind that portable examinations are suboptimal compared to examinations done in the department. The area that requests the portable
examination is responsible for properly completing the radiologic request form and should have the form available when the technologist
arrives on the area.
Radiographic support for intraoperative procedures is provided.
Advance notice is required giving information concerning approximate case time and duration. A completed radiologic request form
should be available to the technologist prior to the procedure. After
the procedure is performed, films will be sent to the Radiology Department. Radiology reports are available via Invision OAS Gold.
CENTRAL VIEWING ROOM
The Central Viewing Room is open twenty-four hours a day, seven
days a week and is located in the main area of the department, 3E041.
Examinations of all inpatients are displayed in this room by service or
radiologic specialty on motorized views and are displayed throughout
the patientʼs hospital stay. If a film is not displayed, the file room personnel are available for assistance. Radiology reports are available
on-line via CRTʼs in the Central Viewing Room and at other locations
throughout the Hospital. In addition, consultation by radiologists is
available 24 hours a day either on the third floor or in the Emergency
Radiology Division.
Films may not be removed from the Central Viewing Room without being properly signed for. In addition, films should not leave the
Central Viewing Room until they have been read by a radiologist.
In emergency situations, unread films may be signed out provided
they are properly returned. All other films should be returned to the
department within 24 hours. When signing for films, physicians must
provide their names, ID numbers, and telephone or pager number.
Radiologic examinations are part of the patientʼs medical record
and may be released from the Hospital only upon court order, subpoena, or by written request from a physician and the patientʼs signed
consent. For assistance, please call 5-3935.
When requesting films for conferences or clinics, please provide
24-hour advance notice to assure availability.
5K NEONATAL ICU VIEWING ROOM
The Neonatal Viewing Room is open twenty-four hours a day, seven days a week and is located in room 5K032. Examinations of all
patients admitted to the Neonatal ICU are kept here until the patient
is discharged. Only those patients with examinations taken within
the last two days are displayed on the alternator. Each frame of the
alternator has two panels. Those patients with films on the lower
panel have their names listed on the right side of the alternator. Those
patients with films on the upper panel have their names listed on the
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left side of the alternator. If a film is not displayed, it will be in the
record bin. Film room support is available as needed by telephoning extensions 5-3935, 5-3934, or 5-3933. Clerical staff visit the 5K
reading room twice each eight hours shift. Radiology reports are
available on-line via the CRT located in room 5K032 and from other
locations throughout the hospital. In addition, consultation by radiologists is available 24 hours a day in the Emergency Radiology (extension 5-4002). Pediatric consultation is available daily from 0800
until 1700 at Hughes Spalding through extension 5-5721 or 5-5723.
Please review the film and jacket sign out policy in the Central Viewing Room section of the manual.
ORDERING RADIOLOGIC EXAMINATIONS ON
SERIOUSLY OR CRITICALLY ILL OR INJURED PATIENTS
Appropriate arrangements must be made concerning examinations
which are to be done in the department for patients who are seriously
or critically ill or injured. A phone call from the ICU, Ward or Clinic
should be made to the appropriate service in the Radiology Department to notify the service that a seriously or critically ill or injured
patient is being sent for an examination. This will allow for planning for space, equipment, and personnel so that the examination can
be don expeditiously. All seriously or critically ill or injured patients
must be accompanied by the physician responsible for the patientʼs
care or his/her designee. For patients sent to General Diagnostics or
Special Procedures, notification will be given to the nurse on duty
so that he/she will be available to assist the physician if needed. For
patients sent to Emergency Radiology, the supervisor on duty should
be notified.
ORDERING RADIOLOGIC EXAMINATIONS
ON PREGNANT PATIENTS
The danger of radiation to the fetus is greatest during the first trimester of pregnancy. Abdominal or pelvic radiographic examinations
of a pregnant patient must be approved by a radiologist and include
the gestational age of the fetus. All requisitions for pregnant patients
should so state. CT should be utilized for all pelvimetry exams. In
all women patients of childbearing age, radiation to the pelvic area
should be restricted to the two weeks following the last menstrual
period.
PEDIATRIC RADIOLOGY PROGRAM DESCRIPTION
PEDIATRIC RADIOLOGY
Available at CHOA- Hughes Spalding
The Diagnostic Radiology Department is responsible for providing coverage for the neonatal ICUʼs and nurseries. All requests for
examinations should be paged at 404-650-8573.
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PEDIATRIC CT AND MRI EXAMINATIONS
All pediatric CT and MRI examinations should be scheduled
through the Imaging Center receptionist at 5-6750. The Imaging
Center operates Monday-Friday 0700-2200. 0700-1900 Saturday
and Sunday. All pediatric CT studies should be scheduled through the
Emergency CT department (located within the Emergency Radiology
department on the ground floor). The phone extensions are 5-2649
and 5-2849.
Neonatal ICU and Nursery patients should be scheduled for CT
studies through the main hospital, third floor CT area. The extension
is 7002, Monday-Friday 0700-2200.
The requisition must be as complete for MRI and CT examinations
as it would be for all other requests to the Radiology Department.
Request must be legible and include ordering physicianʼs beeper #
and name. After hours call ERCT @ 5-2649.
PEDIATRIC VIEWING ROOM
Located at CHOA – Hughes Spalding
The viewing room is open twenty-four hours a day, seven days a
week and is located in the pediatric radiology department area on the
fifth floor or HSCH. Examinations of all patients are displayed on a
motorized viewer. The films are displayed throughout the patients
hospital stay. If a film is not displayed, file room personnel are available for assistance. Radiology reports are available on-line through
the Novius and OAS Gold System in the viewing room. Consultation
by a radiologist is available 24 hours a day either at HSCH, or in the
Emergency Radiology Division in the main hospital.
Films may not be removed from the viewing room without being
properly signed for. In emergency situations, unread films may be
signed out provided they are promptly returned. All films should be
returned to the department within 24 hours of their being signed out
of the viewing room. When signing for films, physicians must provide their name, ID number and pager number.
Original Radiology examinations are part of the patientʼs medical
record and may be released from the hospital only upon court order
or subpoena. Copies of the Radiology examinations are available by
written request from a physician with the patientʼs signed consent.
For assistance please call 5-3935.
When requesting films for conferences or clinics, please provide
24 hours advance notice to assure availability.
IMAGING SERVICES
Breast Imaging Overview
Breast Imaging is located on the third floor (A) wing of the main
hospital. The hours of operation are 08:00 to 16:30 Monday through
Friday. This department performs outpatient screening mammography examinations only. For services please in this area complete
and submit a mammography order requisition that has the following: ordering physicianʼs name, PIC ID#, clinic of origin, complete
patient breast history, and the purpose of the examination. Fax the
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completed mammography order requisition to Central Scheduling at
404-616-5090 and place a copy of the mammography order requisition in the patients record in the clinic. To speak with someone in
scheduling dial 404-616-2204. Direct all inpatient request and other
questions to extension 404-616-4526.
Georgia Cancer Center for Excellence
Diagnostic Mammography Overview
Diagnostic Mammography is located on the ninth floor (B) wing of
the main hospital. The hours of operation are 08:00 to 16:30 Monday
through Friday. This department performs diagnostic mammography
examinations, wire localizations, fine needle aspirations, stereotactic
core biopsies, and galactograms. For services in this area complete
and submit a mammography order requisition that has the following: ordering physicianʼs name, PIC ID#, clinic of origin, complete
patient breast history, and the purpose of the examination. Fax the
completed mammography order requisition to Central Scheduling at
404-616-5090 and place a copy of the mammography order requisition the patientʼs record in the clinic. To speak with someone in
scheduling dial 404-616-5800. Direct all inpatient request and other
questions to extension 404-489-9001.
MRI AND CT SCANNING
MRI (5-6760)
The Magnetic Resonance Imaging Scanner is located in the Imaging
Center, 56 Jesse Hill Jr. Drive. Normal operating hours is 07302230 Monday-Friday. 0830-1900 Saturday.
To schedule an outpatient appointment, the physician should call
5-5800 for an appointment.
All requisitions should have the patientʼs history, including a description of allergies or other special medical conditions. The patient
patientʼs name, hospital number, and referring area should be stamped
on the request. Additionally, inpatient requests should include the
patientʼs room and bed number, transportation requirements (acute
or routine, ambulatory, wheelchair, stretcher), and the pager number
of the patientʼs physician. Patient conditions, which should be identified on the requisition, include past contrast reactions, abdominal
surgery and pregnancy. The requisition should state if the patient has
a pacemaker, tattoo, IUD, joint prosthesis, orthopedic metal plate, or
Harrington rod. The requisition should state whether a patient has
had a gunshot wound, metal injury to the body (especially to the eye),
or has worked with metals (i.e. welding).
All requisitions should be forwarded to the Imaging Center in a
timely manner. All outpatients will be
reminded of their exam by a telephone call.
MRI films will be available on Invision/Novius in the same manner
as other examines currently done by the Radiology Department.
To schedule an outpatient appointment, the physician should call
Central Scheduling 404/616-5800(5-5800)
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ORDERING EMERGENT MRI EXAMINATION
For STAT MRI, requesting physician must call the neuro-reading
room at 5-7055 or 5-6768 for approval by a radiologist. After approval, the radiologist needs to communicate with the MRI technologist
to do the studies.
The requesting physician must fax the written requisition to the
technologist at 404-616-8652, or tube the requisition to tube # 085, or
personally hand over the requisition to the technologist in the Imaging Center.
After completing the studies, the MRI technologist is required to
call the radiologist (resident) to review the studies. After reviewing
the studies, the radiologist must contact the requesting physician with
the preliminary report.
Emergent MRI can be requested after hours in the following
cases:
Trauma
Neurosurgery
Orthopedic Spines
Approval to do these cases must come from a fellow (radiologist).
After approval the radiologist is required to contact the on-call MRI
technologist via beeper # 404-619-9976, which is posted in the ER
reading room, for the studies to be done.
The MRI technologist, after arriving at the Imaging Center is required to contact the requesting physician to expedite transportation
of the patient and the written requisition to the Imaging Center for the
studies to be done.
After completing the scan, the technologist must make hard copies
of the images, and send with the patient. This will eliminate the problem of looking for films if surgery is needed. The images must also
be transmitted to the IC-PRO, and the ISITE PACS for easy review.
To obtain preliminary results requesting physician can call 5-4000.
CT Scanning
Imaging Center 5-6762
Main Hospital 5-7002
Emergency CT 5-2649
GCCT: 4-9097
OUT PATIENT
All outpatient CT exams excluding, ECC patients, are performed
in the Georgia Cancer Center located in the main hospital on the 10th
floor (B area) Monday-Friday from 7:30a.m until 3:30 p.m. Each out
patient scheduled for a CT exam requiring IV contrast must be sent
to laboratory for blood work to include creatine. Lab results must be
available for review at least one day prior to the patientʼs CT appointment. The creatine value must be no more than 30 days old at the
time of the CT exam.
To schedule an outpatient appointment the patient should contact
central scheduling department at 5-2204.
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INPATIENT
Inpatient request for CT exams should be entered into OAS Gold.
Hours of operations are 0700-2200 Monday –Friday. 0700-1900
Saturday and Sunday. The telephone extension is 5-7002. All after
hours request should be entered into OAS Gold and routed to Emergency CT. Inpatient procedures are typically performed within 24
hrs. The technologist will contact the patientʼs area and arrange for
transportation to CT.
Any patient who is clinically unstable or admitted to an ICU must
be accompanied to the department by the patientʼs physician or an
individual designated by the patientʼs physician. This person should
remain with the patient until returned to the floor.
ECC PATIENTS
ECC patients who require CT examinations are scheduled through
the Emergency CT department (located within the Emergency Radiology department on the ground floor). The phone extensions are
5-2649 and 5-2849. The order should be placed into OAS Gold. The
technologist will arrange for transportation when the scanner is available. The patient should arrive with patient ID stickers and x-ray requisition complete with clinical history requested exam, physicianʼs
signature, physicianʼs ID number and pager number.
ORDERING CT SCANS IN THE ECC
• These are in a few basic steps that will assist you in ordering the
correct CT examination for your patient in the Emergency Care
Center.
• There are three types of contrast used in performing CT exams.
1. IV Contrast
2. Oral Contrast
3. Rectal Contrast
Please Note: When the order reads WITH CONTRAST, this means
IV CONTRAST.
Only CT exams of the Abdomen and Pelvis routinely require
ORAL CONTRAST.
