Overall approach
Page 3
Page 3 Content
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STRUCTURED ON-CALL CLINICAL PROBLEM SOLVING – DETAILED SYSTEM
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│ STAGE │ FOCUS │
├────────────────────┼───────────────────────────────────────────────┤
│ 1. Phone Call │ ⚫ First point of contact for most problems. │
│ │ │
│ │ ➤ Assess urgency without seeing the patient. │
│ │ ➤ Prioritize patient evaluation. │
│ │ ➤ Structure: │
│ │ 1. Questions – Clarify problem & urgency │
│ │ 2. Orders – Immediate investigations/treatment│
│ │ 3. Inform RN – ETA & interim instructions │
├────────────────────┼───────────────────────────────────────────────┤
│ 2. En route DDx │ ⚫ Use travel time wisely (e.g., walking, │
│ │ elevator) to form a mental differential. │
│ │ │
│ │ ➤ Identify serious or common causes. │
│ │ ➤ Focus on what is likely and what is deadly. │
│ │ ➤ Helps guide questions and exam at bedside. │
├────────────────────┼───────────────────────────────────────────────┤
│ 3. Major Threats │ ⚫ Pinpoint the most immediate life threats. │
│ to Life │ │
│ │ ➤ Consider differential, but prioritize 1–2 │
│ │ key threats. │
│ │ ➤ Direct early evaluation around these. │
│ │ ➤ Ensures life-threatening conditions are not │
│ │ missed or delayed. │
├────────────────────┼───────────────────────────────────────────────┤
│ 4. Bedside │ ⚫ In-person focused assessment and action. │
│ │ │
│ │ ➤ Steps (may vary in order): │
│ │ • Quick-look test – Visual status (well/sick│
│ │ /critical) │
│ │ • Airway & vitals – Immediate safety check │
│ │ • Selective history – Targeted questions │
│ │ • Selective physical exam – Directed exam │
│ │ • Selective chart review – Key data only │
│ │ • Management – Prioritize critical actions │
│ │ ➤ Some steps may be skipped or reordered │
│ │ based on clinical need │
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