Nightfloat Information

Last updated 5/12/2012

Hours

Weeknights 9pm-8am. Morning checkout 7am.                                  
Weekends & Holiday Nights 5pm-8am. Morning checkout 7:30am

* Page staff if not there by 7:30am weekday or 8:00am weekend!

Duties

Note: Read all ER/Inpatient studies with Staff under Draft until about
           10:30 PM Mon-Fri except CTAs, which are read under TUH Prelim. 

1. Read all ER / Inpatient studies: Split between the two residents on call.
        -Use "Recently Performed + TUH/MAB/Drake" or "On Call-Resident"
            filter. 
        -Wait for the studies to be stamped "OK" in McKesson before dictating.

2. Review all Portable & CXR:  Use "All CR Reviewed" filter.
        -Dictate/call critical changes then checkout those studies in the
            morning.
        -Otherwise, assign to yourself and it will be dictated by staff later.

3. VA Studies: Use "VA Cincinnati Medical Center Workgroup" filter.
        -VA tech should call to inform you and fax study information (CT & XR).
        -Read the study and call the results to the ordering physician.
        -You can now access VA CPRS via RDC.
        -Email a preliminary report and who/when you called using vaprelim.
        -Friday or Saturday night checkout the studies with morning attending.
        -Additional information including contact numbers found here.

4. Emergent MRI: Stroke (Brain w/ & w/o) or Cauda Equina Syn (L spine).
        -Call the MRI tech in if they are no longer in house (Pager 269-4380).
        -Call the ER techs at 4-5845 to find out who is on call if needed etc.

5. MSK Studies: Occult fractures and infections (septic hip/fasiitis).
        -Call in the MRI tech (Pager 269-4380) or via the ER tech 4-5845.
        -MRI tech should have protocol, basically T1 and T2 in every plane.
        -Review all MSK CT and assign to yourself if no significant
            abnormalities.
        -Dictate critical findings under TUH Prelim and leave a note for Staff.
        -Guidelines for reading emergent MSK studies.       

6. Ultrasound: U/S tech on call until 11pm (Schedule on wall).
        -After 11pm, you are the official technologist.
        -Perform and interpret emergent studies: Ovarian/testicular torsion,
            renal transplant, and liver transplant. 
        -Check out Dr. Squire's awesome Ultrasound Guide for the basics.
        -Liver Doppler Made Simple article.
        -Any pregnant patients are covered by the OB service.

7. Emergent Fluoroscopy: Anything you deem "emergent".
        -Esophageal perforations (Gastrografin) or LP.
        -Talk to the techs to work out timing etc.

8. IR Coordination (Body and Neuro): IR calls will be handled by you.
        -You can page the IR resident/fellow or IR attending on call as
            necessary. 
        -Try to determine if it emergent or not and collect the information*.
        -Staff will determine whether or not to do the case.
        -Ask staff if they want the fellow/resident called in and when.
        -Document patient calls on the IR Phone Sheet in the call room
            and place them in IR Reading Room to be addressed the next day.
        -The all-page number is 577-0404. Make a notation of who calls back.
        -PICCs are not performed on the weekend or on call.
                *Info: Pt name/MRN, Physician and contact number, clinical course,
                    relevant labs (Coag, PLT, ect), Can patient consent/agree
                    to procedure?

9. Nuc Med Coordination: Typically V/Q, Heart ER, and GI Bleed studies.
        -Page the tech on call with the information* for the studies.
        -Call schedule is on wall of the Abd Reading Room.
        -Studies are read out by staff at home and called to the ordering
            physician.
            *Info: Name, MRN, Ordering physician, phone # to call results, and ER
                room #.  (Negative CXR w/in 24 hrs for V/Q)

        -Inject "Heart ER" studies after 11pm Mon-Thurs, otherwise call the tech
            (Rey) at 4-2287 or overhead page 3150.
        -Review this ACS Protocl. Lockbox code in Nucs hallway: 1&5, then 3.
        -Check to make sure doses are not expired prior to injection.
        -If expired, page the tech to come in and make a dose. This takes 3-4
            hrs so make sure the ED doc still wants the study.
        -These are scanned at 5am when the techs come in, except Fri after
            6pm until early Monday morning when you need to call the tech to
            come in.
        -Page the tech with any questions.
        -It helps to check the lockbox prior to your shift to see when doses
            expire.

ED Tracking Guide


Checkout Tips

1. Assign Body CT: Assign the studies to yourself overnight and do not assign Neuro studies so the “assigned to” field is an easy way to re-open the cases.