CT Contrast Administered Via Intravenous Injection
• Intravenous contrast is used in CT to highlight blood vessels and
to enhance the tissue structure of various organs such as the brain,
spine, liver and kidneys.
“Intravenous” means that the contrast is injected into a vein using
a needle.
• Most imaging exams of the abdomen and gastrointestinal system
use both the intravenous iodine and orally administered contrast
for maximum sensitivity. On rare occasions, rectal contrast may
be required for optimal lower bowel/rectal opacification.
All patients who are to receive IV contrast
must have a valid creatinine.
225
• Obtaining a good history from the patient is paramount before injecting IV contrast. A history of allergies (especially to medications, previous iodine injections, or shellfish), diabetes, asthma,
a heart condition, kidney problems, or thyroid conditions should
be noted on the exam request as these conditions may indicate a
higher risk of iodine reactions or problems with eliminating the
iodine after the exam.
Patients with a creatinine of greater than 1.5 must be approved
by the Radiologist.
• If the patient is on dialysis please make a note of this on the radiology request. IV contrast can be administered if the patient is
scheduled to have dialysis within 24 hours of the administration of
intravenous contrast.
• If the patient is diabetic and takes an oral medication please make
a note on the Radiology Request. There are many diabetic medications that cannot be taken after the administration of IV contrast.
• Patients with a known allergy to IV contrast may be premeditated
and the procedure performed at a later time.
• If the patient is not able to consent for themselves or does not speak
English, please make a note of this to insure that proper arrangements are made prior to the patientʼs arrival to the CT department.
CT Contrast Administered Orally
• Oral contrast is often used to enhance CT images of the abdomen
and pelvis.
• There are two different types of substances used for oral CT contrast.
1. The first, barium sulfate, is the most common oral contrast agent
used in CT.
2. The second type of contrast agent used is called Gastroview
which is what is currently being used here at Grady.
3. Gastroview may be obtained from the ER medication pyxis.
• The correct mixture is 40 ml of Gastrografin in 800ml of sterile
water. Crystal light may be added to the mixture to improve the
taste and the solution may be poured over ice.
• The patient should receive one cup (240 ml) of oral contrast mixture approximately every 15 minutes to ensure proper bowel opacification (Please do not administer all of the mixture at once).
• In an effort to expedite your patientʼs exam and communicate the
findings please complete the radiology request with the following
pertinent information.
– Putting the patientʼs location in the zone will help the transportation department find your patient in a more timely manner
and will prevent you from receiving a phone call asking for the
patientʼs location.
– Writing legibly, please make sure order form is signed and that
your PIC number is easily read. This will also help you receive
the results of the ordered examination in a timely manner.
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CT EXAMS
HEAD/BRAIN
Headaches or recent trauma
CT Brain without contrast
r/o acoustic neuroma
MRI exam of choice, otherwise
no contrast
trauma to face, fracture or for- Orbits without contrast
eign body
r/o cellulitis or abscess
Face with contrast
ST NECK
r/o neck mass or neck swelling
CT neck with contrast
CT ABDOMEN AND PELVIS
• In the Emergency Care Center you must Always order an abdomen and pelvis CT Scan.
The majority of the Abdomen and pelvis CT scans are performed
with both oral and IV contrast.
The only exceptions are as follows:
1. If the patient is allergic to Iodine, oral contrast is be administered.
2. If the patient has a creatine greater than 1.5 oral contrast is must
be administered.
3. The patient has already received IV Contrast within the past 24
hours
Kidney Stones
No Oral Contrast
Retropertoneal Bleed
No Oral Contrast
Dissection
No Oral Contrast
Pulmonary Embolism
No Oral Contrast
CTA of the Abdomen
and Pelvis
No Oral Contrast
• A Pelvis Only CT Scan may be ordered to rule out a fractured pelvis without contrast.
Any changes to the routine protocols must be approved by the
body CT radiologist or the radiology resident reading CT scans
in the emergency radiology reading room after 5pm .
CT CHEST
CT chest with contrast
• Abnormal chest x-ray, lung nodules, SOB, Pulmonary emboli,
Cancer and Chest pain
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HIGH RESOLUTION EXAMS OF THE CHEST ARE NOT
EMERGENCT AND ARE NOT PERFORMED IN THE ER CT.
CT ANGIOGRAPHY
For all CT Angiography PE Protocols and Dissection Protocols
• The Neuro Radiologist, or the Radiology resident reading CT exams must approve all CTA exams after 5pm.
• The patient must have an 18 gauge or 20gauge needle in the anticubical vein. The CTA exam cannot be performed with an IV
placed in the patientʼs hand. The technologist will access the IV
and determine if it will hold up to the injection which is performed
at a rate of 4.O ML / SEC.
GENERAL DIAGNOSTICS
(ext 5-4500, 5-4501)
The General Diagnostic Division is located on the third floor. The
hours of operation are 24- hours Monday-Friday. All routine inpatient
and outpatient fluoroscopic and radiographic examinations as well
as arthrography, and other miscellaneous procedures are performed
in this area. Arthrography, sialography, and hysteroscalpingography
do not require prior consultation. Consultation is required prior to
scheduling the following procedures: fistulography, guided fluoroscopy (pulmonary and GI procedures by non-radiologist physicians),
bronchography, biopsy and mammography for patients less than 35
years of age.
PREPARATION FOR STUDIES
IVP ( Intravenous Pylogram)
Since contrast agents are detrimental in patients with renal failure, consultation with a staff radiologist should be obtained prior to
scheduling.
Preparation
Day before study
1. Take 1.5oz. bottle of Phospho-soda oral saline laxative combined
with an 8 oz of water at 3:p.m. in the afternoon.
2. Then drink another an 8 oz glass of water.
What to Eat:
1. Light fat-free lunch
2. For dinner, only clear soup, plain jello ( non-red without fruit),
apple juice, soft drinks, water, coffee or tea with sugar (no cream
or milk)
3. At bedtime take four fleet bisocodyl tablets with 8 oz of water.
4. After 10 p.m. no eating or drinking permitted until the examination has been completed.
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The Day of the X-ray
1. Do not eat or drink anything.
2. Do not take insulin. (Bring to the Department)
3. Two hours prior to the appointment – a lukewarm enema should
be performed.
Important: Patients that are diabetic and take Glucophage (metformin) must speak with the resident radiologist or the radiology
nurse before leaving the department.
UGI Series (Upper Gastrointestinal Series)
Preparation Day before Study:
1. Light Dinner (toast, coffee, jelly, tea and fruit)
2. NPO after midnight
Barium Swallow/Esophagram
Preparation
1. Same as for UGI Series
Barium Enema (Lower Gastrointestinal Series)
Preparation
Day before study:
1. Light breakfast. (toast and coffee, no dairy products)
2. At 0900: 1000; 1100; drink 8oz clear liquid.
3. One-half hour prior to lunch, take the fleet phosphosoda. (bottle
of liquid provided in fleet prep kit). Take entire bottle (1.5 oz) of
fleet phosphosoda in one-half glass of cool, clear water. Follow
with full glass of water.
4. Clear liquid lunch at approximately 1230.
5. AT 1400; 1500; drink 8 oz of clear liquid.
6. AT approximately 1800 clear liquid dinner.
7. After eating, take all four bisacodyl tablets. Bisacodyl tablets are
in one packet in the fleet prep kit.
8. NPO after midnight
Day of examination:
0500 soapsuds enema using the castile soap in the fleet prep kit. Entire enema bag should be emptied into the bowel. The patient is lying
on his/her side. The patient should remain on the left side for five
minutes; then turn onto the stomach for five minutes; then roll onto
the right side for five minutes. The enema can then be evacuated.
The radiology department should be contacted for information on
preparation for other studies, i.e. gastric dumping UGIs.
PEDIATRIC RADIOLOGY
Available – CHOA- Hughes Spalding
For routine work-up of recurrent urinary tract infection, avoiding
cystourethrogram followed by renal ultrasound study will provide
adequate information in most children if reflux is not demonstrated.
These studies may be obtained by ordering VCUG and Renal Ul-
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trasound on separate request forms and will be coordinated by the
Pediatric Radiology Section.
UROLOGIC DIAGNOSTIC STUDIES
A. All patients over 20 pounds in weight.
1. Intravenous Pyelogram:
a. Give surgical liquid diet on the day before the examination.
b. At 1600 on the afternoon before the examination give Xprep liquid (1 m l/2 pounds body weight). Give no solid
foods after x-prep.
c. NPO after midnight.
d. At 0600 on the morning of the examination give pediatric
Fleet enema.
e. To x-ray department, on call.
B. All patients under 20 pounds in weight.
1. Intravenous Pyelogram.
a. Give surgical liquid diet after the noon meal on the day
before the scheduled examination.
b. NPO 4 hours prior to examination.
c. To x-ray department, on call.
2. Voiding Cystogram (NO Prep)
GASTROINTESTINAL DIAGNOSTIC STUDIES
A. All patients over 20 pounds in weight.
1. Barium Enema
a. Give surgical liquid diet after the evening meal on the day
before the examination.
b. At 1600 on the afternoon before the examination give xprep liquid (1 m1/2 pounds body weight). Give no solid
foods after x-prep
c. NPO after midnight.
d. At 0600 on the morning of the examination give fleet enema.
e. To x-ray department, to call.
2. GI Series
a. NPO after midnight.
b. Patient may have clear liquids, but NPO 4 hours prior to
examination.
3. Barium Swallow
a. NPO for 4 hours prior to examination
b. To x-ray department, on call
4. Gallbladder and Biliary Tree
a. NPO after midnight
b. To x-ray department, on call
Dosage for X-prep
All patients over 20 pounds in weight -x-prep liquid dosage is the
following:
1cc per pounds of body weight
The usage of this formula should facilitate accurate calculation of the
dosage required.
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EMERGENCY RADIOLOGY
(ext 5-4001)
The Division of Emergency Radiology is located on the ground
floor adjacent to the Emergency Care Center The Division is open
7 days a week, 24 hours a day. Its primary purpose is to provide
radiologic support services to the emergency clinics either in the Division itself or through the use of the mobile radiologic units in the
emergency clinic areas. The division is also responsible for providing coverage for the operating rooms, the high-risk nurseries, Sickle
Cell Clinic, the ICUs triage and the inpatient examinations during the
hours when General Diagnostics is closed.
When a patient is admitted to the hospital from an emergency clinic, emergency radiology personnel should be notified of the team responsible for the patientʼs care so that films can be sent to the Central
Viewing Room for proper display.
ULTRASOUNDOGRAPHY
(ext 5-4519)
The Ultrasoundography Division is located on the third floor,
3G058. Hours of operation are 0700-1700 Monday-Friday. Routine sonographic examinations include: neonatal cranial, pediatrics,
thyroid, duplex carotid, chest (to localize pleural fluid), gallbladder,
abdomen, renal, abdominal aorta and pelvis. Sonographic examinations include:
Abdominal/Retroperitoneal Doppler Abdomen
Retroperitoneum Complete (kidney) Pelvic
Trans Vaginal
Testicular
Thoracentesis
Liver Biopsy or Renal
Carotid Doppler
Superficial
Peripheral Vascular Doppler (DBT) Thyroid
Chest Pleural Effusion
Aorta
Other examinations, e.g. biopsies, thoracentesis, paracentesis, or
abscess drainage are scheduled after consulting with the Ultrasound
Radiology Resident or Fellow.
Patient Preparation
1. Abdominal examinations: NPO for hours prior to examination.
This includes the gallbladder biliary tract, pancreas, and abdominal aorta.
2. Pelvic examination: Drink five 8 oz. Glasses of water when they
arrive in the department. Examination must be done with the
bladder full.
3. No preparation is needed prior to other routine sonographic examinations.
Emergency examinations after 1700 until 0700 maybe arranged
through the CT/Ultrasound Resident or Fellow on call.
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Pediatric Radiology Department
This department is staffed by the Ultrasonographer from Grady
Ultrasound Department, Monday through Friday, 0700-1700 Routine
sonographic examinations include:
Abdomen
Hips
Renal
Neonatal Cranial
ANGIOGRAPY AND INTERVENTIAL RADIOLOGY
The angiographyʼs division consists of the vascular and Neuro angiographyʼs sections. The angio suites are located in the 3E corridor in
room 3E032 and 3E034; telephone extension 5-7005. The hours of
operation are 0730-1600 Monday through Friday. Twenty-four hour
emergency service is available by contacting the vascular or Neuro
fellow on call through the in house radiology resident.
