Combined management: Combined management is a comprehensive care, with the involvement of more than one specialty for the patients requiring complex care. Patient will be admitted under the Most Responsible Physician who will be able to provide the maximum care to the most significant presenting symptoms of the patient.

Most Responsible Physician (MRP): Most Responsible Physician is the Admitting Physician who is responsible for the overall care rendered to the patient and accountable for the outcome of care provided to the patient except in closed ICU system where the MRP will be the lntensivist/ ICU physician with admission privilege.

  1. Plan of care based on the initial assessment findings aimed to meet all patient’s needs will be done by the admitting team.
  2. Consultation will be requested by the admitting team whenever patient’s condition requires.
  3. Whenever there is a multidisciplinary involvement, proper co-ordination and communication should be done with concerned specialty, to decide whether combined management is needed. If needed, plan of care is developed through a collaborative approach between the healthcare teams.
  4. Patients for combined management will be admitted under the most responsible Physician and documentation should be done about the combined management with the concerned specialty.
  5. The most responsible physician carries the overall responsibility and accountability for the outcome of care provided to the patient.
  6. The most responsible physician provides the principal care plan and co -ordinates when required for additional plans of other healthcare providers.
  7. Multidisciplinary rounds by all the involved specialties should be conducted daily for the critically ill patient.
  8. Consulted specialty is responsible for the follow-up of the patient until patient is clinically stable or free from that specialty and to be document clearly in the patient medical record that this patient need no further acute management from that specialty.
  9. Plan of care is modified as appropriate upon any significant change in the patient condition or when new treatments are added or discontinued and to be reviewed by the most responsible physician on a daily basis. This changes and modifications should be communicated to other specialties.
  10. Information about the patient’s care and response to the treatment is shared between medical, nursing, and other care providers.
  11. Most Responsible Physician is responsible to notify Patient or authorized family member about the condition of patient, ongoing treatments and expected outcome. Other specialty can be involved if needed.

When a patient moves from one phase of care to another (for example medical to surgical) the individual responsible for the patient care (MRP) may change and this should be documented clearly in the patient medical record along with summery of patient care information which includes reason for admission, significant findings, diagnosis, procedures performed, medications administered and other treatments provided and patient’s condition at the time of transfer.