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CALL OVERVIEW


FACULTY CONTACTS

SLW ED FACULTY REPRESENTATIVE:
David Frager (x23-4222 or david.frager@mountsinai.org See Qgenda for availability.)

NIGHT FLOAT/EVENING CALL FACULTY ADVISOR:

Dairon Garcia (dairon.garcia@mountsinai.org)


BI or SLW ED LIASON:

  • Dr. Kagetsu: Nolan.Kagetsu@mountsinai.org
  • Dr. Somwaru: Alexander.Somwaru@mountsinai.org
  • The Chiefs: MSWChiefs@mountsinai.org


ED FOLLOW-UP:

  • SLW:
    • Call ED charge nurse if the attending changes the preliminary report with findings that affect management and the patient has already been discharged from the ED
    • Email Dr. Kagetsu, Dr. Somwaru and the Chiefs
  • BI specifically:
    • There is a BI ED follow up group made of ER PAs that handle callbacks at MSBI
    • BIEDFollowUp@mountsinai.org with the patient's information and reason for callback
    • Dr. Zeifer 
    • Shari Fernandez: Shari.Fernandez@mountsinai.org 


INTERESTING CASES:

Please add interesting cases to Body ICC filter to review at the Body ICC Conference.


ON-CALL PAGERS:

 Beth Israel 16119
 St Luke's 33214
 West 35830


SAFE RIDES:
  • Mount Sinai Safe-ride account
  • Uber pool during 9 pm - 5 am (no solo UberX rides)
  • Out of state not covered

CALL ROTATIONS

Responsibilities & Duties:
  • All QC/verified ER (XR, CT, MRI) cases up until 15 minutes before your shift ends on weekend/NF shifts. QC ED cases at 11PM for EVE shifts (if caught up, continue to read until 12 AM!).
  • All STAT/neuro/msk inpatient CT and MRI cases, as described below
  • Perform all necessary and appropriate ER US requests up to 30 minutes prior to end of shift.
  • Begin dictating cases at the start of your shift
  • Protocol all CT and MRI cases for that day

  • Do NOT dictate from resident lounges
  • Send an email to the assigned attending on Qgenda at the start of your weekend shift stating your hospital site, contact number, and coverage period
  • Use the common worklist (as time allows)
  • Assist the junior residents with cases (even at a different site, as time allows)
  • Only leave once touching base with each resident at each site (Eve)

  • R1's allowed to independently prelim XR ONLY after January (draft CT, MRI)
  • R1's can prelim CT/MRI once case reviewed with an attending or senior resident
  • R2-R4 will prelim all studies
  • Be mindful that the ED may take action based on preliminary reports (including discharging patients). 

Time Stamp:
  • Weekday Eve: Dictate all ER studies verified by 11 pm, and dictate all STAT/msk/neuro inpatient studies VERIFIED by 11 pm 
  • Weekday NF: Dictate all ER studies verified after 11 pm, and STAT/msk/neuro inpatient studies verified after 11 pm - 7:45 am
  • Weekend day/NF shifts: Dictate all ER or STAT inpatient studies verified 15 minutes before the end of your shift
  • Dictate inpatient cases as per list of required inpatients below
  • Perform and dictate all US ordered 30 minutes before the end of your shift
  • Follow up on studies that are in “Arrived” status for more than 1 hour. Open exam and investigate why it is taking so long. DO NOT LEAVE IT FOR THE NEXT RESIDENT.

WEEKDAY CALL ROTATIONS:
  • BI JR Call
    • Hours:          5 - 9 pm
    • Location:      BI Main reading room
  • SL EVE
    • Hours:          4 pm - 12 am  (Mon, Tues, Thurs, Fri)
    •                     11:30 am - 10:30 pm  (Wednesday)
    • Location:      3rd Floor, Clark Building
  • W EVE:
    • Hours:        4 pm - 12 am (Monday - Friday)
    •                   12 - 8 am: Scrotal US coverage (Everyday)
    • Location:    4th Floor, Radiology Ballroom
  • BI EVE
    • Hours:         4 pm - 12 am
    • Location:     BI Main reading room