All requests for vascular angio or interventional should be entered
into the order entry through oas gold along with a hand written copy
of a radiology physician order form placed in the MD request section
of the patients chart. All out patients are scheduled by the referring
clinic by calling the interventional radiology secretary @ ext5-7007
or 5-7006 and by faxing an order requisition to the Interventional Radiology department at 404/616-3645. All Neuro angio and interventional procedures should be scheduled through the neuro radiology
secretary @ ext 5-9874 or by consulting with the neuroradiologist
located in room 3F017 or by calling ext 5-7005..
The original copy of the Radiology Request must be placed in the
patientʼs chart, dated and signed by the requesting physician including the PIC# and the Physicianʼs ID#.
All angiographic and interventional procedures generate a small
amount of discomfort and a large amount of anxiety. This is aggravated if the patient does not understand the procedure. The physician caring for the patient must inform him/her that the procedure
has been ordered to ensure that the patient does not hear of the study
when visited by the radiologist.
A “Special Consent to Operation or Other Procedure” must be signed
by each patient undergoing a procedure. The radiologist will visit the
patient, review the chart, examine the patient and obtain the necessary informed consent at the time the pre-op orders are written for
the written for the procedure. In emergencies the referring physician
may be asked to obtain the consent in order to expedite the procedure.
Clinicians are requested to accompany patients during emergency
procedures.
Patient Preparation
Creatinine, PT, and PTT are required prior to arteriography and most
interventional procedures. Since complications are decreased by hy-
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dration, a well-placed IV is necessary on all patients before coming to
the department. Ordinarily, the patient should not be NPO but have
the last solid meal withheld prior to a procedure. The radiologist will
adjust or terminate anticoagulants long enough before a procedure to
allow safe performance of the procedure.
Follow-up ordinarily will be done the next day on most procedures,
but on certain procedures, i.e., when a catheter is in place for infusion
purposes, multiple visits may be necessary by the Radiology Fellow
or Resident. Any inadvertent reaction or evidence of complication
should be brought to the attention of the radiology resident immediately.
Body CT
Routine requests for body CT studies should be entered into OAS
Gold. Routine body exams include those of the thorax, abdomen,
pelvis and extremities. Creatine and BUN levels are required. Emergency after hour examinations may be arranged thought he radiology
resident or fellow on call at 5-4002 or through Grady operator.
Patient Preparation
All trauma patients for body CT scans will follow the trauma protocol established by the Radiology Department.
1. Patients will have a nasogatric tube placed in the Emergency Clinic. Stomach contents including air will be aspirated and 800 ml of
2% gastrografin solution instilled into the nasogastric tube in the
Emergency Clinic when notified by the CT technologist.
2. All patients will receive oral contrast except those who are both
comatose and not intubated. Patients not requiring nasogastric
tube will receive oral contrast mixed as follows: 40cc of gastroview and 800ml of sterile water to be given in 10-15 minutes
intervals.
3. Other protocol details may be obtained from the Radiology Department.
Neuroradiology
Non-emergency studies should be scheduled through OAS Gold.
CT technologist will arrange for transport to CT Department (3D016)
extension 5-7002. Emergency studies during regular hours should
be approved by the resident or neuroradiology fellow. Seven days a
week 24 hrs service is available and is encouraged.
“Special Consent to Operation or Other Procedure” must be signed
by each patient undergoing certain procedures. The Radiologist will
visit the patient, review his chart, examine him, and obtain the necessary informed consent at the time that he writes pro-op orders.
Patient Preparation
CT Scans
Scans of the brain, head, neck and spine are performed on a routine
basis. Since many scans should be performed with contrast, clinical
information is important, as is the patientʼs renal status. Emergency
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scans are performed non-contrast and contrast will only be administered after approval by the fellow on call.
Myelography
Myelography are performed on both an emergency and routine basis. The patient should be well hydrated prior to the examination.
Consent will be obtained by the resident or fellow performing the
examination.
NUCLEAR MEDICINE (Ext 5-4602)
The Nuclear Medicine Division is located on the third floor “A”
area. Hours of operation are 0700-1900, Monday-Friday. Emergency studies during regular hours should be scheduled by contacting the
resident or staff physician. Seven-day-a-week, 24-hour emergency
service is available by contacting the Emergency Radiology Resident
at ext 5-4002. These are most effective in studies of small organs
such as the heart. Patients for Nuclear Medicine procedures need to
have an I.V. in place.
I. Diagnostic Procedures
A. Central Nervous System
1. Brain (requires 1-2 hours)
2. Cerebrospinal flow
3. Cisernography (requires 24-72 hours).
4. Demonstration of cerebrospinal fluid leaks (may require 1-2 days)
B. Pulmonary Studies
1. Ventilation-Perfusion lung imaging (requires 1-2 hours).
This examination should be performed in all patients
with suspected pulmonary embolism prior to contrast
angiography. Lateral and PA chest x-ray should be performed in the main Radiology Department immediately
prior to the Nuclear Medicine examination.
2. Gallium-67 lung imaging (injection and return 48 hours
later for 30 minutes of imaging). In order to obtain
accurate quantitative data, a bowel preparation similar
to that for a barium enema should be performed on the
night prior to imaging.
C. Cardiac Imaging
1. Thall Thallium or Persantine Thallium. Imaging requires four hours of imaging. Patients need to be NPO
after midnight. The study may be performed in the
resting state or after exercise stress. In order for the patient to exercise to an adequate heart rate, (greater than
85% predicted heart rate), or if persantine is being administered, a requisite for maximum sensitivity of the
test in the detection of coronary stenosis, medications
which interfere with peak exercise or increase in heart
rate should be discontinued, if clinically feasible.
2. Infarct avid imaging (requires 1-2 hours)
3. Multi Gated Acquision Imaging (requires 2 hours)
4. Accute Myocardial Perfusion Imaging (requires 2
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hours)
Gastrointestinal
1. Liver-Spleen imaging (requires 30 minutes-1 hour).
2. Hepatobilary imaging (requires 1-4 hours). Inpatients
with suspected acute Cholecystitis, preparation should
include the patient being NPO for 4-6 hours prior to
examination. Hyperalimentation also should be discontinued during this period.
3. Gastric emptying (requires 2 hours). Patients should be
NPO after midnight.
4. Gastroesophageal reflux (requires 102 hours). Patient
should be NPO after midnight.
5. Gastrointestinal bleeding studies (requires 1-24 hours).
This study should be performed in all patients with suspected cavital GI bleeding prior to contrast angiography.
a. Acute bleeding should be imaged during the bleeding episode for maximum detection and visualization
of the bleeding site. The Nuclear Medicine Department should be contacted immediately so that these
images may be performed at the proper time.
b. Intermittent bleeding (may require 24 hours of imaging). If there is clinical evidence of bleeding during
the 24 hours post injection. Nuclear Medicine should
be requested to image the patient at that time.
E. Genito-Uninary Imaging.
1. Renal imaging with total and differential function (requires 1-2 hours) Patients should be hydrated.
F. Skeletal imaging (requires 2-3 hrs). While body imaging or
regional imaging may be performed as requested, there is a
3-hour interval between tracer administration and imaging.
Three Phase Bone imaging requires the patient to be injected
in the department and return three hours later. White Blood
Cell imaging ( requires 6 hours).
G. Whole body imaging for infection or neoplasia (Gallium-67)
(requires 1-4 days). Since Gallium-67 is normally secreted
into the bowel, abdominal disease can only be assessed if bowel cleansing is performed prior to each imaging session. These
examinations also may be directed toward a specific area, such
as the skeleton or lung, etc.
H. Thyroid imaging and radioiodine uptake ( two day procedure)
The quality of images and accuracy of the uptake are affected
by the administration of exogenous iodine. Consult Nuclear
Medicine Department for appropriate scheduling if iodides or
iodinated contrast agents have been administered.
I. Whole body imaging for functioning thyroid carcinoma metastasis in post-thyroidectomy patients. Discuss the procedure
with Nuclear Medicine Department prior to scheduling
D.
II. Therapeutic Studies
A. Therapy for hyperthyroidism (requires 3 days). Patients
should be referred through Endocinology so that pre and
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post-dose treatment can be done.
B. Therapy for thyroid carcinoma (requires 3-5 days of hospitalization). Should be referred through Endocrinology.
C. Radioactive phosphorus therapy for hematological disease
will be performed only after a Hematology consult.
III. Special considerations:
Many of the radionuclide procedures require patients to remain immobile for prolonged periods. Pediatric and certain adult patents may
require sedation.
Patients should be made aware of the fact that although radioactivity will be administered, the dosage is low and usually lower than for
x-ray procedures. Consultation with the Nuclear Medicine Staff is
encourage.
IV. Radiation Safety Considerations.
A. Diagnostic Tests. The dosage to the patient is low and does
not require isolation of the patient. The use of these tests
on pregnant or lactating women is not recommended unless the expected benefit outweighs the potential risk to the
fetus or neonate. These patients should be discussed with
the Nuclear Medicine Staff.
B. Therapeutic
1. Any therapeutic dosage greater than 30 mCi requires
hospitalization until the whole body retention drops to
less than 30 mCi.
2. Incidents involving a therapeutic dosage should be reported to Radiation Safety (5-3321) and the Division of
Nuclear Medicine Staff.
3. Death of a patient who has received a therapeutic dosage. The House Staff must notify Radiation Safety (53321) and obtain clearance from that office prior to
autopsy or release of the body.
4. Release of Radioactive Patient. If a patient receiving a
therapeutic dosage insists on leaving the Hospital, the
House Officer must:
a. Obtain a signed release from the patient.
b. Notify Radiation Safety
c. Notify the Office of the Executive Director or Assistant Director (s) of Patient Care (contact through
the Grady Operation)
POSITRON EMISSION TOMOGRAPHY
PET/CT (4/9216)
The PET/CT Department is located in the Georgia Cancer Center on
the tenth floor B area. Hours of operation are 0700-1550, MondayFriday.
All inpatients requests for PET/CT should be taken directly to 10B
for approval by the Nuclear Medicine Physician. Outpatients are
scheduled through Centralized Scheduling pending approval.
PET/CT Imaging (requires 2-3 hours). Patients must be NPO after
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midnight. Diabetic patients should eat at approximately 6:00 a.m.,
take their medication and is then NPO until exam is complete. Blood
glucose levels must be in the range of 60-180mg/dl in order for the
exam to be administered.
RESPIRATORY CARE DEPARTMENT
The Respiratory Care Department (RCD) staff includes certified and
registered respiratory therapists who provide services to inpatients
and outpatients at Grady Memorial Hospital and Hughes Spalding
Childrenʼs Hospital (HSCH) as well as residents at Crestview Health
and Rehabilitation Center, which are a part of the Grady Health System (GHS). The Medical Director of RCD is a board certified pulmonologist/intensivist, currently from the Pulmonary-Critical Care
section of Morehouse School of Medicine. Administratively, the
RCD reports to the Vice President for Professional Services. Services
provided include:
1. Cardiopulmonary resuscitation.
2. Airway management, including endotracheal intubation and extubation.
3. Provision of supplemental oxygen and aerosol therapy.
4. Provision of mechanical ventilatory support.
5. Arterial blood gas sampling and arterial cannulation.
6. Bedside monitoring of ventilation and oxygenation.
7. Participation in transport of intubated adult patients within the hospitals. Neonatal transport inside and outside the hospital.
9. Sputum induction utilizing isolation booths.
The RCD staff will perform diagnostic, monitoring, therapeutic,
and supportive actions in accordance with appropriate orders by a
physician with GHS privileges. Orders may be general if they pertain
to existing RCD protocols (e.g., weaning from mechanical ventilation
support.) However, verbal orders will be accepted by the RCD staff,
but must be countersigned by the physician within hours. For patients
receiving ventilatory support, appropriate monitoring, including use
of alarms, are established by RCD policies and may not be countermanded by written orders from house staff. To ensure that ventilator changes are made appropriately and all alarm parameters are set
correctly, the therapist will make ventilator adjustments. Attendings
on an Intensive Care Unit Service, Neonatal Attendings and Fellows,
Pediatric Surgical Attendings, Trauma, ER Attendings, Critical Care
and Pulmonary Fellows are allowed to make ventilatory adjustments
accompanied by an appropriate order, documentation on the flow
sheet, and notification of respiratory therapy. Residents, Interns and
Medical Students are not allowed to make ventilator changes unless
in the presence of these same Physicians.
