https://drive.google.com/file/d/1-44Xd092jwKrZ2f5GU01D9UQ7kI4Xi6c/view

UHN-wide highlights: "Bounce back" within 14 days: Last service prior to discharge, excluding acute critical illness requiring alternative specialty management (make almost no exceptions; should be staff conversation before accepting. Tell (especially the surgeons) that if urgent, I can ask my staff about a med consult overnight, and we can have to Med Consults in the AM. Remind the surgeon that we are unable to monitor for many post-op complications. Decompensated heart failure known to UHN/SH Heart Failure Clinic: Cardiology

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Note that Decompensated heart failure is for both UHN and Sinai

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Pelvic/Lower extremity fractures impairing ambulation: Orthopedics Facial**/Upper extremity cellulitis**: Plastic Surgery Dialysis-related issues: Nephrology Dialysis-dependant patients with general medical issues: GIM Lower gastrointestinal bleeding: General Surgery Pancreatitis: GIM if alcohol-related Post-transplant Patient: Transplant

Expectations to call staff: Conflict with a consulting service or need for a staff-to-staff consult Discharge from the ED Significant clinical deterioration (e.g., CCRT activation, Code Blue, ICU transfer, unexpected patient death)

Reasons to call the CMR on call: More than "12 before 12" More than 8 outstanding, not yet triaged consults More than 45 inpatients covered by a junior resident Etc.

TGH-specific highlights:

Malignant bowel obstructions:

• If actively followed (within last 12 months) by UHN/affiliated medical or radiation oncologist with malignant small bowel → Medicine, but then will be referred to nocturnist regardless of cap
• All others (and large bowel obstruction) → Gynecology Oncology or General Surgery

Skin and soft tissue infections

• Facial, upper limb or surgical intervention required OR probable/proven necrotizing fasciitis (which is a clinical, nor radiographic Dx): Plastics
• Oropharyngeal/laryngeal: ENT
• Perineum involved: General surgery

ACS with ST elevation, raised troponin (>0.3), dynamic ECG changes, hemodynamic instability, PCI within last year: Cardiology

Lower limb potentially requiring amputation: Vascular Surgery