Call Duties
Call is divided equally between the fellows / IR resident with prospective cover for vacation and absences. An initial call schedule will be devised for the first 1 month. Changes to the pattern of call can be made following agreement of both fellows. The chief fellow is expected to communicate these changes with the schedule coordinator, Ethan Bremner.
Phone numbers
- Hospital Operator= 617-355-6000 (56000)
- Radiology Front Desk= 617-355-6286 (56286)
- Anesthesia Anesthesiologist=617-355-9111 (59111)
- OR Front Desk=617-355-7731 (7731)
- Emergency Department=617-355-6611 (6611)
- Hospital numbers that start with 5 Dial 617-355-number (ex.59227=617-355-9227)
- Spectralink Phone outside of hospital
-Dial 857-218-7001
-Enter Spectralink Extension (ex. 7-93713)
-External number from hospital, Dial 0 then number, NOT 9
Responsibilities
- On call as of 5pm. As of 5pm the virtual pager 0434, which is covered by our NP’s during normal business hours will be forwarded to on call fellow.
- Responsible for ensuring a verbal sign-off from NP’s prior to the end of the day to review all pending cases
- Review cases for the next day.
- Obtain consents for all inpatients scheduled for next day including phone consent if necessary. Place completed consents in “signed consents” folder in filing cabinet in control room 14.
Call Team Information
- The on call team contact information is listed on the wipe board in control room 14 and at the inpatient Radiology front desk.
- Suggest taking a picture of call team information for your reference
**If there is a delay in responding to your page, text or phone call from any member of on call team, contact IR Attending immediately**
Communication of Call Procedures
- Call in will happen via a phone call, text or page from physician (Attending or Fellow) to the call team
- Patient information is to ONLY to be shared via a text in Care Aware Application not regular text on personal cell phone
- Care Aware Application is NOT to be used by physician to call staff in for a case. It is only for communicating patient information.
Anesthesia Cases
- Anesthesia Case timing is coordinated between IR Attending Physician and OR Anesthesia board runner
- If an anesthesia case is being booked for the following day, the IR Attending/fellow will contact team once there is communication with anesthesia with regards to timing.
Call Procedure or Add-On Cases Intake
-Required Intake Information for ALL Call and Add-on Procedures
- Name
- MRN
-Diagnosis
-Procedure Requested
-Referring Attending and Service
-HCG (if applicable)
-NPO Status
-COVID Status
-Guardian available for consent
-IR consult entered into Powerchart
**Never guarantee an add-on procedure. Tell them we will discuss in morning rounds and then get back to them to let them know if/when it will happen. Have them make the patient NPO after midnight in case we can add the procedure on.
**For urgent cases, discuss with IR Attending immediately, formulate plan and coordinate procedure time with technologist and nurse.
**For less urgent cases (e.g. GJ Tubes change scheduled for next morning), notify the attending, technologist and nurse with the plan and time of procedure the night before the planned procedure
**If you believe the requested procedure is not indicated or not urgent, consult with the attending on call. Avoid unnecessary debates or arguments.
**If we review imaging but decline to perform procedure, writing a very brief IR Consult note is very helpful. Note should include 1) what we asked, 2) what imaging was reviewed 3) what recommendations are.
Overnight add-ons
These are emailed the same night (or before 6:30 am the next morning) to the IR Pt List-dl. Please see general and procedure specific e-mail templates.
Calls from families or patients
- State your name, title (IR fellow)
- Name and DOB (and MRN if possible), history, duration, new symptoms vs. recurrent.
- Date and type of most recent intervention
- Review the clinical notes and procedures/imaging on Powerchart and Synapse.
- Address/access to ED.
- Discuss with IR attending
- If the family/patient is directed to go to CHB ED:
- Notify the ED attending and ask him/her to page you to see the patient.
- If the problem is not related to IR, call the service likely to care for the patient (e.g surgery, pediatrics).
- For ED visits outside CHB, give the family/patient your pager number (either 10 digit long distance or via CHB operator 6173556000 and your 4 digit pager #).
- Document the conversation in PowerChart as a “Phone message/call” note. This can be a very brief summary.
