MW - On Call
Remember to check in on BIKH residents & lists, help each other out!
(Traumas) AAST Injury Scoring Scale: https://www.aast.org/resources-detail/injury-scoring-scale
General Info
*IF reading a Body MR, ADD THE ADDENDUM!
Dictate all ER cases marked as "Verified" up to 15 minutes before the end of your shift
Dictate all Inpatient cases marked as "Verified" up to 1 hour before the end of your shift (11 pm for all Eve rotations)
Protocol inpatient studies through IDX (ED studies if confusing order or requested by Technologist)
Perform/dictate all US ordered 30 minutes before the end of your shift.
DO NOT call for an ultrasound after your shift, if you are not the one performing it
Ultrasound (Tech Hours)
Morningside
Weekdays: 8am -11pm
Weekends: 8am - 11pm
Holidays: 8am - 4 pm
West
Weekdays (Mon-Fri):
Starts 8:30am. Yuliana Alesker 5pm-11pm (last case 10:10pm, break 6pm-7pm, covered by Aida Lysenko)
Overnight coverage is Sunday-Thursday, Aliaksandr (Alex) Zharnasek 11pm-7am (break 3am-4am) no lunch coverage..last patient 6:10am. No coverage Friday night!
Weekends (Sat-Sun)
11am-7pm. Gee Wong.
Holidays:
No Ultrasound Tech coverage
*If the Evening US tech calls out sick, the resident on Peds-US backup rotation may need to be called in. Check with with Chief on Call before calling someone in for this!!! (+1 PD as they are a "backup" resident.
* If Overnight US tech calls out sick, the Mw Eve/Wm weekend resident is called in as part of regular Call duties. (no PD earned; do not notify Chief on Call).
*If called in overnight, but you have regular weekday duties (Peds-US backup), or called on Sunday night/Monday morning, the called-in resident may choose to come in ~8hrs after US is completed on Monday (i.e. finish at 2am, come in 10am) but must email that time to: (1) covering attendings/fellows/residents + and (2) cc MSWChiefs@mountsinai.org.
Communication
(Nonurgent) Epic chat for RH/SL inpatients:
"Front Line Provider"TEXT PAGE (Chrome only)
West/Morningside Inpatient FLOOR #s
CODE 23-4444
SECURITY 23-1000
READING ROOM NAVIGATOR
READING ROOM NAVIGATOR
Here is the MW Reading Room Navigator Liaison schedule (the RRN should be physically next to you in reading room; if they are late / for contact info please reach out to Nick or Divya)
Calling in reads
For acute or crucial findings, you may share the report with the following providers:
Ordering provider, responding clinician (e.g. resident, NP, PA)
Green Team Attending (if unable to reach ordering provider)
ER Charge nurse (only as a last resort if a provider is not available in timely fashion)
Is there a significant change for patient dispo following final attending review? See CALL OVERVIEW for appropriate action
Callbacks
Use this method for non-emergent callbacks for discharged patients from the ED @ MSW/MSM:
Macro 'Recall' in report
US Duties/Troubleshooting
If resident (not US tech), then:
Troubleshooting: Click here
Only testicular US required!!!
+US Pelvic at Morningside, NO Pelvic at West.
Otherwise, discuss urgency/need of other indications with Attending on Call
At West - key is in plastic shelf/bin behind Body MR resident station
At Morningside - US room 2 should be unlocked. If US room 2 is locked overnight, call Security at 23-1000 to have it unlocked
Any US expected to arrive at M/W after 11:00 PM must be accompanied by a chaperone.
Important Links
IT HELP
GENERAL HELP DESK 23-6486
RIS HOTLINE 212-844-5353
IT ON CALL
(Nights 6 pm - 7 am / All weekend)
Primary: 646-477-9798
Secondary: 917-572-7670
M/W Pagers
#33214 (M) | #35830 (W)
Please stop page copying the M and W 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 M/W pagers to your personal pagers.
Follow instructions below:
Step 1: 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.
Step 2: Forward the call pager to your personal pager is as easy as forwarding phones remotely
Dial “05” (in hospital) or dial 212-523-2828 (outside)
Dial 2 (“to change status")
Dial 33214 (M pager) or 35830 (W pager)
Dial 5 (“covered by”)
Dial your pager number
Press “2” to confirm
Daytime (8:00am-4:00pm)
CXR covers both MSM and MSW pagers 8:00am-4:00 pm
Eve + NF residents
At start of shift - forward M or W (or both) pagers to your personal pager at beginning of shift
At end of shift - forward M or W (or both) pagers at the end of your shift (Remember - Mw NF resident covers both sites)
Phone numbers
To enlarge the below Reading Room images, right click on the image --> Open image in new tab!
MRI TECH ON-CALL
#1: VERIFY PATIENT LOCATION
What are EMERGENT INDICATIONS (click this link) for MRI Tech ON-CALL?
CHECKLIST(CLICK) before calling MRI Tech ON-CALL
MORNINGSIDE MRI TECH ON-CALL:
Call MRI Tech ON-CALL with the hospital phone/cell phone - based on this SCHEDULE (entire 2023 included; click on tabs at the bottom).
If no answer from both hospital and cell phone, leave a voicemail and send a text that you're trying to reach a MRI Tech ON-CALL.