CARDIOPULMONARY RESUSCITATION (CPR). A respiratory therapist will respond to all “Dr. 99” pages. This therapist will provide
airway management, including intubation, unless a physician with
more airway management experience is present.
EMERGENCY CALLS. Emergency calls to the RCD can be placed
237
through the GHS operator or directly to the supervisor (beeper 7433780). Emergency pages will be answered by phone to determine appropriate personnel and equipment needed for the emergency.
AIRWAY EQUlPMENT. Ventilation kits with a self-inflating bagvalve mask and intubation kits are available on all patient care areas.
Tracheostomy tubes are available through the RCD (5-2291). Type
and size of tracheostomy tube must be specified by a physician.
RCD PHONE NUMBERS
Adult Care Services
Administration
Medical Director
Pediatric Floor and Critical Care Services
Neonatal Floor and Critical Care Services
Crestview
5-5432
5-5430
5-5430
5-5781
5-8955
5-8178
EKG DEPARTMENT
The EKG Department is located in the 2-E area next to the Cardiac
Clinic.
The Electrocardiograph Department is responsible for obtaining
Electrocardiograms and Echocardiograms on inpatients and outpatients. These tests must be requested by a physician. Requisitions must
be completed by requesting physician prior to tests. The department
operates 24 hours a day for EKG requests only. EKG requests may be
called in at ext. 5-4441. Day shift Techs routinely make rounds to the
in-patient areas. Out-patient EKGʼs are done until 1600 in the department. After 1600 the evening and night Techs can be reached at ext.
5-4441 or pager 864-0824.
The Department utilizes the Hewlett-Packard Tracemaster ECG
System. This system provides computerized interpretation for the
EKG and provides disc storage and retrieval of previously recorded
EKGʼs. All 12-1ead EKGʼ s should be recorded using this Management System.
Patients for Echocardiograms must be scheduled in advance. The
Echo Lab operates Monday through Friday, 0800 to 1630. Scheduling
hours are between 0800 and 1630 for outpatients. Emergency Echo
requests should be referred to the Cardiologist on call after hours and
on weekends. Outpatients should be referred to the Echocardiograph
Lab to schedule appointments prior to next clinic visit. Inpatient requisitions should be taken to room 5GO15 for patients assigned to
Emory physicians. Requisitions for patients assigned to Morehouse
physicians should be taken to the Echocardiograph Lab.
CARDIAC FUNCTION (EXERCISE) LABORATORY
The Cardiac Function Laboratory is located in the 2A hallway. Exercise Stress Testing is done in room 2A011. Holter Monitor application is done in room 2A014.
The Cardiac Function Lab is responsible for routine Thallium Exercise Stress Tests and 26 hour Ambulatory EKGs (Holter monitor)
238
on outpatients and inpatients. The lab operates Monday through Friday, 0800 to 1630 for exercise tests and Holter monitoring. Holter
monitoring is also available on Saturday and Sunday, 0700 to 1530
for inpatient requests only.
Patient testing utilizes treadmill exercise with continuous EKG
monitoring using the Bruce, Naughton, modified Bruce, and arm
ergometer protocols. Please put referring Doctor, and beeper # and
when the patient is expected to be discharged on the requisition slip.
Patients may be scheduled for routine exercise tests, Thallium Stress
Tests, and 26 hour ambulatory ECGʼs (holter monitor) by phoning
ext. 5-4447. Scheduling hours are between 0800 and 1630. All routine and Thallium Stress Tests requests must be approved by a Cardiology Fellow or Cardiology faculty member prior to scheduling.
CARDlAC CATHETERIZATION LABORATORY
The Cardiac Catheterization Laboratory is located at the junction
of the 2A and 2G corridors, rooms 2A033 and 2A028.
Tests performed include, but are not limited to, right and left
heart catheterization, ventriculography, percutaneous transluminal
coronary angioplasty (PTCA), intra-aortic balloon counter-pulsation
(IABP), electrophysiological studies and cinefluoroscopy.
The Cardiac Catheterization Laboratory is open Monday-Friday
from 0700-1630 hours. Emergency call is provided by the staff following a PTCA procedure.
Patients referred from medical clinics may be scheduled for cardiac catheterization procedures by contacting the Cath Lab Fellow at
5-2848 or 5-6719. All other patients should be screened by the Cardiology Fellow assigned to the wards or by a Cardiology Attending. If
catheterization is indicated, contact the Cath Lab Fellow at 5-2848 or
5-6719.
Films are available for review with the Cath Lab Fellow or Attending by coming to the lab during normal hours or by calling the above
numbers.
EEG/EMG LABORATORY
(Neurodiagnostic Laboratories)
The EEG/EMG Laboratory, located on 11E, obtains electroencephalograms, electromyelograms, brain death studies, evoked response studies, and special sleep studies which are performed under
the supervision of the faculty of the Department of Neurology. These
tests must be requested by a physician and scheduled in advance. The
laboratory hours are 0830 to 1700, Monday through Friday. Scheduling can be accomplished by calling extension 5-4457. Preliminary
EEG/EMG reports may be obtained by calling the EEG/EMG Lab
(5-4457) the first weekday following the recording.
PULMONARY FUNCTION LABORATORY
The Pulmonary Function Laboratory is located in 2D051. Laboratory hours for pulmonary function tests are 0700 - 1930. The Sleep
239
Labʼs operating hours are 2000 - 0830, Monday through Friday and
Saturday 2000 - 0830. Testing on Fridays is reserved for the Pulmonary Clinic and inpatient testing. Requests may be called in at 5-4454
or brought to the laboratory by hand. Request times should be made
relevant to the patientʼs needs. Emergency or ASAP pulmonary functions will be performed within 24 hours of receiving the requisition.
Others will be performed within 48 hours of receiving the requisition,
or as specified by the ordering/attending physician.
The Pulmonary Function Laboratory offers a wide selection of
procedures. Routine tests include: Spirometry (pre- and postbronchodilator studies), lung volumes (plethysmograph, nitrogen washout),
arterial blood gases including co-oximetry, flow-volume loops, and
diffusion studies (single-breath method).
More specialized tests include: resting and exercise blood gases
(please indicate any cardiac abnormalities on request slip); bronchoprovocation studies utilizing methacholine chloride for the detection
of reactivity in the airways; P50ʼs; the separation of membrane vs
vascular elements in diffusion capacity; and, treadmill protocols for
preoperative evaluation.
Polysomnographic evaluations for suspected sleep apnea syndromes also and for titration of CPAP with an established diagnosis
are available through the Pulmonary Clinic with a pulmonary consultation.
Failure to mention a test does not preclude its availability. Call the
laboratory and check, as we are flexible.
Bronchoscopies are performed by the Pulmonary Consultation
Service. They should be scheduled through one of the attending physicians or the Pulmonary Fellow, extension 5-4455.
Bronchoscopies are done either in the Pulmonary Laboratory, ICU
or in Radiology if fluoroscopy is required.
NEPHROLOGY
End-Stage Renal Disease, Dialysis and Transplantation
The Department of Medicine, through the Division of Nephrology
and Inorganic Metabolism, runs the Atlanta Regional Nephrology
Center (ARNC) on Floor 7-E of Grady Health System. The ARNC
is designed to treat patients with renal failure of such severity that
artificial measures of support are necessary for survival, either on
an acute or chronic basis. It is not intended to be the primary site of
hospitalization of patients admitted for the diagnosis and treatment of
less severe forms of renal disease nor the management of terminally
ill patients for whom dialysis or transplantation is either impossible
or adjudged to be of no benefit.
ORAL SURGERY CARE
The Oral Surgery Section at Grady Health System provides emergency and routine oral surgery treatment for eligible patients. Patients
with facial trauma, facial deformities, oral pathology or in need of
dental extractions can be referred for treatment. No general dental
care is available.
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GEORGIA POISON CENTER
The Georgia Poison Center (GaPC) is located in the basement of
the Hughes Spalding Childrenʼs Hospital in room B39H. The Georgia
Poison Center is the Regional Poison Center for the State. It has been
designated as such by the American Association of Poison Control
Centers (AAPCC) and the Georgia Department of Human Resources
(GaDHR). The Center receives primary funding from the GaDHR
with additional support from the Grady Health System.
The Center is available 24 hours a day, seven days a week for
telephone consultation about toxicologic emergencies. The Center is
staffed by Specialists in Poison Information (SPIʼs), who have been
specially trained to answer these inquiries. The Center utilizes a number of resources including computerized Poisindex, and a wide range
of books and reprint articles. Five board certified toxicologists are
available for consultation: other consultants and consultation with
manufacturers support the staff in answering inquiries. Adverse drug
reaction questions are answered or appropriately referred by Center
staff.
The GaPC can be contacted from inside the Grady telephone, 59000. In Metro-Atlanta call (404) 616-9000. The Center has a tollfree WATS line for the state of Georgia, 1-800-222-1222, and a TIY/
TTD line for the deaf and hearing impaired, (404) 616-9287.
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SECTION IV
GENERAL RESPONSIBILITIES AND INFORMATION
242
DINING FACILITIES
The Hospital operates a cafeteria for the convenience of staff and
employees.
Food Court–Second Floor “E” Corridor
Breakfast
0630-1000
Monday-Sunday
Lunch
1100-1430
Monday-Friday
Lunch
1100-1400
Saturday-Sunday
Holidays
Dinner
1630-2000
Monday-Sunday
Full meals, salad bars, deli, pizza and grill are available.
Vending area, canned drinks, beverage vending
machines are located throughout the complex. Refunds are available
from vendor.
Problems associated with patient or staff food service should be
handled by contacting the Director of Food Service at 5-4210; if unavailable, the Operator may be asked to locate a representative of
Food Service. The Food Service Department is staffed weekends and
holidays to ensure expected levels of service being reached.
PLEASE DO NOT TAKE DISHES AND TRAYS FROM FOOD
COURT. CARRY OUT SERVICE IS AVAILABLE.
A turnstile is present at the entrance to the cafeteria. Please use
turnstile to enter. A handicapped gate is available for the individuals needing it. Please open the gate by pushing the button the side
entrance wall. Please exit cafeteria behind registers.
The Georgia State Department of Human Resources, Division Vocational Rehabilitation operates a snack bar which is open 23 hours
each day in the “D” hallway on the ground floor.
The snack bar is closed from 0600 to 0700 daily for cleaning.
CALL ROOMS ASSIGNMENTS - DOCTORSʼ LOUNGE
On Call sleep space is provided for medical residents in the following locations: Basement of Hughes Spalding Childrenʼs HospitalPediatrics; 5K Clinic Building - Neonatal; 4F Obstetrics and MICU;
and1400 ABC and D area. Daily room assignments are made from
the Public Safety Department Valuables Clerk, Room E1203, Ext.
4100, between the hours of 0630 - 2300. The Assistant Director(s) of
Patient Care (contact through the Grady Operator).
THE HOSPITAL CANNOT BE RESPONSIBLE FOR THE LOSS
OF PERSONAL PROPERTY BECAUSE OF THEFT, MYSTERIOUS DISAPPEARANCE, FIRE, ETC. WE SUGGEST YOU MAKE
SURE YOUR PERSONAL PROPERTY IS COVERED BY PERSONAL INSURANCE.
A special Doctorsʼ Lounge is located on areas 16-CD for use by
the House Staff for rest and recreational purposes. Access keys to this
area can be obtained from the Security Office, Room EI203
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SAMPLE DRUGS
Sample drugs are items of medication that are approved by the
Food and Drug Administration to be distributed by the manufacturing
company free of charge to physicians for the purpose of distribution
to patients. Sample drugs are not permitted in any Grady Health System area unless specifically approved by the Pharmacy and Therapeutics Committee. When such approval is granted, adherence to
specific procedures regarding procurement, storage, dispensation,
record keeping and disposal is required. This policy applies to both
prescription and non-prescription drugs. All exceptions to the policy
must, be submitted to the Pharmacy Department for approval.
Sample drugs are not permitted in the inpatient areas and must
be secured and segregated from clinic floor stock supplies when authorized for use in non-inpatient areas. Sample drugs of controlled
medications and/or non-formulary prescription medications are not
allowed in the Grady Health System. Samples of formulary-restricted
drugs may not be distributed to unauthorized areas.
Pharmaceutical Sales Representatives must deliver samples for use
within the Grady Health System to the Main Pharmacy Storeroom.
Samples intended for use in a neighborhood clinic that houses a prescription pharmacy will be received and logged by that pharmacy.