WEEKENDS
Inpatient Rounds
- Inpatient rounds are performed daily on weekends and holidays. These are coordinated with the attending on call. All of the patients on the service are reviewed. The findings and the plan should be communicated to the patient's nurse or physician.
- All inpatients require an IR Progress Note on Saturday and Sunday. Interventional Radiology Consultation is the document type, then you can type IR Progress Note into the subject line. Just cut & paste the note from the NP the day prior and modify as necessary. A brief note is then placed in Powerchart and the IR patient care list on DockHealth updated.
Weekend sign out
Email sent to IR Pt List-dl on Sunday evening. Please see weekend sign out template.
Time off for cases performed between 12 am and 6 am.
For procedures performed by fellows during this time period, the fellow on call is allowed an equal amount of time off the schedule in the morning.
E.g. Hip tap performed between 1:30 AM and the fellow returns home at 3:30 AM, the fellow is allowed 2 hours off (i.e. joins IR team at 9 AM, instead of 7 AM).
PROCEDURE SPECIFIC CALL GUIDELINES
GJ Tubes
-Can be performed independently once signed off by the fellowship director
-Text attending for awareness of GJ Tube procedure
-Coordinate timing of procedure with technologist and nurse on call.
-Performed on weekends from 800am-6pm 7 days a week
-Exceptions to this rule may occur based on physician clinical judgement and patient condition requiring admission to ICU
- For example: trached patient in ED that will have to be admitted to ICU overnight
Outpatients coming from home to IR Directly
- Can come straight to IR (avoid ED)
- Patient arrival time will be coordinated by IR MD Attending or Fellow, Tech and Nurse
- IR MD will communicate with patient/parents for arrival time
***If No Standing Order in Powerchart, GI on call needs to be paged and an IR Consult for Exchange needs to be placed in Powerchart***
-The procedure cannot be started until there is an order placed.
ED and Inpatients
- Ensure that there is an IR Consult for Exchange from ED or Inpatient floor.
***A Standing Order and Department Order Entry (outpatient workflow) can’t be used for an ED patient or inpatient***
- If no order in Powerchart requesting team to place an IR Enteral Feeding tube consult or IR Consult in Powerchart.
- Patient should not be called for or come to IR until the IR Consult has been placed.
NJ Tubes
-Primarily placed by the diagnostic radiologists.
-If NJ placement is Fluoroscopy fails IR is consulted.
-Considered elective procedure and not performed outside of regular working hours (Exceptions to this rule may occur based on physician clinical judgement and patient condition).
PICCs
- The placement of a PICC is only performed during working hours of 8am-5pm Monday-Friday.
- A PICC is only placed by IR outside of these hours if a child has no IV access and all other in-house services, including surgery and anesthesia have failed.
- If patient requires IR placement of PICC for an anatomic reason, we will discuss the case on Monday morning in rounds to decide if and when to add it on.
**PICCs can be a pain point of the weekend. DO NOT let frustration build up or a conversation turn into an argument. If conversation becomes difficult ask referring attending to speak to the IR Attending.
Portable Cases
- Portable Cases are only the technologist and the physician.
- Ensure that there is an IR Consult for procedure in Powerchart.
- Ensure there is a parent for consent, witnessed phone consent to be obtained if no parent present.
Hip Taps
- Performed by the IR Fellow at the discretion of the IR Attending anytime of the day in ED
- Notify Attending that you are performing hip tap procedure
- No technologist or IR nurse support indicated
- Ensure ED Staff is prepared for patient sedation needs
- Ensure there is an IR Consult placed in Powerchart with laterality (Right not R) prior to performing hip tap procedure in ED
- Will need Portable U/S machine and Hip Tap Kit (stored in clean supply room, all the way in back left hand side of room)
- Manually enter all patient information into Portable U/S machine
- Perform Timeout in ED prior to the start of procedure
- Provide the board runner on the next work day with patient information and date of service for completion of case in computer system. Portable U/S Images will then be moved accordingly into correct Synapse Folder.
