VIR - ON CALL

NOTE THAT AS OF JULY 1, 2018 THERE WILL BE NO MANDATORY RESIDENT VIR CALL!

Time:  1 week starting at 8 am Monday through 8 am the next Monday

*For rotation specific information, click here.

MOUNT SINAI ATTENDING SCHEDULE/INFO:

FELLOW SCHEDULE:

FORWARD PAGER

  • Start forwarding the pager at 8 am on Monday
  • During the daytime hours, you can cancel forwarding to avoid being bothered on your rotation or you can return all pages and tell them to call the department
  • Pagers:    
    • SL VIR: 31118
    • RH VIR: 36481 
    • BI VIR: 13215
  • Forward pages to yourself
    • 212-523-2828 > press 2 to change status > pager number > 5 to forward ("covered by") > new number > 2 to confirm
    • Confirm through miTeam paging system
  • Cancel forward and make available
    • 212-523-2828 > press 2 to change status > pager number > 4 to "refer to another number" > new number (IR dept: 23-4446 or 23-7257) > 2 to confirm
    • You can make the pagers status to "available," which will allow the fellows to receive pages (VIR fellows are paged copied to all VIR pagers)
IMPORTANT NUMBERS
  • IR Dept       
    • SL IR: 212-523-4446
    • RH IR: 212-523-7257
    • BI IR: 212-420-3883
  • Operator
    • Page Operator: 05 / 212-523-2828
    • Operator: 00 / 212-523-5678
ANSWER PAGES & GET INFORMATION
  • Answer the pages and take information regarding the case
  • Use the IR CONSULT FORM
  • Look up info in Prism/EPIC/EMSTAT/PACS when possible
  • What to expect?  
    • 70% PICC problems
    • 10% non-emergent consults
    • 10% emergent cases
    • 10% scheduling (i.e. getting called at 6am for "Can you make sure my patient is first on the schedule today?"  
      • Appropriate response:  “I have no control over the daytime schedule, call the dept at 8 am.”
HOW TO ARRANGE A CASE 
  • Fellow
    • Introduce yourself to the fellow on the first day and ask how best to contact them.
    • If there is a possible case, call the fellow first!
  • Attending
    • Touch base with the attending on the first day, introduce yourself, and ask how best to contact them on call
    • If there is a possible case, call the attending by VIR Attending Schedule & Contact Numbers
  • Technologist
    • There is a technologist covering each site
    • Call the RH VIR Dept on Monday (23-7257), ask for the tech on call for RH, and ask them the best way to contact them
    • If there is a case at RH, call ahead so the tech has time to get there
    • The CT tech overnight at SL is IR certified and you should call them at 23-5383 (CT scanner) or main desk (23-4272) before to tell them there will be a case
    • Tech schedule
  • Nursing (covering both sites)
    • Nursing office number: 212-523-3240 or 212-523-3237; pager 6927
    • On the weekend days, tell the radiology supervisor to contact the nurse on call (its a radiology nurse who comes from home)
    • Evenings and nights, call the hospital operator for the nursing supervisor (SL or RH)
    • Typically they pull a nurse from the ER or ICU which is where the patient usually comes from anyway so I found it easiest to just talk to the nurse taking care of the patient (when you go to see/consent the patient) and ask them if the nurse is available to go with you for the case
    • Tell the nurse about sedation meds (you may have to get them yourself from the Pharmacy prior to the case)
  • Anesthesia
    • For intubated/unstable patients, especially for pulmonary and GI bleeds, anesthesia will have to be part of the case and needs to be called
    • They should be called early as they sometimes take a while (eg. A-line, etc)
  • Radiation goggles (DO NOT REMOVE OR TAKE OFF SITE)
    • There are 2 pairs at each site: one regular and one for wear over glasses
      • RH: resident lounge locker (23 / 37 / 31)
      • SL: 70 (19 / 21 / 39) click here for location
    • Each is in a case, with a cloth and wiping spray
    • Please keep them clean and put them back LOCKED UP before you leave for the day (each pair is $$$)
PICCS/MILDLINES
  • The most common call situation is difficulty removing a PICC
    • The primary team will often try to unsuccessfully remove a tunneled PICC right before discharge
    • Go see the patient just to make sure it is not an easy fix like they forgot to remove the sutures or they are just too gentle
    • If unable to remove it, just tell them it has to be removed with local anesthesia with some blunt dissection if necessary
      • The patient has to stay till morning (or till Monday if its the weekend)
    • If that does not satisfy them, you can also call the attending, but they will probably tell you the same thing and will not want to come in just to remove a PICC
  • PICCs are not emergent. The team will have to place a CVC if they need access over the weekend or after hours.
    • PICCs are preferred in patients who are about to be discharged.
  • Midlines can only stay in patients for 29 days. If the patient will need antibiotics or treatment for over 29 days, they should receive an alternative line placement.

EMERGENCY CASES

  • GI bleeds
    • If they are slowly dropping the Hgb/Hct, make sure they have at least 2 serial Hgb/Hct
    • For most GI bleeds, the attending will ask for a bleeding scan (e.g. CTA r/o gi bleed), which usually delays the case until morning
  • Pulmonary embolisms 
    • Determine the patient's hemodynamic status, troponin levels, presence of heart strain on CTA of the chest.
    • IR usually does not intervene in elderly patients
  • Bleeds from pelvic fracture
    • If patient is hemodynamically unstable after trauma, they should go to OR not the IR table
    • For pelvic fractures, they should get a CT to see where the pelvic hematoma(s) are while you are getting the IR team together
  • IVC filters 
  • Septic cholecystitis or abscess

 HOSPITAL ACCESS ON CALL

    • The main entrances are locked at night, enter the hospitals through the ER entrances
    • At RH, it’s easiest to go in through the ambulance entrance (the door code is 911)
    • Save your cab receipts from call for reimbursement by Maritza

SCHEDULING NON-EMERGENT PROCEDURES FOR THE NEXT DAY

  • For urgent procedures referred during on-call hours that that can be safely scheduled for the following morning, the on-call attending can schedule the procedure as a 1st case
  • The referral/procedure becomes the responsibility of the IR attending assigned to the site during the following morning (RH, SL, Petrie AM attending)
  • Subsequent scheduling changes, cancellations, and communication with the referring service become the responsibility of the IR attending assigned to the site during the following morning
  • The on-call attending must contact the on-site IR attending assigned for the next day by e-mail (or telephone, if before 11 pm) upon scheduling the procedure with the referring service
  • A follow-up confirmation call must be made to the daytime IR attending assigned to the site the following morning by 6:30 am, if telephone contact was not made the previous evening
  • The on-call resident/fellow must contact the resident/fellow on the IR rotation assigned for the next day by e-mail (or telephone if before 11 pm) upon scheduling the procedure with the referring service
  • A follow-up confirmation call must be made to the resident/fellow the following morning by 6:30 am, if telephone contact was not made the previous evening
  • One exception is at SL, when there is no on-site attending the following morning (typically Tuesdays). These procedures must be completed by the on-call attending before the start of the next workday.