Rules & Regulations of the Medical Staff

	1.5	The Medical Executive Committee will establish policy for the framework for the decision-making process in determining levels of care.
	1.6	Judgment as to the serious nature of the (patient's) illness and any question of doubt as to the diagnosis and treatment rests with the practitioner responsible for the care of the patient and the department chairperson or designee.
	1.7	All members of the Medical Staff shall attend to emergencies within a timeframe appropriate to the particular emergency. Response times to emergencies specific to individual departments or services may be established by those departments or services with the approval of the Medical Executive Committee. (This does not apply to consultations called by the Emergency Department physician – see Consultations 3.2(e).)
ADMISSIONS / DISCHARGES
	2.1	The care of all patients in the Medical Center shall be managed and coordinated by a physician, oral and maxillofacial surgeon or podiatrist holding appropriate privileges, subject to the standards of care as maintained by the Chairperson of each department and within limitations imposed by the Board of Trustees after consideration by the Medical Executive Committee.
		2.1(a)	Exceptions to the attendance by the patient's physician, oral and maxillofacial surgeon or podiatrist may occur under the following circumstances.
				When the physician, oral and maxillofacial surgeon or podiatrist delegates responsibility to another in writing on the patient's chart;
				When the physician, oral and maxillofacial surgeon or podiatrist is regularly associated in practice with one or more other physicians, such other physicians may attend the patient during the primary admitting physician's absence.
				When the physician is temporarily unavailable due to an emergency.
				Until or unless their own practitioner is present, Emergency Department patients are the responsibility of the Emergency Department attending physician.
				In rare and exceptional situations where professional administrative decisions dictate otherwise.
	2.2	Physicians, oral and maxillofacial surgeons and podiatrists requesting admission of any patient shall provide a provisional diagnosis, which is consistent with a need for care in an acute care hospital. The practitioner shall be given such other information as may be necessary to protect other patients already in the Medical Center from patients who are or may be a source of danger from whatever cause.
		2.2(a)	Emergency patients may be admitted without the above required data, but the attending staff member must finish said data within 24 hours after admission of the patient.
				An emergency patient shall be defined as one whose condition is such that any delay in initiating care could compromise the well-being of the patient.
	2.3	Hospitalized patients shall be seen by the attending or physician at least once daily or every other day if there is clinical justification, which is documented in the medical record. A chronological pertinent progress note shall accompany each visit.
	2.4	A patient may be discharged only on written order of the attending physician, oral and maxillofacial surgeon or podiatrist, except when the patient or the patient's representative signs a legal release and leaves the hospital at his own request but against advice
	2.5	The transferring physician will give a verbal report to the accepting physician prior to patient transfer, allowing time for questions. The transferring physician shall complete a transfer-of-care document prior to transfer.
CONSULTATIONS
	3.1	Consultations shall be in conformity with defined medical staff privileges and shall be available for all patients when needed and requested 3.2 All consultations must be dictated into the HMC Dictation System
	3.3	It shall be the duty of the Vice President of Medical Affairs through the department chairperson and the Medical Executive Committee to see that other members call for appropriate consultations.
		3.3(a)	All consultations shall be performed as set forth in the Medical Staff Bylaws. A satisfactory consultation shall include an examination by the consultant who shall record it as part of the patient's record.
		3.3(b)	When operative procedures are involved, the consultation note, except in an emergency, shall be recorded prior to the operation.
		3.3(c)	In circumstances of great urgency or where consultation is required by the rules of the hospital, the department chairperson shall have the right to call in a consultant.
		3.3(d)	Psychiatric consultation and treatment is recommended, and shall be made available to all patients who have attempted suicide or taken a chemical overdose. Documentation of this action shall appear in the medical record.
		3.3(e)	The Medical Staff shall maintain an on-call list of appropriate physicians for all patients who require emergency department treatment or admission to the hospital. Consult requests shall be considered either routine or emergent.