If no response after two attempts and waiting 15 MINUTES after each attempt, CALL MRI tech supervisor Carlos Rodriguez Jr's – CELL PHONE
Non-HOLIDAYS:
8 am - 11 pm Technologist is ON SITE
11 pm - 7 am technologist is ON CALL
HOLIDAYS:
8 am - 4 pm Technologist is ON SITE
4pm - 7am Technologist is ON CALL
WEST MRI TECH ON-CALL:
Page West MR Tech ON CALL pager 32194
and/or Call # listed through pagingIf no response after two attempts and waiting 15 MINUTES after each attempt, call below:
Primary: Lead MRI Tech Ana's CELL PHONE
Secondary: MSW Operation Manager James' CELL PHONE
Mon-Fri
7 am - 11 pm Technologist is ON SITE
11 pm - 7 am Technologist ON CALL
Sat-Sun
8 am - 11 pm Technologist is ON SITE
11 pm - 8 am Technologist ON CALL
MSM TRAUMA ACTIVATIONS (3/16/2020)
The CT technologist will call the resident or attending radiologist to alert them that a super stat study has been performed
If the radiology resident receives the phone call, please review and let the attending radiologist know as soon as you are done reviewing so that the attending can sign it off
MS URGENT CARE
See file on bottom of page with Urgent care workflow guidelines and contact list.
Contact appropriate specialty attending and notify patient is en route
Review study ASAP as it is completed and notify subspecialty attending.
If there is a delay in attending review, the most senior resident available can call in the preliminary results.
Dictate preliminary report and contact MS Urgent Care provider with positive and negative results.
Contact information:
Call provider directly via cell phone (contacts attached below), or
638 Columbus Avenue (at 91st Street); 212-828-3250
AFTER HOURS: Dr. Joseph Feldman, 347-920-7090 (cell)
Let radiology supervisor know the patient disposition.
(MSM (MORNINGSIDE ONLY!!!)
PELVIC US ALGORITHM
PURPOSE:
Outline indications for utilization of available radiology resources to obtain emergency ultrasound
POLICY:
Emergency Department ultrasonography coverage for patients presenting with OB/GYN emergencies requiring ultrasound will be covered by ultrasound technologists during scheduled hours and by the radiology resident on call for identified emergency indications during hours without a designated ultrasound technologist on site.
PROCEDURE:
Radiology is staffed by ultrasound technologists during the following hours:
Monday-Friday 8a – 7pm (last scan 6pm)
Saturday and Sunday 11a – 7p (last scan 6pm)
Ultrasounds may be ordered for gynecologic emergencies and will be interpreted by radiologist on duty or on call through normal EPIC order process and reading procedure.
During hours when an ultrasound technologist is not in house, radiology residents will scan these patients.
Requested exams through EPIC will also need a direct call to the radiology resident.
However, if an issue arises from a request to do a scan by a radiology resident that cannot be easily resolved between the provider who ordered the scan and the radiology resident, then a discussion should be escalated to the attendings of the respective services (ED, Radiology, and/or Ob/Gyn) currently involved in the care. If the clinical case warrants, the escalated discussion can include attendings from all three services (ED, Ob/Gyn and Radiology).
All sonograms performed by the radiology resident will be read by the radiology attending on duty or on call through normal EPIC order process and reading procedure.
Indications for emergency ultrasound include but not limited to the evaluation and work up of:
Severe undifferentiated pelvic pain
Pregnancy of unknown location
Bleeding in the first trimester
Severe abnormal uterine bleeding
This is to add in the diagnostic work up of possible gynecologic emergent diagnoses such as ectopic pregnancy, ovarian torsion, tubo –ovarian abscess, etc.
GYN consult 33463 for 2nd trimester pregnant patients (13 wks and Up)
Full Policy (PDF below)
NOTE: Emergency Medicine and Ob/Gyn have discretion to discuss additional emergent indications for Ob/Gyn sonography. The studies should be discussed by the Emergency Medicine attending, Ob/Gyn Attending, and the Radiology attending to discuss feasibility and expected yield.
If the radiology resident is not available for conducting the study emergently due to other emergencies and duties or if the radiology resident is not qualified to perform the ultrasound examination, the Emergency Medicine attending and GYN attending will determine the next steps in the care of this patient.
The Emergency Medicine Attending will be the lead in the triage of the need of the ultrasound in relation to other emergent radiologic procedures that are needed in the ED.
When patient transfer is required, Emergency Medicine and GYN will coordinate transport through MSHS transfer service.
QUALITY ASSURANCE:
All Ob/Gyn ultrasounds performed by the Radiology resident during hours ultrasound technologist is not available will be reviewed by MSHS telemedicine, Radiology, Ob/Gyn, and Emergency Medicine for compliance with policy for indications.
TRANSVAGINAL (TV) US PROBES & TROPHON
4 pelvic probes will be put into room 1 at Morningside (across the ballroom) by Pam the late tech before she leaves
Cleaning will be handled the same way as at BI (instructions below)
The trophon machine is the same at BI, and can be used if there are more than 4 pelvic ultrasounds are requested during evening hours.
The code for the trophon room is 1+3 (press together), then 2
If the resident on call is too busy with reading cross sectional studies, the pelvic cases may be delayed and thus you can suggest to the ED that they may need to transfer the patient to a different facility or wait for a next day ultrasound by the sonographer, at their discretion
Further details regarding the cleaning procedure at BI (similiar procedure should be used at Morningside)
After using trophon transducer with the probe cover:
Put on gloves
Remove transducer cover
Get red box and bag ready
Wipe entire transducer with sterile wipe to remove all ultrasound gel
Place transducer in red biohazard bag and then in red box
Write patient info (Name, MRN, ACC, Date , Time) on a piece of paper or use the printed patient order form and place either one into the red biohazard bag with wiped probe for proper idenficiation
Remove gloves and wash hands
Take red box to trophon room
Place red box on counter
In the event that you have more than 4 pelvic ultrasounds overnight, you will need to clean the probes prior to the 5th exam. Turn the trophon machine on prior to your 4th pelvic study in order to warm the machine up, otherwise you will have to wait once you return plus the time it takes to clean the probe. Do not use a used/dirty probe on a patient. It is not hygienic and unethical.