Your Patient is Crashing and the Doctor Isn’t Responding

One of the most stressful situations for nurses is when a patient's condition deteriorates, and the physician does not call back. If your patient is crashing:

• Contact the physician as soon as possible.

• Notify the charge nurse about the situation.

• If available, call the critical care response team or the Rapid Response Team.

If you've called the physician and there is no response, escalate the situation:

• If there’s no callback after your initial message, contact the physician again within 1-2 minutes.

• If there is still no response, call any personal numbers available or request the physician's answering service to directly call them.

• If the physician remains unreachable, ask the answering service for the covering doctor or escalate to other medical staff in a position to help.

  
  

Example Scenario:

• A patient presents with respiratory distress, breathing 28 times per minute, and feeling severely short of breath.

• You contact the physician at 10:05 with no response and again at 10:10, still without reply.

• The patient’s condition worsens, and by 10:30, they are breathing 35 times per minute.

• When the physician finally responds at 10:40, they order treatments, but it is too late; the patient needs intubation, is transferred to the ICU, and eventually develops complications related to mechanical ventilation, resulting in their death.

  
  

In this case, legal and professional responsibility could be questioned:

• Was it the physician’s failure to respond?

• Did the nurse sufficiently escalate the situation?

  
  

Advice for New Nurses:

• Do not hesitate to call a physician directly or to contact the covering physician. If the patient’s condition is serious, the physician will appreciate your efforts.

• With modern communication technology, there are various reasons for missed calls—poor signal, technical issues, or the physician’s phone being on silent. However, these factors do not negate the priority of the patient's life. Don’t hesitate to escalate and ask for help.

• Remember, in an emergency, the patient's well-being is the top priority. Repeatedly reach out until you receive the necessary support and involve your supervisors.

Frequently Asked Questions (FAQ)

• What does escalating the situation mean in a hospital setting?Escalating means involving other members of the medical team when you don’t get an initial response.

• How long should I wait between contact attempts?No more than 1-2 minutes in critical emergencies.

• What should I do if I lack experience and feel hesitant to call the doctor?Always prioritize the patient’s well-being. Always inform your supervisor.

• Could there be legal repercussions if I don’t act in time?Yes, both the physician and the staff involved in the patient’s care could face legal consequences.

• How can I improve my performance in these situations?Practice simulations of complex situations and how to respond to them.