Call Duties

Call Distribution

• Call duties are divided equally between fellows and IR residents
• Prospective coverage arranged for vacations and absences
• Initial call schedule created for first month
• Schedule changes require agreement between both fellows
• Chief fellow communicates changes to schedule coordinator: Ethan Bremner​

Daily Handoff Responsibilities
At 5:00 PM:

• Virtual pager 0434 transfers from NPs to on-call fellow
• Obtain verbal sign-off from NPs before the end of the business day
• Review all inpatients, pending cases, and patients in PACU awaiting discharge
• Review and assign all cases for the following day
• Obtain consents for all inpatients scheduled for the next day (including phone consents if necessary)
• Place completed consents in the "signed consents" folder in control room 14

Dialing Instructions:

• Hospital numbers starting with 5: Dial 617-355-[number]
• External numbers from hospital: Dial 0 + number (NOT 9)

Call Team Information

• Contact information posted on the whiteboard in control room 14
• Take photo of call team information for reference

Case Approval and Coordination

• After case approval, the fellow contacts call team via phone or pager
• **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**
• Share written patient information only through HIPAA-compliant methods:
  • Hospital email
  • Vocera

Anesthesia Cases

• Timing coordinated between IR Attending and OR Anesthesia board runner
• If an anesthesia case is booked for the following day, the IR Attending/fellow will contact team once there is communication with anesthesia with regards to timing.

Call and Add-On Case Procedures
For ALL call and add-on procedures, obtain:

• Patient name
• MRN (Medical Record Number)
• Diagnosis
• Procedure requested
• Referring attending and service
• HCG status (if applicable)
• NPO status
• Guardian availability for consent
• IR consult entered in Epic

Critical Guidelines

• NEVER guarantee an add-on procedure
• Tell requesting service: "We will discuss in morning rounds and get back to you"
• Have them make patient NPO after midnight in case procedure can be added

Case Urgency Protocols
Urgent Cases:

• Discuss with IR Attending immediately
• Formulate plan and coordinate timing with technologist and nurse

Less Urgent Cases (e.g., GJ tube changes):

• Notify attending, technologist, and nurse with plan and timing the night before

Questionable Indications:

• Consult with attending on call
• Avoid unnecessary debates or arguments
• If declining procedure after imaging review, write brief IR Consult note including clinical review and recommendations

Overnight Add-Ons

• Email same night (or before 6:30 AM) to: IR Add On-dl
• Use appropriate email templates

Patient and Family Communications
Phone Call Protocol

1. Identify yourself: State name and title (IR Fellow)
2. Verify patient: Name, DOB, MRN if possible
3. Gather information: History, duration, new vs. recurrent symptoms
4. Review records: Most recent intervention date/type, clinical notes, procedures/imaging in PowerChart and Synapse
5. Consult attending: Discuss with IR attending
6. Document: Create "Phone message/call" note in Epic

Weekend Responsibilities
Inpatient Rounds

• Performed daily on weekends and holidays
• Coordinated with attending on call
• Review all patients on service
• Communicate findings and plan to patient's nurse or physician

Documentation Requirements

• All inpatients require IR Progress Note on Saturday and Sunday
• Document type: "Interventional Radiology Consultation"
• Subject line: "IR Progress Note"
• Copy/modify previous day's NP note as needed
• Update IR patient care list on Epic

Weekend Sign-Out

• Email IR Pt List-dl on Sunday evening
• Use weekend sign-out template

Time Off Policy
Overnight Cases (11 PM - 6 AM): Fellows receive equal time off in morning for overnight procedures.
Example: Hip tap performed 1:30 AM - 3:30 AM (2 hours) = Join IR team at 9:00 AM instead of 7:00 AM

Procedure-Specific Guidelines
GJ Tubes
Authorization:

• Can be performed independently once signed off by fellowship director

Scheduling:

• Coordinate timing with technologist and nurse on call
• Performed weekends 8:00 AM - 6:00 PM, 7 days/week
• Exceptions based on physician judgment and patient condition (e.g., trached patient requiring ICU admission)

Orders Required:

• Epic standing order required - If absent, page GI on call and place IR Consult for Exchange
• Procedure cannot start without correct order

​Patient Categories:
Outpatients (from home):

• Can come directly to IR (avoid ED)
• Arrival time coordinated by IR MD/Fellow, Tech, and Nurse

ED and Inpatients:

• Ensure IR Consult for Exchange is placed
• Standing Order and Department Order Entry cannot be used for ED/inpatient
• Patient should not come to IR until IR Consult placed

NJ Tubes

• Primarily placed by diagnostic radiologists
• IR consulted if fluoroscopy fails
• Elective procedure - not performed outside regular hours
• Exceptions based on physician judgment and patient condition

PICCs
Standard Hours: Monday-Friday, 8:00 AM - 5:00 PM only
After-Hours Exceptions:

• Only if child has no IV access AND all other services (surgery, anesthesia) have failed
• For anatomic reasons, discuss in Monday morning rounds

Important: PICCs can be contentious on weekends. Avoid arguments - refer difficult conversations to IR Attending.

Portable Cases
Requirements:

• Technologist and physician only
• IR Consult in Epic required
• Parent present for consent (or witnessed phone consent)

Hip Taps
Authorization:

• Performed by IR Fellow at IR Attending discretion
• Available 24/7 in ED
• Notify attending before procedure

Requirements:

• No technologist or IR nurse support
• Ensure ED prepared for sedation
• IR Consult with laterality (spell out "Right," not "R") required before procedure
• Portable U/S machine and Hip Tap Kit (clean supply room, back left)

Procedure:

• Manually enter patient info in portable U/S
• Perform timeout in ED
• Provide board runner with patient info and date for system completion next workday

NP COVERAGE

Weekday Coverage

• Pager 0434: 7:00 AM - 5:00 PM
• NPs triage patients, communicate with consult attending and anesthesiologist
• 5:00 PM handoff to call fellow with review of inpatients and pending cases

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.

IR NP Responsibilities

REMOTE ACCESS (VPN) TO BCH

Website: https://webvpn.childrens.harvard.edu/

Use hospital ID and password then enter the code from the Duo app.

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.

remote access