Phone numbers
- Hospital Operator= 617-355-6000 (56000)
- Radiology Front Desk= 617-355-6286 (56286)
- Anesthesia Anesthesiologist=617-355-9111 (59111)
- OR Front Desk=617-355-7731 (7731)
- Emergency Department=617-355-6611 (6611)
- Hospital numbers that start with 5 Dial 617-355-number (ex.59227=617-355-9227)
- Spectralink Phone outside of hospital
-Dial 857-218-7001
-Enter Spectralink Extension (ex. 7-93713)
-External number from hospital, Dial 0 then number, NOT 9
Responsibilities
- On call as of 5pm. As of 5pm the virtual pager 0434, which is covered by our NP’s during normal business hours will be forwarded to on call fellow.
- Responsible for ensuring a verbal sign-off from NP’s prior to the end of the day to review all pending cases
- Review cases for the next day.
- Obtain consents for all inpatients scheduled for next day including phone consent if necessary. Place completed consents in “signed consents” folder in filing cabinet in control room 14.
Call Team Information
- The on call team contact information is listed on the wipe board in control room 14 and at the inpatient Radiology front desk.
- Suggest taking a picture of call team information for your reference
**If there is a delay in responding to your page, text or phone call from any member of on call team, contact IR Attending immediately**
Communication of Call Procedures
- Call in will happen via a phone call, text or page from physician (Attending or Fellow) to the call team
- Patient information is to ONLY to be shared via a text in Care Aware Application not regular text on personal cell phone
- Care Aware Application is NOT to be used by physician to call staff in for a case. It is only for communicating patient information.
Anesthesia Cases
- Anesthesia Case timing is coordinated between IR Attending Physician and OR Anesthesia board runner
- If an anesthesia case is being booked for the following day, the IR Attending/fellow will contact team once there is communication with anesthesia with regards to timing.
Call Procedure or Add-On Cases Intake
-Required Intake Information for ALL Call and Add-on Procedures
- Name
- MRN
-Diagnosis
-Procedure Requested
-Referring Attending and Service
-HCG (if applicable)
-NPO Status
-COVID Status
-Guardian available for consent
-IR consult entered into Powerchart
**Never guarantee an add-on procedure. Tell them we will discuss in morning rounds and then get back to them to let them know if/when it will happen. Have them make the patient NPO after midnight in case we can add the procedure on.
**For urgent cases, discuss with IR Attending immediately, formulate plan and coordinate procedure time with technologist and nurse.
**For less urgent cases (e.g. GJ Tubes change scheduled for next morning), notify the attending, technologist and nurse with the plan and time of procedure the night before the planned procedure
**If you believe the requested procedure is not indicated or not urgent, consult with the attending on call. Avoid unnecessary debates or arguments.
**If we review imaging but decline to perform procedure, writing a very brief IR Consult note is very helpful. Note should include 1) what we asked, 2) what imaging was reviewed 3) what recommendations are.
Overnight add-ons
These are emailed the same night (or before 6:30 am the next morning) to the IR Pt List-dl. Please see general and procedure specific e-mail templates.
Calls from families or patients
- State your name, title (IR fellow)
- Name and DOB (and MRN if possible), history, duration, new symptoms vs. recurrent.
- Date and type of most recent intervention
- Review the clinical notes and procedures/imaging on Powerchart and Synapse.
- Address/access to ED.
- Discuss with IR attending
- If the family/patient is directed to go to CHB ED:
- Notify the ED attending and ask him/her to page you to see the patient.
- If the problem is not related to IR, call the service likely to care for the patient (e.g surgery, pediatrics).
- For ED visits outside CHB, give the family/patient your pager number (either 10 digit long distance or via CHB operator 6173556000 and your 4 digit pager #).
- Document the conversation in PowerChart as a “Phone message/call” note. This can be a very brief summary.
WEEKENDS
Inpatient Rounds
- Inpatient rounds are performed daily on weekends and holidays. These are coordinated with the attending on call. All of the patients on the service are reviewed. The findings and the plan should be communicated to the patient's nurse or physician.
- All inpatients require an IR Progress Note on Saturday and Sunday. Interventional Radiology Consultation is the document type, then you can type IR Progress Note into the subject line. Just cut & paste the note from the NP the day prior and modify as necessary. A brief note is then placed in Powerchart and the IR patient care list on DockHealth updated.
Weekend sign out
Email sent to IR Pt List-dl on Sunday evening. Please see weekend sign out template.
Time off for cases performed between 12 am and 6 am.