NIGHT FLOAT:
  • SL NF
    • Hours:        10 pm - 8 am (Monday - Friday)
    •                    7 pm - 8 am (Saturday, Sunday)
    • Locations:   3rd Floor, Clark Building
  • BI NF
    • Hours:        10 pm - 8 am (Monday - Friday)
    •                    7 pm - 8 am (Saturday, Sunday)
    • Locations:   BI Main reading room


WEEKEND (AND HOLIDAY) CALL ROTATIONS:
  • BI JR Call
    • Hours:        1 - 9 pm
    • Location:    BI Main reading room
  • SL EVE
    • Hours:        8 am - 7 pm
    • Location:    3rd Floor, Clark Building
  • W EVE:
    • Hours:        8 am - 12 am (Saturday, Sunday)
    •                    8 am - 4 pm; 4 pm - 12 am (Holiday)
    •                   12 - 8 am: Scrotal US coverage (Everyday)
    • Location:    4th Floor, Radiology Ballroom
    • Additional:
      • If on Sunday shift, arrive to your daytime rotation at 10 am
      • If overnight US, arrive 10 hours after that scan completed
  • BI EVE
    • Hours:         8 am - 7 pm (Including Holiday)
    • Location:     BI Main reading room


OVERNIGHT ATTENDING SCHEDULES:
  • Monday-Thursday:     8 pm - 8 am
  • Friday:                        8pm - 7 am
  • Saturday:                    7pm - 7 am
  • Sunday:                      7pm - 6 am

SLW Pager

  • MSW pager coverage from 8am-4:00 pm to be assigned (Pagers: 33214, 35830)
Please stop page copying the RH and SL pagers to your personal cell phones. If you prefer to receive pages on your cell phones, then page copy your personal pagers to your cell and then forward the RH/SL pagers to your personal pagers.

Follow instructions below:

Forward your personal pager to your cell phone
Call operator at 212-523-4000 and request them "page copy” your pager to your cell. Do not undo this step.

Forward the call pager to your personal pager is as easy as forwarding phones remotely
1. Dial “05” (in hospital) or dial 212-523-2828 (outside)
2. Dial 2 (“to change status")
3. Dial 33214 (SL pager) or 35830 (RH pager)
4. Dial 5 (“covered by”)
5. Dial your pager number
6. Press “2” to confirm

W Eve resident
At start of shift - forward RH pager to your personal pager at beginning of shift
At end of shift - forward RH pager to SL pager at the end of your shift (W NF resident covers both sites)


BI JR

Location: BI, 2 Linsky-07
Time: Weekday: 5pm-9pm after your normal day rotation; Weekend 1p-9p

Coverage: 
  • BI (Petrie)
  • KH (BI Brooklyn)
  • KD (Kingsway Diagnostic): CT and MR from KD do not need to be read unless the office calls for something urgent and they need a final attending read
  • CityMD: These patients are registered as Petrie or (rarely) PACC outpatients and must be read
  • PUC (PACC/DUS Urgent care)
  • NYEE (NY Eye & Ear): XR/CT do not need to be read unless it is emergent and in that case they would call the reading room. 
    • NYEE patients needing an MRI are sent to Petrie - these need to be read, and a neurorad attending needs to at least consult if not finalize; there are 2 classes of NYEEI MRI: those going to the Petrie ED and those getting a roundtrip transfer via the transfer service:
      • The ED cases are handled as any other ED case
      • Please see the roundtrip flowchart for the protocol regarding roundtrip transfers
  • SV (Stuyvesent Town Urgent Care): Some of these are ortho and are not reportable. Some are regular cases that we do read - these come over in red to distinguish them from ortho cases. 
  • NYRA (34th Street): Occasional STAT read at the end of the day for which they will call the reading room. 

Worklists: 
  • BISLW--> Residents--> Dwtn CALL ED

  • BISLW-->Residents--> Dtwn IP CT MR

Responsibilities:
  • Dictating/Drafting as per common responsibilities. Answer phones, protocol, if no US tech then ultrasound up to 30 minutes prior to end of shift.