The Pharmacy will log all samples as to drug name and strength,
manufacturer, drug lot number, drug expiration date, quantity received and clinic area of distribution. Sample drugs will be forwarded
to the designated clinic only if the clinic is on the approved list for
sample medications. Pharmaceutical representatives are not allowed
to enter drug sample storage areas within the clinics.
Please refer to Pharmacy Department Policy and Procedure Manual Policy #2.1 for additional information.
INSURANCE
There is a group policy which covers all residents in the Emory
University Affiliated Hospitals Residency Training Program at no
cost to the residents. Dependent coverage is available on a payroll
deduction basis.
Clinic care and formulary drugs for the House staff and their immediate families will be available. However, if the insurance policy
should cover these expenses, the Hospital will file a claim for reimbursement with the insurance carrier. Non-formulary drugs may be
purchased through the pharmacy.
Houseofficers are entitled to an employee discount of 25 percent
of the total hospital bill, but in no case can the discount exceed the
balance of the bill after applying all insurance proceeds.
Professional Liability Coverage.
The Hospital provides to members of the House Staff and Medical Staff professional liability coverage for activities for or on behalf
of the Hospital within the scope of the residency training programs.
Coverage includes defense and payment of loss
It should be noted that should a member of the Grady House Staff
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or Medical Staff engage in practice outside the scope of the residency
program, such practice is not covered by the professional liability
coverage provided by the Hospital. Care should be taken to obtain
and maintain appropriate malpractice insurance for any activities outside of the scope of the intern and residency program.
GRADY BRANCH LIBRARY
Emory and Morehouse House Staff are invited to use the Grady
Branch of the Health Sciences Center Library. The Grady Branch Library is located on the first floor of the Thomas K. Glenn Building
which is across from Grady Hospital. This Library, a branch of the
Health Sciences Library of the Emory University School of Medicine, is open the following hours:
Monday – Thursday
0800-2100
Friday
0800 – 1800
Saturday
1000 – 1700
Sunday
1300 – 1700
Holiday hours are posted on the Library doors.
The front door of the Grady Branch is used Monday - Friday til
1700. After 1700 Monday -Friday and all weekend hours, the back
door of the Library is used. The back door is located at the top of the
iron steps on the back of the Glenn Building. When accessing the
Library via the back door, please ring the doorbell so that the Library
Assistant may let you in. You will need to present current Grady ID
to be admitted to the Library after 1700.
The Grady Branch maintains a small clinically oriented collection
designed to meet the needs of medical students, residents and faculty
located at Grady Hospital. A reference librarian is generally available
from 0800 - 1700 Monday through Friday to explain the use of guides
to the literature, to suggest sources to be searched for information
and to obtain loans and photocopies of material not owned by the
library.
All books and journals (including current periodicals) may be borrowed on an overnight basis and due the following day. Materials
borrowed on Friday or Saturday are due the following Monday. Audiovisuals may be charged out for one week. Any item not requested
by another patron may be renewed up to three times. A library card
must be shown in order to charge out materials. Reference materials
(including indexes, dictionaries, directories, encyclopedias, etc.) and
certain other volumes do not circulate.
Items not returned promptly the next day are subject to a fine of
twenty-five cents ($.25) per day beginning with the day they are due.
For repeated offenses and lack of cooperation, borrowing privileges
may be withdrawn. Borrowers are responsible for the return of materials charged out in their names and for the payment or replacement
of any lost or damaged items.
A self-service photocopy service offers copies at ten cents ($.10)
per sheet using the Grady Branch Library copy card. Copy cards may
also be purchased with a valid account number or cash. With proper
identification, Emory, Grady and Morehouse personnel may purchase
copy cards in 100, 200, and 300 denominations for $7.00, $14.00,
and $21.00 respectively (7 cents [$.07] per copy). Photocopying of
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Emory materials for Grady Branch users may be requested at $2.00
per article. Request forms for this service may be obtained in the
circulation area.
The Grady Branch has a small collection of audiovisual materials and some limited amount of audiovisual equipment for use with
this collection. Audiovisuals from the main Health Sciences Center
Library will be sent to the Grady Branch upon request.
The library offers computerized searching of a number of databases through OVID, a database vendor. MEDLINE, CINAHL,
EMBASE, PsycInfo, CancerLit, BioethicsLine, AIDSLINE, HealthSTAR and some full-text journal databases are available to Emory,
and Morehouse faculty, fellows, residents and medical students after
applying for and receiving an access password. There are classes offered at both Emory and Grady in the basics of searching of OVID
databases. It is strongly recommended that each person requesting an
OVID password take the class.
The library will borrow needed materials which are not owned
in the Emory libraries from other libraries or other sources as required. Interlibrary loan request forms may be submitted at the Grady
Branch.
All requests for materials from Emory (photocopy requests) or
from other libraries (interlibrary loan requests) must originate at
the Grady Branch Library if you are working at or rotating through
Grady.
Emory House Staff physicians are welcome to use the main Health
Sciences Center Library located on the Emory University Campus.
Likewise, Morehouse House Staff physicians are welcome to use the
Morehouse School of Medicine Multi-Media Center on the Morehouse School of Medicine Campus Morehouse Multi-Media Center
has a contract with the Grady Branch Library to serve Morehouse
faculty, residents and medical students while working at Grady Hospital. As part of this contract the Grady Branch may request materials
from the Emory Health Sciences Center Library for Morehouse personnel, but the request must originate at the Grady Branch Library.
For purposes of convenience, a daily transportation service is maintained so that material from the main Emory Health Sciences Center
Library may be sent to the Grady Branch.
The Grady Branch telephone number is 616-3532.
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GRADY HOSPITAL SATELLITE LIBRARY
The Grady Hospital Satellite Library is an outreach program of
the Grady Branch, Health Sciences Center Library, Emory University. This unstaffed Library is located in 1622 (D-Wing) of Grady
Memorial Hospital. The purpose of the Satellite Library is to provide
24-hour electronic and textbook access to the medical literature so
that the patrons (faculty, residents, medical students of Emory and
Morehouse) can provide the best possible patient care.
Each individual must personally accept responsibility for
abiding by the Satellite Library policies in order to maintain the
Iibraryʼs usefulness. A new security system is being installed to provide better security for both the users and the library materials. This
new security system will be monitored by Grady Security. Each eligible user will have a card with authorization which allows entrance
into the library.
The Satellite Library policies are as follows:
1. NO food and/or drink in the library.
2. NO sleeping in the library.
3. The textbooks do NOT circulate. Therefore, please do not remove the textbooks from room 1622.
4. PLEASE RESHELVE THE BOOKS which you use in the
proper places. The books are on the shelves in broad subject
categories, i.e. Cardiology, Dermatology, Emergency Medicine,
Internal Medicine, Neurology, Pediatrics, Surgery, etc.
5. The computers in the Satellite Library offer all of the OVID
databases (MEDLlNE, CINAHL, EMBASE, HealthSTAR, PsycInfo, BioethicsLine, AIDSLINE, CancerLit, and some full-text
journal databases), AMA FRIEDA and Theresa. Users of the
Satellite Library computers must obtain passwords to use OVID
databases from the Grady Branch Library Staff and Theresa
passwords from the Theresa Staff at Grady.
6. A telefacsimile machine is available to request those articles
which are not available in the full text databases and which are
needed to make an immediate clinical decision. Telefacsimile
requests are not available to increase your article file or for your
research needs. They are to be limited to immediate case management. A maximum of three articles per patron may be requested at any one time.
At your orientation you will be asked to sign an HONOR STATEMENT pledging to abide by the Satellite Library Policies before being given the authorization for entrance into the Library.
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TELECOMMUNICATIONS
TELEPHONES
Grady Memorial Hospital has a Northern Telecom Meridian SL
100 telephone switching system. The “SL 100” is a computerized
digital telephone system containing many desirable features such as:
conference calling, three way calling/consultation, ring again (automatic call back), call pickup, speed call, call forward busy/no answer
instructions on using this system can be found in the Grady Memorial
Hospital Telephone Directory. Telephone equipment includes Merlin
telephones, Meridian telephones and other single line instruments.
Requests for repair of all telephone instruments including pay/coin
telephones are routed to the Grady Health System Telephone Trouble
Line, dial 3-5510.
Requests for additional telephone services or relocation of service
should be addressed through the use of ISRF and sent to Information
Services Support Services Department, P.O. Box 26045.
LONG DISTANCE TELEPHONE CALLS
Key members of Administration, Medical Staff, Department Heads
and others who required to use the telephone in performing their duties have been assigned a unique A.N.I. code number to make long
distance calls.
These individuals are responsible for completing the long distance
report form each time a call is placed, using the A.N.I. system and
retaining these calling details with departmental records. These forms
are available in the Printing Department.
Other Employees and House Staff who find it necessary to place
long distance calls in performing their duties, should call the Grady
Operator, dial 0, for assistance in placing hospital related calls.
Those individuals who are assigned the unique A.N.I. code number
will be sent, monthly, a computer printout, showing calls placed and
charged to the A.N.I. account.
This report and departmental call summaries will be routed to Directors for budget report and analysis of expense. If the individual
assigned the unique A.N.I. number should determine that calls have
been placed and charged to this number by unauthorized individuals,
please call the Help Desk at 5-1715 immediately so appropriate action can be taken to correct the problem.
Individuals who want to place a direct call, a credit card or their
number billed call, you may dial these direct without going through
the Grady Operator.
Calling Cards
The procedure is: dial 9 + 0 + area code +7 digit number called. At the
prompt enter your charge card number.
To access your personal long distance carrier if other than SPRINT:
Dial 9 + 10 + XXX (company code) + area code + 7 digits + credit
card number. There is an approximate ten second delay. Please hold
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until your call is completed.
Collect Call, Third Number Billed Call or Person to Person Call
Dial 9 + 0 + 0 then wait for the Operator.
If your long distance call is for hospital business, please use the
A.N.I. number assigned by your department.
HOSPITAL-WIDE PAGING
The routine paging of doctors at Grady is handled by telephone
switchboard operators through a hospital-wide intercom system. A
doctor will be paged, for example, as “Dr. Smith, Dr. Smith, 1772.”
Immediate response should be made to a page by dialing the number
given; if no number is given the operator should be called by the
individual paged (dial “0”), and the message or call will be relayed.
Except in cases of emergency, doctors will be paged only once for
each call. When answering the telephone, the physician is asked to
identify the ward or clinic and give his name, for example, “Medical
Clinic, Dr. Smith,” or , “4-C. Dr. Smith.”
Hospital-wide alerts of emergency situations must be referred to
the Grady Telephone Operator, e.g., “Dr. G. Red,” “Dr. 99,” tornado,
man-made disaster. “Dial ʻ0ʼ.”
Announcements relating to conferences and seminars scheduled
for auditoriums and conference rooms within the Grady building will
be announced once when requested.
ALPHA NUMERIC PAGING
Certain physicians and employees, including certain members of
the House Staff, utilize a “Pocket Paging” system intercommunicating purposed within the Hospital. Grady Health Systems has two (2)
such systems. These two systems allow instant communications capabilities to selected personnel anywhere within and outside the Hospital through the use of small electronic devices known as “Pocket
Pagers”. Each unit weighs only a few ounces and is designed to fit
within the standard shirt pocket.
The paging of an individual having a pocket pager may be accomplished by using any telephone within the Hospital. Please consult
your Grady Memorial Hospital telephone directory for listings of individuals carrying pocket pagers and for instructions in dialing the
desired pager.
Additional paging over the Crawford W. Long “Simon” pocket
paging system may be accomplished by dialing “6-5500” followed
by the “ID” or “PIC” number assigned to the person you wish to
page. The system provides access via any touch tone telephone without operator assistance.
Directory information for persons listed on “PIC” numbers may be
obtained from the Crawford W. Long operator; dial 6-6003.
The Crawford W. Long pocket paging system may be dialed from
any of the five points on the tie line network (Grady Health System, Crawford W. Long Hospital, Emory University Hospital, Emory
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Clinic and Henrietta Egleston Hospital for Children).
Users are required to report all pager malfunction to the Communications Department, room B44-22.
Lost pagers must be reported to the Communication Department,
room B44-22. Lost pagers are replaced and call charged to that particular department. Periodic audits are made of the paging services at
Grady to determine that appropriate use is being made of this equipment, and that proper assignment has been made.
When House Staff members leave Grady Health System they are
asked to return Grady Health System assigned pagers to Support Services, Resource Accounting Department ext 5-1700, for inspection
and service needed before the pager is re-assigned to a new House
Staff member.