2. Addend CTs with "Agree": Immediately after signing the Body CT reports in Powerscribe under TUH-Prelim addend an “agree” to the study and save it under the staff. This will allow you to type additions on the separate workstation during check out and prevents forgetting cases since they will still be in your queue. This also allows you to review the initial report by using History in Pscribe.

3. Use Prelim All Night: Select Prelim-TUH as staff with initial PACS login. This will assign all your reports to Prelim (XR, Body, and Neuro).  Use Prelim will keep studies in your list. Approve ER CTs and Neuro studies. Toward the end of the night change Attending to your AM checkout.

4. Saving Inpatient Studies: Some non-urgent inpatient studies can be held until the morning check out.  Dictate studies and click draft rather than Prelim or Approve. Remember to change Staff from prelim to your morning check out in your queue. Be aware that no one will see your report (i.e. inpatient CTPA will be expecting a preliminary report).

5. Review Prelim Report Addendums: Under Pscribe you can search for reports with an addendum. Look for the Neuro studies. Your overnight Neuro reports will have your name towards the bottom.

Discrepancies/Additional Findings

- Noncritical findings can be addended to the original report without calling.

- Changes that would change clinical management must be called to the primary team or ordering physician and documented in the report. If the patient was sent home, contact the A-Pod ER attending physician at 4-2636 and document in the report. Fill out the discrepancy form and fax it to the ER. No need to walk it down.

- Changes that require followup but are not emergent in nature (i.e. Followup CT for pulmonary nodule etc) can be submitted to Kathy Hamilton, RN in the ER. Fill out the discrepancy form and fax it to 584-2642 or slide it under Carolyn's door with note to submit to Kathy.


Important Numbers

Front Desk 4-4391

ER Techs 4-5845

Main Techs 4-0638

ER CT 4-1971

Main CT 4-0611

MR Techs 4-1095

Nucs Techs 4-2287

US Techs 4-1646

Nucs Overhead Page 3150

Radiology Overhead Page 3737


A-Pod Attending 4-2636

A-Pod Resident 4-2655

A-Pod PA 4-5186

B/D-Pod Attending 4-2639

B-Pod Resident 4-2620

D-Pod Resident 4-2675

I-Pod/Minor Care 4-5131

ED Charge Nurse 4-2630


CCU 4-6580        CICU 4-7262

CSD 4-4890        MICU 4-2550

NSICU 4-7273        SICU 4-4433

SDS 4-7300        PACU 4-7575

4N 4-7000        4E 4-2201

5E 4-8300        5NW 4-8070

6N 4-2290        6S 4-4733

7NW 4-2250        7S 4-4954

8S 4-3189        8N 4-4268

8CCP 4-3280        9CCP 4-4260


Drake 418-2500        Drake 8-2892

MAB CT 475-8760

University Pointe CT 475-8085

Children's Stat Box 636-6286

VA Hospital 861-3100

VA Jr x4296        VA Sr x5281

VA MR x5400        VA PACS x5628

VA CT x4290/4291 or 475-6547

VA Paging System 475-6550

In-House Paging


3D Lab 4-2789

Abdomen CT 1 4-2788

Abdomen CT 2 4-6213

Abdomen CT 3 4-2452

Body Overflow 4-6232

Bone / ER 4-2786

Chest CR 4-0633

Chest CT 4-4876

Chest Portables 4-2334

IR Desk 4-0602

MSB 3T 558-3881

MSK MR 4-2787

Neuro CT 4-6376

Neuro MR 4-0621

Neuro Overflow 4-0926

Nucs 4-9052

Ultrasound 4-3893


Rose 4-6484

Evelyn (Childrens) 636-4504

Maria (Neuro) 4-7544

Princess (Body) 4-2146

Julie (VA Coordinator) x4299


Long Distance Code: 9849239


CT Resident Pager 269-4657

ER Resident Pager 230-3681

IR All-Page 577-0404

MR Tech On Call 269-4380

On Call Room 4-2004

Resident Room 4-1991

Rick or Karen (PACS) 40689/40682

Bob Staton (Powerscribe) 4-0644/269-4831



Forward Phone: *3 Number. #3 to clear.

Listen to Batch Read Dictations: 4-2330, enter Lastword number, then MRN (Used often by Dr. Choe)

Helpful Resources:

Stat Dx

Pulmonary Nodules

Renal Cysts

Liver/Spleen Lacerations

Gadolinium Dosing

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ACR CIP

E-Anatomy

MSK MR Anatomy

Radiology Assistant

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UC EMR