SL EVE

- LocationSL Ballroom (Clark floor 3)
Time:  see hours at top of this page 
- Worklists and Pager
  • BISLW--> Residents--> SLW CALL ED
  • BISLW--> Residents--> SLW CALL IP
  • Pager: 33214
- Responsibilities:

Monday, Tuesday, Thursday, and Friday
  • Refer to responsibilities above
  • Arrive 4:00 pm
  • Forward SL ED pager and phones (23-3799; 23-4219; pager 33214)
  • Directly hand off pager to NF at end of shift
  • When the US is not available, perform all appropriate ER ultrasounds ordered before 11:30pm (DVTs, cholecystitis, appy/intussusception, testes, donor transplant organ harvest)
  • Protocol ER CT's ONLY IF CALLED with a specific indication by the tech
  • Consent outpatient or inpatient MRI studies
  • Address patient contrast extravasations
Wednesday
  • Shift runs 11:30 am - 4 pm for ER XR from both SL and W 
  • 4 - 10:30p pm responsibilities as described above
Weekends/Holidays
  • If both W eve and SL eve weekend have upper class residents (R2 - R4), each covers their own site
  • OPTIONAL FOR WEEKENDS IF R1 on SL EVE:  
    • 8:00 am – 3:00 pm: R1 does all body CT’s from both sites (review with CT Attending)
    • Draft Neuro cases and review with senior resident at West
    • Perform and draft all emergent US and review with senior resident at West
    • Protocol ER CT's ONLY if called
    • 3:00 pm – 7:00 pm:  
    • R1 does all plain films from both sites (review with XR Attending)
    • Draft Neuro cases and review with senior resident at West
    • Perform and draft all emergent US studies ordered before 6:30 and review with senior resident at West
    • Protocol ER CT's ONLY if called


W EVE

Location:  West Ballroom, 4th floor
Time:  See hours at the top of this page

Worklists/Pager: 
  • BISLW--> Residents--> COMBINED CALL ED
  • BISLW--> Residents--> SLW CALL ED
  • BISLW--> Residents--> SLW CALL IP
  • Pager 35830
Responsibilities:      
  • Common responsibilities
  • NM on call cases from SLW until 12:00 MN
  • When US tech unavailable, perform ED US ordered before 11:30pm (cholecystitis, DVTs, scrotal, appy/intussusception, organ harvest); ED scrotal US 12a-8am
  • Protocol ER CT's ONLY IF CALLED with a specific indication by the tech (Dr. Friedman has provided a protocol list for routine ED studies so the techs should be protocol'ing ED cases on their own).
                 
OPTION FOR WEEKENDS AT WEST IF R1 IS AT ST. LUKE's: 
  • 8:00 am - 3:00 pm:  SL ER and RH ER plain films (if R1 at SL)
  • 3:00 pm - 7:00 pm:  SL ER and RH ER CTs (if R1 at SL)
  • 8:00 pm - 12:00 MN:  Split by sites (RH/SL) 
    • If there is an upperclassman on SL EVE, you can split by site throughout the whole day
  • NM on call cases from both sites until 12:00 MN

BI EVE

Location:  BI, 2-linksy 07
Time:  M-F 4:15p-12a; Weekend/Holiday 8a-7p

Coverage: 
  • BI (Petrie)
  • KH (BI Brooklyn)
  • KD (Kingsway Diagnostic): CT and MR from KD do not need to be read unless the office calls for something urgent and they need a final attending read
  • CityMD: These patients are registered as Petrie or (rarely) PACC outpatients and must be read
  • PUC (PACC/DUS Urgent care)
  • NYEE (NY Eye & Ear): XR/CT do not need to be read unless it is emergent and in that case they would call the reading room. 
    • NYEE patients needing an MRI are sent to Petrie - these need to be read, and an attending needs to at least consult if not finalize; there are 2 classes of NYEEI MRI: those going to the Petrie ED and those getting a roundtrip transfer via the transfer service:
      • The ED cases are handled as any other ED case
      • Please see the roundtrip flowchart for the protocol regarding roundtrip transfers
      • Please see explanation of steps to follow for NYEE roundtrip transfers
  • SV (Stuyvesent Town Urgent Care): Some of these are ortho and are not reportable. Some are regular cases that we do read - these come over in red to distinguish them from ortho cases. 
  • NYRA (34th Street), Hudson Yards, One Medical, Credit Suisse: Occasional STAT read at the end of the day for which they will call the reading room. 