PARKING
Arrangements for parking can be made at the AAA Parking Office located on third floor of the Butler Street Parking Deck (404)
616-3769. Parking is available for members of the Medical Staff and
employees for a monthly fee.
A special card will be needed to operate the parking gate at any of
the Grady lots or decks A $10.00 deposit is required for the card and
will be refunded within three weeks after the card is turned in.
POST OFFICE AND MAIL
The Hospital Post Office is open Monday through Friday from
0800 to 1600. During this time, letters and packages may be mailed
(except packages going to foreign countries), and stamps purchased.
Money orders may be purchased up to 1600. When addressing interoffice mail, include the name and Post Office Box 252.
Number of both the sender and the address. When giving your address to someone outside the hospital, your Post Office Box Number
in addition to your name and the hospitals street address. Failure to
include the Post Office Box Number in the address of all hospital
mail may result in the delayed delivery of the mail.
All inter-office mail must be sent in the “blue” Grady envelopes.
Failure to do so may delay the processing of your mail.
A current list of Post Office Box Numbers may be obtained from
Post Office personnel. Departmental Post Office Box Numbers are
listed in the Grady Telephone Directory.
MEDICAL ILLUSTRATIONS
The Emory University School of Medicine maintains a Department of Medical Illustrations in Room G-220 of the Hospital. This
full-time operation provides services in photography. House staff
physicians are encouraged to utilize these services as valuable adjuncts to their training program
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HUMAN RESOURCES
INTERFACING WITH GRADY HEALTH SYSTEM EMPLOYEES
The Grady Health System has a long and distinguished tradition of
service to the community. We have been able to sustain this tradition
due to the dedicated service of our employees, our affiliation with
the Emory and Morehouse Schools of Medicine, and their medical
staffs and volunteers. We are committed to providing high quality
healthcare services in a cost effective manner while treating patients
with care concern and dignity. The attainment of our mission requires
a patient-focused approach to teamwork.
All patients that we serve are entitled to high quality care and services, regardless of their ability to pay. Most of our patients limited
financial resources and depend significantly on Grady Health System
for their healthcare services. Each person working in our institution
is expected to exhibit care, consideration and courtesy in dealing with
employees, patients, their families and visitors.
From time to time it may be necessary for you to interface with
the Grady Health System Human Resources organization or its components. The main office of Human Resources is currently located
in Georgia Hall which is also the original Grady Memorial Hospital
building. This building was erected around 1892. Training, Chaplaincy, and Mediation Services are all located in other buildings around
the GHS main campus. All members of Human Resources Division
are familiar with the operations in these buildings and are able to
answer any questions that you may have.
IDENTIFICATION BADGES
All employees, physicians, health care workers, volunteers and persons doing business with the Grady Health System (GHS) are required to wear a current GHS Identification Badge (ID Badge) at all
times while on the GHS premises. ID Badges are to be worn above
the waist with the picture and last name in plain view, or a non-metal
lanyard.
The wearing of ID Badges is necessary for purposes of identification, safety, security, and ensuring compliance with the Tuberculosis
Control Policy. You share a responsibility for maintaining the safety
and security of your work area.
ID BADGE ISSUANCE AND RENEWAL
ID Badges are made in Human Resources Information Systems
and Records (HRIS) Department, Monday-Friday from 0730-1700
hours except on GHS observed holidays. In general, physicians receive their ID Badge as part of their orientation process to GHS. For
physicians, GHS provides the first and all scheduled renewal badges
at no charge. GHS will assess a fee if you require a replacement ID
Badge.
Compliance with the TB Control Policy is an individual employee responsibility. For most persons compliance with the TB Policy
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means taking a PPD (Purified Protein Derivative) Mantoux method
tuberculin inoculation test and having the results documented within
48-72 hours.
It is a good practice to renew ID Badge early in the renewal month.
Persons failing to renew their ID Badge on or before the expiration
date are subject to disciplinary action through their sponsoring intuitions.
TEMPORARY AND REPLACEMENT lD BADGES
Obtaining a Temporary ID Badge: Temporary ID Badges are
valid for 24 hours only. Individuals reporting to work during the day
shift (0730 - 1700 hours) without their ID Badge must obtain a temporary badge from GHS Human Resources. Individuals must appear
in person with a valid picture ID (e.g. Georgia Drivers License or
Georgia Identification Badge) to confirm their identity and a written
request for a temporary ID badge issued by their supervisor.
Individuals reporting to work during the second and third shifts
(1700 - 0730 hours) may obtain a temporary badge from their immediate supervisor. Supervisors will not issue more than two temporary
badges per employee within a one month period.
Replacement of a Lost ID Badge: Physicians should go to the
Medical Affairs Office to get a memorandum verifying continued active affiliation with Grady Health System. This memorandum is taken
to the Employee Health Services Department to obtain a PPD Card
that verifies PPD compliance. The physician takes the memorandum
and the PPD Card to the HRIS/Records Department where they will
issue the replacement badge.
ID Badge Renewals: The physicians should have their expired or
expiring ID Badge at time of renewal to avoid an ID Badge replacement fee.
Please remember that your established identity is essential to the
safety and security of our patients, visitors, your coworkers and yourself.
OTHER IMPORTANT INFORMATION CONCERNING ID BADGES
The GHS Human Resources Division will not photograph any
person who is inappropriately attired as defined by the GHS Dress
Code.
Individuals who alter their ID Badges by changing the information on the ID Badge (e.g. changing of job titles) will be required to
replace the ID Badge and they will be assessed a fee for replacement
badge. Continued ID Badge alteration may result in revocation of
privileges.
Individuals whose appearance significantly changes since their
Badge was issued or whose picture does not represent a likeness adequate for identification purposes may be asked by their department
head or Security to obtain a new ID Badge. No charge will be assessed for ID Badge replacement under these circumstances.
All persons must surrender their ID Badge upon termination their
assignment with the Grady Health System. These ID badges should
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be turned in to the Medical Affairs Department. The Medical Affairs
Department should send the badges of terminated medical staff to the
HRIS/Records Department.
CHAPLAINCY SERVICES
In keeping with the mission of the Grady Health System, the Department of Chaplaincy Services is committed to a holistic approach to
caring and healing. Pastoral care and support is offered without reference to age, culture, ethnicity, gender, race and religious affiliation.
Chaplains are available to provide spiritual care to patients, families
and staff. Services offered include:
Direct Spiritual Care: Chaplains are available to patients, families and staff on a 24-hour a day basis. Their primary role and function is to provide caring, compassionate, empathic care.
Bereavement Care: Chaplains are available to assist families and
staff in the grieving process.
Crisis Ministry and Counseling: Chaplains are available to staff
as a resource in times of crisis. Short-term individual counseling help
with personal and/or professional issues, as well as grief counseling
and support groups are offered. Referral for long term counseling is
also available.
Religious Ceremonies: Chaplains are available to patients, families and staff to offer religious ceremonies, i.e., weddings, memorial
services, funerals, baptisms, communion and worship. The Goddard
Memorial Chapel, located on the first floor of the hospital (1A), is
open every day from 7 am to 11 pm for prayer meditation. Each
Sunday morning at 0930, a worship service held in the Chapel for all
patients, families and staff. Services for our Roman Catholic, Jewish
and Muslim populations are available upon request. Chaplains are
also available to assist patients and families in contacting clergy from
their particular faith groups.
Staff Consultation and Training: Chaplains are available as an
educational resource for staff. They are trained in the areas of Crisis Intervention, Death and Dying, Grief and Spiritual Assessment.
Chaplains are available to consult with staff as well as provide training on any of the above areas.
To reach a Chaplain, please call 616-4270 or page the On-Call
Chaplain at 404-703-1670. To reach Staff Chaplains assigned to specific areas in the GHS please call their individual pagers listed below:
HSCH
404-283-5866
ECC
404-650-7371
IDP-CLINIC
404-896-0423
lDP-MAIN HOSPITAL 404-570-1740
CRESTVIEW
404-650-7384
Chaplaincy Services is a joint venture between Grady Health System and Georgia Association For Pastoral Care.
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PUBLIC AFFAIRS
Vice President
5-8754/4831
NEWS MEDIA
Report all news media inquiries and contacts to the Corporate
Communications Department (5-7080), which is designated and authorized by the Grady Health System to clear all information released
outside of Grady Health System and to designate a spokesperson for
each inquiry. No one shall interact with the news media at a Grady
Health System facility or on behalf of the Health System without prior authorization by Corporate Communications. Types of new media
inquiries that must be referred to Corporate Communications include,
but are not limited to:
a. Inquiries on patients, including condition reports.
b. Request by news media to interview house staff or Grady employees.
c. Requests to film, video tape, photograph or sketch within Grady
facilities or on Grady property.
d. Requests by news media for Grady Health System documents,
reports, records or magnetically recorded data.
PUBLICATIONS
All publications (brochures, flyers, books, newsletters, banners, Tshirts, web pages or postings, etc.) which may be distributed to external audiences outside the Grady Health System must be approved by
Corporate Communications prior to production. Contact Corporate
Communications at 5-7080 for specific details.
Additionally, Corporate Communications produces the following
publications for Grady Health System at no cost to staff and employees.
a. Inside Grady: Published weekly and includes news and useful
information about Grady Health System policies and employees.
b. Hugheyʼs News: A publication published for and in the interest
of pediatric patients of Grady Health System.
c. Grady Matters: A publication published for and in the interest
of primary care promotions and patients.
d. Annual Report: Published each year and includes important information and highlights of Grady Health System for the previous 12 month period.
e. Brochures: Several brochures are available through the Public
Affairs Division that detail the various services and programs
provided by the Grady Health System.
TOURS: Distinguished Visitors / General Public
All inquiries for tours of any Grady Health System facility must
directed to Community Affairs (5-1698).
Prior to inviting a distinguished visitor to Grady Health item, authorization must be obtained from Community Affairs which will co-
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ordinate and obtain approval for the visit from the Chief Executive
Officer of Grady Health System. Coordination of visits and tours by
distinguished visitors, including establishing the agenda, providing
escorts, and coordinating executive team involvement, is the responsibility of Community Affairs.
Requests for tours of inpatient and patient treatment areas by elementary, middle, and high schools will normally not be granted as
an epidemiology safeguard for Grady Health System patients. Tour
groups will generally be limited to not more than 15 persons per site
visited.
VOLUNTEER SERVICES
Volunteers are assigned to assist patients and staff in a variety of
areas throughout the Grady Health System and its outlying facilities.
Volunteers perform non-medical duties as designated by volunteer
job description under the supervision of an assigned area supervisor.
All persons functioning as volunteers must be registered through
Volunteer Services (5-4360). Volunteers complete an application process and screening, go through a volunteer orientation and are assigned specific duties. Volunteers are issued I.D. ages to be worn at
all times while on duty, as well as, volunteer jackets (in most areas)
for identification.
Requests for volunteers should be placed with Volunteer Services (5-4360). Requests for community organization group activities
should be made in the same manner.
DEVELOPMENT AND CHARITABLE CONTRIBUTIONS
All charitable contributions and fundraising activities are managed
for the Grady Health System by the Development Office (5-6216).
All proposals for fundraising activities must be approved by the Henry W. Grady Foundation Board of Directors prior to implementation.
The Henry W. Grady Board of Directors is the only Grady Health
System entity authorized to seek charitable contributions of funds,
services or goods, from agencies and organizations outside the Grady
Health System.
PHOTOGRAPHY AND VIDEO RECORDING
No patient will be photographed without the written authorization
of the patient or their legal parent or guardian. Video recording of
patient care is strictly prohibited, and shall only be permitted for educational or teaching purposes.
Cameras and video taping equipment are prohibited inside the facilities of Grady Health System except for those approved by Public
Affairs and Media Services staff members in the performance of their
official Health System duties, or by external news media when prior
approval has been granted by Grady Health System administration
and under escort by members of the Public Affairs staff.
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MANAGED CARE DEPARTMENT
The Managed Care Department will create, establish and maintain
relationships with the payor community. This effort will help secure
agreements with commercial and medicaid insurance payors to successfully position the Health System in the managed care arena. This
initiative will entail marketing the Health System and its services to
the general public.
The Hospitalʼs Centers of Excellence, Neighborhood Health Centers, Hughes Spauldings Childrenʼs Hospital, Emergency Center, Infectious Disease Center, Crestview Health and Rehabilitation Center
and its affiliations with Emory School of Medicine and Morehouse
School of Medicine will be used as marketing strategies to attract
new and more commercial business to the Health System.
