VIR - ON CALL

MOUNT SINAI ATTENDING SCHEDULE/INFO:

• Mount Sinai attending schedule (intranet)
  
  

FELLOW SCHEDULE:

• MSH Fellow schedule (click Schedule tab)
  
  
  

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 (BI control room 20-2002 and 20-2231)

• 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 Epic smart phrase (search for Consult Note in search box, or copy the note template from a co-resident/fellow).

• Look up info in 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.”

 HOSPITAL ACCESS ON CALL

• • Hospital front entrances are open 24/7  (make sure to wear hospital badge)

    • If ever locked, enter the hospitals through the ER entrances

      • At RH,  ambulance entrance - door code is 911

  • Save your cab receipts from call for reimbursement by Paula

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

BIOPSIES

• Thyroid US FNAS:

  • Dept of Pathology at MSDUS, 212-844-6001

  • Dr. Chen 917-349-9221 

• West H&N biopsies

  • Consultation to Dr. Khorsandi

• East/Main Hospital biopsies

  • MSH Neuroradiology Janice Cardoza at janice.cardoza@mountsinai.org or 212-241-4536

• Bone Lesion Biopsies

  • Dr. Etan Dayan and Anita Sanchez biopsy coordinator

  • anita.sanchez@mountsinai.org or 212-241-8376

• Lung Biopsies

  • Dr. Yankelevitz and Natalie Mckenzie biopsy coordinator

  • natalie.mckenzie@mountsinai.org or 212-241-8243

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.