Worklists/Pager: 
  • BISLW--> Residents--> Dwtn CALL ED

  • BISLW-->Residents--> Dtwn IP CT MR

  • Tech gives residents paperwork for CityMD→ look on "Body CT South" or "US BI" (which includes outpatients).

  • Pager 16119

Responsiblities:      
  • Common responsibilities.
  • If a full report is requested for any inpatient study, the resident should dictate a full report. 
  • ALL CITYMD studies must be called in. The secretary and tech manager can help you reach the clinician if necessary. 
  • Inpatient ultrasounds are sometimes requested during call shifts. Please discuss the immediate necessity of the case with the ordering physician. If they insist it is emergent and you do not agree, please discuss the case with your attending. 
  • ER and inpatient fluoro examinations will be performed on a case by case basis.

SLW NF

Location: St. Luke's Ballroom, Clark floor 3
Time: M-F 10:00p-8am; Weekend/Holiday 7p-8am (*NF week is Sun-Fri)

Main Sites: MSSL, MSW

Worklists/Pager: 
  • BISLW--> Residents--> SLW CALL ED
  • BISLW--> Residents--> SLW CALL IP
  • Pager 33214
Responsibilities: 
  • SL: 
    • 10:00 pm - 8:00 am:  Prelim all SL/RH ER studies
  • Inpatients:  
    • Neuro: All ER Head CT and MRI. Inpatient's from 4-8PM: Dictate as time permits.  Inpatient after 8PM: Prelim all CT and MRI (both STAT and nonSTAT cases).  MRI examinations can be abbreviated to a one-liner w/ pertinent findings (add header).
    • Abbreviated report for the following cases as time allows: STAT CT cases (PE chest, dissection, fall out of bed), plain radiographs if asked by team
    • Provide wet read for critical findings on all inpatient MSK CT/MRI
Other:
  • Perform and dictate emergent ultrasounds ordered after 11:30 pm and before 7:30am (cholecystitis, scrotal, dvt, appy, intussuception, organ harvesting).
  • NM on call cases from both sites beginning after midnight                   
  • If at West, contact RH Eve person for emergency testicular US at RH
  • Carry pager (answering for both sites after MN) 
  • Protocol ER CT's ONLY IF CALLED with a specific indication by the tech (Dr. Friedman has provided a protocol list for routine ED studies so the techs should be protocol'ing ED cases on their own)
  • Protocol ER MR studies and inpatient CT/MR studies as needed

BI NF

Location:  BI, 2 linksy - 07
Time: M-F 10:00p-8am; Weekends/Holiday 7p-8a (NF week shift is Sun-Fri)

Coverage:
  • BI (Petrie)
  • KH (BI Brooklyn)
  • KD (Kingsway Diagnostic): CT and MR from KD do not need to be read unless the office calls for something urgent and they need a final attending read
  • CityMD: These patients are registered as Petrie or (rarely) PACC outpatients and must be read
  • PUC (PACC/DUS Urgent care)
  • NYEE (NY Eye & Ear): XR/CT do not need to be read unless it is emergent and in that case they would call the reading room. 
    • NYEE patients needing an MRI are sent to Petrie - these need to be read, and a neurorad attending needs to at least consult if not finalize; there are 2 classes of NYEEI MRI: those going to the Petrie ED and those getting a roundtrip transfer via the transfer service:
      • The ED cases are handled as any other ED case
      • Please see the roundtrip flowchart for the protocol regarding roundtrip transfers
  • SV (Stuyvesent Town Urgent Care): Some of these are ortho and are not reportable. Some are regular cases that we do read - these come over in red to distinguish them from ortho cases. 
  • NYRA (34th Street): Occasional STAT read at the end of the day for which they will call the reading room. 
 

Worklists/Pager: 
  • BISLW--> Residents--> Dwtn CALL ED

  • BISLW-->Residents--> Dtwn IP CT MR

  • Tech gives residents paperwork for CityMD→ look on "Body CT South" or "US BI" (which includes outpatients).