To ensure consistency of information provided, the Managed Care
Department will act as liaison between the insurance plans and the
Health System and its services.
• Successfully position Grady Health System in the Managed
Care arena
• Establish the Health System as a managed care player in the
Metropolitan Atlanta area
• Help market its services to the Commercial Managed Care market place
• Develop a comprehensive corporate identity to attract major
HMOs
• Develop and implement new strategies so that the Health System can thrive in the Managed Care environment
• Market the Health Systems Specialty Care Services and Medical
Care Centers of Excellence
• Help to improve the public perception of the Health System to
attract new business
• Facilitate contracts with existing Commercial lines of Managed
Care Business
• Create and Establish business relationships with the payor community
• Act as a liaison between contracted HMOs and insurance plans
SECURITY SERVICES DEPARTMENT
The Security Services Department will provide escort service
within the Hospital, to and from your car in a parking lot, and to and
from the dormitories. Call the Security Dispatcher at extension 54024.
Telephone Numbers:
911# - Emergency only (life threatening or serious
property damage)
5-4024 - Non-Emergency
5-4100 - Patient Valuables Office, E1203 - Patient valuables
and Lost and Found
5-8832 - Security Administration located in the old Annex
5-8837 - Access Cards - Annex
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Hospital Entrances and Exits:
Doors opened all hours –
Butler Street Clinic Atrium Entrance
Pratt Street Main Entrance
Ambulance Ramp Emergency Doors
ECC Waiting Room Entrance
All other entrances are closed/alarmed from 2100 to 0630
Pratt Street Clinic Entrance
REPORTING SECURITY INCIDENTS
Please assist the Security Services Department with our Loss Prevention and Risk Management Programs by contacting our department when you observe any security breaches.
You may report incidents in the following manner:
Dial 911# for emergencies.
Dial 5-4024 for routine and non-emergency calls
Report to any uniformed GHS officer.
Examples of incidents to report include but are not limited to:
Accident
Arson
Assault
Blackmail
Bribery
Burglary
Complaints
Computer Crime
Disaster
Drug/Alcohol
Ethics Violation
Fire
Forgery
Fraud
Hate Crimes
Hazardous Materials
Homicide
Kidnapping
Larceny/Theft
Phone Incidents
Property Control
Rape/Sexual Assaults
Robbery
Security Alarms
Sexual Harassment
Suicides
Threats
Trespassing
Vandalism
ACCESS CONTROL
Access Control refers to the systemʼs ability to allow approved
people to pass through certain doors at certain times and to stop the
access of unauthorized persons to secured areas. Each card is encoded with its own unique identification number. When the card is issued
to an individual, the person is responsible for all activity on the card.
All employees requiring access into sensitive area(s) must complete and sign an access card application and have it approved by
their Department Head, Clinical Manager, or Administrator.
One access card is issued to each approved employee. The card
will be activated for both Parking and Hospital Access. Parking and
Motor Services will activate your card for parking access and the
Security Services Department will activate your card for Hospital access.
257
Note: All parking access cards with the exception of Dormitory
Access Cards, will be issued by Parking and Motor Services, located
on the 3rd Floor of the Butler Parking Deck.
The Security Services Department will continue to issue Dormitory Access Cards. Employees should submit their completed/approved Dormitory Card Access Control Agreement, which can be
obtained from Personnel Quarters, along with a $10.00 deposit to
the Security Services Department.
A Few Doʼs:
• Attach the access card to your I.D. Badge or secure it in a safe
place, such as a wallet or purse.
• Hold card approximately six inches from the card reader. When
light changes from red to green, you may enter.
• If your card is lost or stolen, report it to Security Services at 54024, and Parking & Motor Services at 5-3765 immediately. The
card will be deactivated so no one else can use it. There will be a
$10.00 replacement fee for a lost or stolen card.
A Few Donʼts:
• Do not allow unauthorized people to follow you (tailgate) through
a locked door.
• Do not use a key on access controlled doors. This causes a forced
entry alert. Always use your assigned access card.
• Do not carry your access card on a key ring. This damages the
card.
• Do not allow others to use your cards.
• Cards should not be taken into the Imaging Center as this will damage the card.
Lost and Found Services
Items can be turned in or retrieved at Room E1203 between the hours
of 0630 and 2300 seven days a week. Be prepared to present proper
identification when retrieving personal property. You may direct to
this office patients and visitors who are seeking lost items or attempting to surrender found items.
POLICIES AND PROCEDURES REGARDING ABUSIVE/
VIOLENT PATIENTS AND VISITORS
PHILOSOPHY AND POLICY:
The Fulton-DeKaIb Hospital Authority d/b/a Grady Health System
strives to assure a safe environment for its patients, visitors, and employees. The physical safety of its patients and personnel is a major
priority of the Hospital in planning patient care. Toward this end, the
following procedure is to be followed in the case of an abusive/violent patient or visitor.
258
PROCEDURE:
Abusive/Violent Visitor (Guest)
If at any time a visitor and/or guest of the Hospital is either verbally or physically abusive toward any employee, patient, or other
visitor, the Security Service Department (extension 911#) should be
contacted immediately. Security Service Department will take any
and all appropriate action including contacting any outside entities,
such as the Police Department. In addition, the supervisor for the area
where the incident took place should be contacted and appropriate
documentation of the incident should be completed.
Abusive/Violent Patient:
If at any time a patient is physically or verbally abusive the following actions should be taken:
1. Security (extension 911#) must be notified immediately if assistance is needed, particularly with regard to physical abuse.
2. Every effort should be made to deal with the patient without physical force.
3. One employee (preferably a supervisor), if at all possible, should
determine and control how the patient should be dealt with.
4. The patientʼs attending physician (or his/her designee) shall be notified of the patientʼs abusive behavior and shall be involved in
determining what actions or disposition is appropriate.
5. Appropriate assessment of the patient should be made to determine the potential cause(s) of the patientʼs behavior, i.e., alcohol
abuse, drug abuse, personality or psychiatric disorders, retardation,
emotional upset, etc. Appropriate emergency medical intervention
should be made if necessary, including notifying Psychiatry, the
Chaplainʼs office, etc.
6. With regard to individuals who may be exhibiting personality and/
or psychiatric disorders, Psychiatry should be notified immediately.
7. Restraints should be applied in accordance with Hospital protocol
when necessary to prevent the patient from injuring himself or others.
8. The supervisor for the area must be notified immediately.
9. Appropriate documentation of the incident should be completed as
soon as possible including documentation in the patientʼs medical
record and completion of appropriate incident reports.
Verbal abuse or physical abuse which occurs to an employee while
acting within the scope of his (her) employment, he (she) must notify
his (her) supervisor immediately. The supervisor shall discuss with
the employee what additional action shall be taken in response to the
alleged abuse, including notifying the Police Department. Any and
all initial contact with the Police Department or any outside entities
with regard to any abusive patient or visitor shall be made by the
Security Department, in consultation with the area supervisor and the
employee, subsequent to a discussion with the employee(s). If any
employee files criminal charges against a patient or visitor, he (she)
must notify his (her) supervisor and Security immediately. Security
will subsequently notify Administration.
259
Nothing in this procedure is intended in any way to interfere or
prevent any employee from exercising his (her) rights, including the
filing of criminal charges.
SMOKING AND EATING
Eating is allowed only in certain areas of the Hospital. Members
of the House Staff will refrain from consuming food or beverages in
clinics, wards, elevators, or in any unauthorized places where they
may come in contact with patients or visitors. No smoking is allowed in any Grady Health System facility except Crestview Nursing
Home.
SUBPOENAS
A subpoena is a command by authority of the courts to appear at
a certain time and place to give testimony. Subpoenas are usually
issued by the countyʼs district attorney for testimony in court, but
may also come from the public defenderʼs office, juvenile court, or a
private attorney. Generally subpoenas relate to treatment issues associated with criminal matters such as assaults, child abuse, rape, drunk
driving, and civil matters, such as auto accidents, work-related injuries, slip and falls, etc. In that a subpoena is a court order, sanctions
may be imposed if you fail to appear when requested.
Normally subpoenas must be served in person or by certified mail
or, if you are a party to a lawsuit, through your attorney. However, as
a convenience to the House Staff, the Office of Legal Affairs of the
Grady Health System will accept subpoenas on your behalf that relate
to care and treatment rendered at Grady, unless the date of appearance
is less than two (2) business days from the date of service. In these
cases, you may expect to be served personally or have the subpoena
mailed to your home or office.
Upon receipt of the subpoena the Office of Legal Affairs will attempt to contact you to arrange for you to obtain the subpoena. If
you receive a call or message from the Office, please respond immediately in that your court appearance may be imminent. It is important to note, that subpoenas may be served within twenty-four (24)
hours of the date of the requested appearance, thus time is often of
the essence. In addition, to the extent possible, the Office will obtain
the pertinent medical records from the Medical Records Department
for your review. Please ensure that you thoroughly review the record
prior to your court appearance.
Upon receipt of your subpoena, the Office of Legal Affairs will
contact the issuing attorney at the phone number noted. The General Counselʼs office will ask for an explanation of the circumstances
of the case and the patientʼs name, date of birth, and Grady Health
System medical record number, to retrieve the records. The Office
of Legal Affairs will attempt to have you placed “on call”. If the attorney agrees to place you “on call” this will still require your attendance at court, but only if you have been first contacted by the
requesting attorney on the date of your scheduled appearance. This
means although you will not have to appear at court until called upon,
260
you will have to keep your calendar flexible in the event that you are
called upon to testify. You will also need to provide the attorney with
a telephone number and/or beeper number(s) where you can be contacted. Whenever possible, the Office of Legal Affairs will obtain this
information for you and have you placed “on call” before you pick up
the subpoena.
Pursuant to Georgia Law you may be entitled to a witness fee of
$10.00 a day. Furthermore, if the subpoena is issued by the State, i.e.,
the solicitor or a district attorney, the defendant in a criminal case, or
the juvenile court a witness fee does not have to be tendered. If the
subpoena is issued in a civil case, payment of the witness fee should
be made by the attorney requesting the testimony.
If the subpoena is for a civil trial, out-of-county, the subpoena
should be accompanied by the witness fee and a fee at the rate of
twenty cents (.20) a mile. In the event you are subpoenaed for a deposition in a civil case, please immediately contact the Office of Legal
Affairs, (404-616-6162) and arrange to come by and meet with a staff
attorney to discuss your testimony. The staff attorney will at that time
review the process of a deposition, and prepare you to provide testimony.
You may also be asked to provide expert opinion or testimony in a
case, i.e., you may be asked to render an opinion as to the nature or
circumstance of a patientʼs care and treatment although you are not
a party to the lawsuit or a factual witness. If you agree to serve as an
expert witness, the attorney should compensate you for same and you
should arrange for payment with the requesting attorney.
On the day of your court appearance report to the appropriate
courthouse and the courtroom as indicated on your subpoena. If necessary, please call the applicable court for directions.
If you have any questions or concerns about any subpoena, including issues with regard to the care and treatment rendered to the patient in question, or if you have any general questions about the litigation process or the court system, please contact the Office of General
Counsel at 404-616-5147 or beeper 1-888-774-6948 or the Director
of Risk Management at 404-616-7747 or beeper 404-415-6998. Also,
if it is your first time testifying, please contact the General Counsel to
discuss your testimony and the litigation process.
VISITING HOURS
The patient is the individual for whom preventative, curative, palliative, supportive or restorative care is provided. The family and
significant others are those individuals who are in a position to be
influential in the patientʼs health and who are directly affected by the
patientʼs condition and its management. We encourage visitors who
are very important to the health and well-being of our patients.
Most patients will be allowed to have two visitors at a time. Grady
Memorial Hospital has established the following visiting hours.
1. Medical, Surgical and Pediatric Inpatient Area – 1100 - 2030
2. Intensive Care Units, Intermediate Care Units, the Burn Center and
Special Care Nurseries – The time and number of visitors may vary
with each unit. Visitation time may be canceled for a particular pe-
261
riod of time if it is felt to be in the best interest of all patients. This
practice is done to protect the privacy of the patients during special
procedures.
3. Obstetrics – 1100-2030
When infants are brought to the motherʼs room, one significant
other may remain in the room. Other visitors are required to leave
the area. The only exception is the rooming where the one significant other may remain until 2200.
4. Psychiatry – 1630-2030
No visitors will be allowed during the first 24 hours after admission. Visitors for 13B patients will be allowed to wait in the waiting room while the patient is being assessed.