For procedures performed by fellows during this time period, the fellow on call is allowed an equal amount of time off the schedule in the morning.
E.g. Hip tap performed between 1:30 AM and the fellow returns home at 3:30 AM, the fellow is allowed 2 hours off (i.e. joins IR team at 9 AM, instead of 7 AM).
PROCEDURE SPECIFIC CALL GUIDELINES
GJ Tubes
-Can be performed independently once signed off by the fellowship director
-Text attending for awareness of GJ Tube procedure
-Coordinate timing of procedure with technologist and nurse on call.
-Performed on weekends from 800am-6pm 7 days a week
-Exceptions to this rule may occur based on physician clinical judgement and patient condition requiring admission to ICU
- For example: trached patient in ED that will have to be admitted to ICU overnight
Outpatients coming from home to IR Directly
- Can come straight to IR (avoid ED)
- Patient arrival time will be coordinated by IR MD Attending or Fellow, Tech and Nurse
- IR MD will communicate with patient/parents for arrival time
***If No Standing Order in Powerchart, GI on call needs to be paged and an IR Consult for Exchange needs to be placed in Powerchart***
-The procedure cannot be started until there is an order placed.
ED and Inpatients
- Ensure that there is an IR Consult for Exchange from ED or Inpatient floor.
***A Standing Order and Department Order Entry (outpatient workflow) can’t be used for an ED patient or inpatient***
- If no order in Powerchart requesting team to place an IR Enteral Feeding tube consult or IR Consult in Powerchart.
- Patient should not be called for or come to IR until the IR Consult has been placed.
NJ Tubes
-Primarily placed by the diagnostic radiologists.
-If NJ placement is Fluoroscopy fails IR is consulted.
-Considered elective procedure and not performed outside of regular working hours (Exceptions to this rule may occur based on physician clinical judgement and patient condition).
PICCs
- The placement of a PICC is only performed during working hours of 8am-5pm Monday-Friday.
- A PICC is only placed by IR outside of these hours if a child has no IV access and all other in-house services, including surgery and anesthesia have failed.
- If patient requires IR placement of PICC for an anatomic reason, we will discuss the case on Monday morning in rounds to decide if and when to add it on.
**PICCs can be a pain point of the weekend. DO NOT let frustration build up or a conversation turn into an argument. If conversation becomes difficult ask referring attending to speak to the IR Attending.
Portable Cases
- Portable Cases are only the technologist and the physician.
- Ensure that there is an IR Consult for procedure in Powerchart.
- Ensure there is a parent for consent, witnessed phone consent to be obtained if no parent present.
Hip Taps
- Performed by the IR Fellow at the discretion of the IR Attending anytime of the day in ED
- Notify Attending that you are performing hip tap procedure
- No technologist or IR nurse support indicated
- Ensure ED Staff is prepared for patient sedation needs
- Ensure there is an IR Consult placed in Powerchart with laterality (Right not R) prior to performing hip tap procedure in ED
- Will need Portable U/S machine and Hip Tap Kit (stored in clean supply room, all the way in back left hand side of room)
- Manually enter all patient information into Portable U/S machine
- Perform Timeout in ED prior to the start of procedure
- Provide the board runner on the next work day with patient information and date of service for completion of case in computer system. Portable U/S Images will then be moved accordingly into correct Synapse Folder.
NP COVERAGENPs cover the 0434 pager from 7 am to 5 pm on weekdays (7.30 am to 5 pm on Wednesday). NPs will triage all patients, communicate with consult attending and anesthesiologist during the working day. At 5 pm, there will be a hand off to the call fellow with review of all inpatients and pending cases. The 0434 virtual pager will then be covered by the call fellow.
There are currently 4 NPs in the IR division (and 2 neuro IR NP). The NP responsibilities are divided by case type and attending physician as per the following link. |
REMOTE ACCESS (VPN) TO BCHWebsite: https://webvpn.childrens.harvard.edu/
Use hospital ID and password then fill in the codes using the VPN card provided. Internal web homepage: https://web2.tch.harvard.edu Help Desk: 24/7 including response to emails. E-mail [email protected] Tel: 5-4357 (5-Help). Further details including iPhone/iPad settings and mapping common drive are available at the following link. |