  • Pager 16119

Responsibilities:      
  • Prelim all ER and urgent care XR/CT/US/NM
  • Neuro: All ER Head CT and MRI. Inpatient's from 4-8PM: Dictate as time permits.  Inpatient after 8PM: Prelim all CT and MRI (including both STAT and nonSTAT cases).  MRI examinations can be abbreviated to a one-liner focusing on acute/pertinent findings (or their absence).
  • Dictate BRIEF prelim report emergent inpatient MRI’s and inpatient chest CTA’s. 
  • Whenever possible, residents should also put in a BRIEF prelim report on emergent/urgent inpatient cross-sectional studies. 
  • If a full report is requested, the resident should dictate a full report. Inpatient XR’s should be dictated with a full report when requested. 
  • Nuclear medicine sentinel node and lymphoscintigraphy injections until 8 AM
  • For ER US, the ED physician must discuss the patient with you to approve the study and confirm if/when it will be performed.
  • Inpatient ultrasounds are sometimes requested during call shifts. Please discuss the immediate necessity of the case with the ordering physician. If they insist it is emergent and you do not agree, please discuss the case with your attending. 
  • ER and inpatient fluoro examinations will be performed on a case by case basis.

Inpatient/ER MR Responsibilities

Body MRI


1.) Body MRI:


- Indications: Rule out appendicitis, ovarian torsion

- Patient: Pregnant patient

- Responsibilities

    - Prelim study (one liner with head allowed)

    - "No acute abnormalities. A full attending report is to follow"

- Attending: On-call attending or daytime Body MRI attending

    - Review case with on-call attending and prelim study

    - Ask on-call attending if will sign study

            - If not, assign to daytime Body MRI attending

            - Call the on-call Body attending (who's on the next day or Monday)

            - Attending numbers are listed on Radrez


2.) MRCP and Body MRI:


Indications: Choledocholithiasis, Cholangitis

Responsibilities:

    - Prelim all Inpatient studies (excluding cancer staging)

Attending: On-call attending or daytime Body MRI attending

    - Review case with on-call attending and prelim study

    - Use similar algorithm tree, as described above


3.) MSK MRI:

Indications: Extreme orthopedic emergencies (eg. Ortho attendings request a final read that could influence medical vs. surgical management)

Responsibilities:

    - Obtain contact information from requesting Orthopedic Surgery attending and notify on-call MSK attending

    - Only an attending Ortho surgeon can request a final MSK read

    - Prelim all inpatient MRI cases (one line allowed)

Attending: MSK attending (next day)


4.) MSK CT:

Indications: Trauma, fractures, etc.

Responsibilities: Prelim all inpatient and ER MSK CT's

Attending: On-call attending


5.) Neuro MRI:

Indications: Any inpatient or ER study

Responsibilities

    - Prelim all ER cases and assign to the on-call attending

    - Prelim all Inpatient cases and assign to the next day/Monday Neuro attending

        - Do not dictate on-call Spine cases level by level

        - One liner with header allowed

        - "No acute abnormalities. A full attending dictation is to follow"

Attending: On-call or Neuro attending or 4 - 8pm attending


ATTENDING COVERAGE

See Qgenda schedule for on call and late shift attendings.

ATTENDINGS *intranet*
BI Nuclear Medicine
Neuroradiology (please refer to monthly email also)

BODY ON CALL ATTENDING
-Please follow Qgenda schedule and call next day's attending. (On weekends, contact Monday attending.)
MSK ON-CALL ATTENDING

-Please see document "+ MSK CALL MSHS" below.


*For overnight MR and NM studies, the overnight attending can look over studies and discuss findings with ED if requested. If a final read is requested immediately, please refer to the above on call schedule. Otherwise, the study will be finalized the next morning by the appropriate attending. 


*For pediatric fluoro cases, please call the on call Pediatric Radiology attending for further instructions.



RESOURCES



RADIOLOGY SUPERVISORS

  • Supervisors are on site until 11 pm if you need help 
  • Transferring images to PACS from an US machine
  • Getting in touch with RIS for system wide problems or if you can’t dictate


CT Perfusion Studies

If you are having difficulty with a CT Perfusion study, please follow the steps outlined below:
  1. If images did not go automatically to OLEA for post-processing, can send images yourself to PACS: 
    • On the Study list, right click on the study 
    • Send to DICOM 
    • Select OLEA AUTOSTROKE
  2. Vitrea post processing (see instructions below)
  3. The ER scanner at MSSL has ability for tech to post-process perfusion studies on the console (overnight and weekend techs should know how to do this)

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