5. Emergency Clinics patients have individualized visiting hours.
ECC – When the patient is initially assessed by the physician and
nurse upon entering the clinic, this assessment will include a determination of whether a family member or other visitor should
remain with the patient in the treatment area. The decision will
be communicated to the patient and the individual(s) accompanying the patient.
No more than one visitor may remain with a patient in the
clinic, unless otherwise approved by the Charge Nurse. When a
visitor is asked to wait outside the clinic, staff will tell the visitor
how to obtain information about the patient. Visitors will wait in
the ECC Clinic waiting area.
PEC – parents and significant others are encouraged to remain with
their child, preferably only two visitors at a time. PEC visitors
are usually allowed to wait in PEC but any overflow will return
to the Butler Street Lobby or Clinic waiting room depending
upon the time of day. GEC visitation is specifically assessed by
the charge nurse. Visitors will wait in the Butler Street waiting
room.
6. Ambulatory Clinics including Walk-In Clinic – In selected clinics
visitors may be asked to wait in other designated waiting areas. We
encourage patients to use the free Grady Child Care Center.
VISITOR BADGES
Color coded visitor badges are issued by Security after the 2030
visiting hours.
When the 2030 visiting hour has ended the operator will announce
that visiting hours are over.
If after a reasonable length of time the visitors do not leave, the
nursing staff will ask all visitors to leave the area. If visitors still do
not leave, Security will ask all visitors to leave the area. The nurse
will explain the situation to the security officer, and he in turn will
request the visitors to leave. If visitors on the patient areas should
become belligerent or appear to be intoxicated, Security should be
called to accompany the nurse in asking those visitors to leave the
patient care area. The nurse should never attempt to remove persons
in this condition without the assistance of Security.
Anyone remaining on the area or in a waiting room adjacent to a
patient area must have a visitor pass. The charge nurse has the author-
262
ity to issue these passes which are color coded by floors. Each request
for a pass should be individually assessed to determine if the after
hours visitation will be beneficial for the patients. The charge nurse
should consult the supervisor if there is a question regarding the after
hour pass.
Only two visitors per patient will be allowed to receive passes.
Passes will be valid from (0830-1100) for the date listed on the card
only.
Unauthorized persons found in the hospital without a visitor pass
will be asked by Security to leave the hospital.
EMORY HOUSE STAFF AUXILIARY
The Auxiliary is a non-profit charitable organization comprised of
spouses of House Staff at the Emory University Affiliated Hospitals.
The principal purpose of the Auxiliary is to provide charitable support to the various hospitals and through the encouragement of activities in support of the Hospital and fund raising activities to provide
for developing a relationship among the spouses of the House Staff
and also to acquaint these spouses with the various hospitals. The
Auxiliary conducts social activities for the purpose of raising funds
for the various hospitals. Participation in the Auxiliary provides an
opportunity for spouses to feel more welcome in the affiliated hospitals community.
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GHS® HOUSE STAFF MANUAL
UPDATE SHEET
Please submit this sheet with your revisions. Send to Box 26088.
To update an existing section:
• photocopy the section
• make your corrections on the photocopy, OR
• attach a typewritten copy of the revisions
For information regarding how to add sections, please call 5-4262.
Title of Section: _________________________________________
Page(s): _______________________________________________
Submitted by:
Name: _________________________________________________
Title: __________________________________________________
Department: ____________________________________________
Telephone #: ____________________________________________
264
Index
A
Abortion, Consent For . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Abusive/ Violent Patients And Visitors . . . . . . . . . . . . . . . . . . . . .258
Access To Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Access To Medical Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Administration Of Blood Or Blood Components . . . . . . . . . . . . . .31
Administrative Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Admission Of Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Advance Directives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Advance Directives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Adverse Drug Reaction Surveillance And Reporting . . . . . . . . . . .12
Advice Nurse Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Appeals Review Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Appointment Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Asthma/allergy, Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Arrest, Emergency Response To Cardiac . . . . . . . . . . . . . . . . . . .161
Authorization For Autopsy Form . . . . . . . . . . . . . . . . . . . . . . . . . .45
Autopsy/post-mortem Examinations . . . . . . . . . . . . . . . . . . . . . . .42
B
Blood And Body Fluid Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Body Fluid Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Bomb Threats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Brain Death, Definition Of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Business Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
C
Call Rooms Assignments - Doctorsʼ Lounge . . . . . . . . . . . . . . . .243
Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Cardiac Function (Exercise) Laboratory . . . . . . . . . . . . . . . . . . . .238
Cardlac Catheterization Laboratory . . . . . . . . . . . . . . . . . . . . . . .239
Care Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Case Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Central Sterile Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Certificate Of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Chaperones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Chaplain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Chaplaincy Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253
Classification Of Urgency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Clinical Engineering Department . . . . . . . . . . . . . . . . . . . . . . . . .158
Clinical Staff Pharmacists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155
Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Clinics, Ambulatory Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Complaints, Resolution Of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Concurring Physicianʼs Statement . . . . . . . . . . . . . . . . . . . . . . . . .69
Confidentiality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
265
Confidential Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Consent For Dnr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Consent for DNR by Authorized Person Form . . . . . . . . . . . . . . . .68
Consultations, Inpatient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Consultations, Outpatient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Consultation With Specialists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Corporate Compliance And Ethics Program . . . . . . . . . . . . . . . . . .13
Crestview Health & Rehabilitation Center . . . . . . . . . . . . . . . . . .153
Crisis Intervention Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
D
Dead On Arrival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Death, Certificate Of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Deaths, Fetal And Neonatal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Deaths/processing Of Death Papers . . . . . . . . . . . . . . . . . . . . . . . .47
Deaths In The Emergency Care Center (Ecc)
Or Ambulatory Care Areas . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Dekalb County Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Department Of Patient Advocacy . . . . . . . . . . . . . . . . . . . . . . . . .151
Department Of Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217
Development And Charitable Contributions. . . . . . . . . . . . . . . . .255
Dining Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243
Discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Discipline And Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Dnr Candidacy Certification Form . . . . . . . . . . . . . . . . . . . . . . . . .70
Doctorsʼs Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Doctorsʼ Lounge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243
Doma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Donation, Organ And Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Do Not Resuscitate: Policy Statement . . . . . . . . . . . . . . . . . . . . . .57
Drugs And Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155
Drug Information Center (Dic) . . . . . . . . . . . . . . . . . . . . . . . . . . .155
Durable Power Of Attorney For Healthcare . . . . . . . . . . . . . . . . . .80
E
Eeg/emg Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239
Effective Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Ekg Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .238
Emergency Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Emergency Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
Emergency Phone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Emergency Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
Emergency Response To Cardiac Arrest . . . . . . . . . . . . . . . . . . . .161
Emory House Staff Auxiliary . . . . . . . . . . . . . . . . . . . . . . . . . . . .263
Employee Health Services (Ehs) . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Endoscopy Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Errors, Possible Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Ethics Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Exposure, Blood And Body Fluid . . . . . . . . . . . . . . . . . . . . . . . . . . .9
External/internal Disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
266
F
Fetal And Neonatal Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Fetal Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Fire 5, 160
Fiscal Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Fulton County Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
G
General House Staff Responsibilities . . . . . . . . . . . . . . . . . . . . . . .15
General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
General Responsibilities And Information . . . . . . . . . . . . . . . . . .242
Georgia Sickle Cell Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Georgia Statutory Short Form, Page 1 . . . . . . . . . . . . . . . . . . . . . .82
Georgia Statutory Short Form, Page 2 . . . . . . . . . . . . . . . . . . . . . .83
Grady Branch Library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .245
Grievance Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Guidelines For Obtaining Autopsies . . . . . . . . . . . . . . . . . . . . . . . .47
H
Health Outcomes Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141
Health Services (Ehs), Employee . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Hiv Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Home Health Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153
Hospice Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
House Staff Auxiliary, Emory . . . . . . . . . . . . . . . . . . . . . . . . . . . .263
Human Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250
I
Identification Badges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .251
Identification Numbers, Physician . . . . . . . . . . . . . . . . . . . . . . . . .15
Incident Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200
Information, Confidential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Information Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Informing Patients And/or Families Of
Unanticipated/unexpected Outcomes Of Care
And/or Possible Medical Errors . . . . . . . . . . . . . . . . . . . . . . .39
Injury Free Coalition For Kids . . . . . . . . . . . . . . . . . . . . . . . . . . .143
Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244
Interpreters, Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
Items That Are Exempted From
Surgical Pathology Examination. . . . . . . . . . . . . . . . . . . . . . .41
L
Laboratory Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
Language Assistance Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Library, Grady Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .245
Living Wills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78
267
Living Will Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
Long Term Care Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153
M
Mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250
Managed Care Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .256
Medical Device Reporting Program . . . . . . . . . . . . . . . . . . . . . . . . 11
Medical Ethics Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Medical Examiner Cases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Medical Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250
Medical Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
Medical Staff Services Department . . . . . . . . . . . . . . . . . . . . . . .162
Medication Clarification Orders . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Medication Error Surveillance Reporting . . . . . . . . . . . . . . . . . . . .12
Medicolegal Clearance Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Multicultural Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
N
Neighborhood Health Centers Network . . . . . . . . . . . . . . . . . . . .131
Neighborhood Health Center Directory . . . . . . . . . . . . . . . . . . . .132
Neighborhood Health Center Pharmacies . . . . . . . . . . . . . . . . . . .132
Neonatal Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Nephrology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240
News Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254
O
Observation Guidelines/requirements . . . . . . . . . . . . . . . . . . . . . . .23
Observation Record Documentation . . . . . . . . . . . . . . . . . . . . . . . .22
Observation Services Not Covered . . . . . . . . . . . . . . . . . . . . . . . . .23
Observation Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Oral Surgery Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240
Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Organ And Tissue Donation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
P
Parking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250
Participation In Planning Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Patientʼs Leave Of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Patients, Admission Of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Patient Advocacy, Department Of. . . . . . . . . . . . . . . . . . . . . . . . .151
Patient Condition Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . .191
Patient Consent Form For Dnr . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Patient Diets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192
Patient Transfers To Other Facilities . . . . . . . . . . . . . . . . . . . . . . . .27
Patient Transport Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
Pediatric Social Services Department . . . . . . . . . . . . . . . . . . . . . .151
Peer Review Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
Pharmacies, Neighborhood Health Center . . . . . . . . . . . . . . . . . .132
Pharmacists, Clinical Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155
268
Pharmacotherapy Consult Clinic . . . . . . . . . . . . . . . . . . . . . . . . . .18
Pharmacy Telephone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . .156
Photography And Video Recording . . . . . . . . . . . . . . . . . . . . . . .255
Physician Identification Numbers . . . . . . . . . . . . . . . . . . . . . . . . . .15
Plant Operations Department . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
Poison Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Possible Medical Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Post-mortem Examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Post Office And Mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250
Power Of Attorney, Durable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
Prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Privacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Professional Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254
Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254
Pulmonary Function Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . .239
Q
Quality Management Department . . . . . . . . . . . . . . . . . . . . .146, 147
R
Radiology, Department Of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217
Rape Crisis Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
Referral/resource Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Refusal Of Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Requesting An Autopsy From Legal Next-of-kin . . . . . . . . . . . . . .46
Resolution Of Complaints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Respect, Dignity And Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Response To The Brain Dead Patient . . . . . . . . . . . . . . . . . . . . . . .53
Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Responsibilities, General House Staff . . . . . . . . . . . . . . . . . . . . . .15
Responsibilities, Professional . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Resuscitate, Do Not: Policy Statement . . . . . . . . . . . . . . . . . . . . . .57
Rules And Regulations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
S
Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160
Sample Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244
Seclusion Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Smoking And Eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .260
Social Worker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
Spanish Health Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Staff, Administrative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Sterilization, Consent For . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Stillbirths/fetal Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Support Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
Surgical Pathology Examination. . . . . . . . . . . . . . . . . . . . . . . . . . .41
269
T
Telecommunications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .248
Terminal Patients, Guidelines For Medical Care . . . . . . . . . . . . . .56
Tornado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Tours: Distinguished Visitors / General Public . . . . . . . . . . . . . . .254
Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Transfers To Other Facilities, Patient . . . . . . . . . . . . . . . . . . . . . . .27
Treatment, Consent For. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Treatment, Refusal Of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Triage Center. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
U
Unanticipated/unexpected Outcomesof Care . . . . . . . . . . . . . . . . .39
Urgency, Classification Of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Utilization Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
Utilization Review Coordinator . . . . . . . . . . . . . . . . . . . . . . . . . .140
V
Visiting Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261
Visitor Badges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .262
Volunteer Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
W
Wills, Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78
Womenʼs Social Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
Y
Your Rights As A Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
270
271
272