Pager Coverage and Night Callplan AY2016-2017

Pager Coverage and Night CallPlan AY2016-2017

Call System2016-2017

Inpatient and Consult Fellows
Weekdays 7AM- approximately 5PM
Each fellow covers their respective service’s calls
VCUHS ED, transfer center, and clinic calls for admissions
VCUHS and VA consults
On-call Inpatient fellow
Nights (Weekday and Weekend) 5PM-7AM
VCUHS ED and transfer calls
VCUHS and VA clinic call (clinic calls start at 4:30PM)
VCUHS and VA consults
Weekend days 7AM-4PM
VCUHS ED and transfer calls
VCUHS clinic call
On-call Consult fellows
Weekend days 7AM-4PM
VCUHS consults
VA consults
VA clinic calls

VCUHS Faculty
Covers admission pagers for the hematology and oncology inpatient services during fellows’ continuity clinics
Back-up to fellows and in-house nocturnist for all VCUHS matters

VA Faculty
Back-up to fellows for all VA matters

VCUHS Heme-Onc Call Management Procedures

Team Census and Composition – NO CHANGE FROM CURRENT SYSTEM
Should be maintained***
No solid tumor oncology on Hematology
No benign hematology on Oncology
Team Census
Oncology
Floor census ~14 – above which “non-essential” admissions can be declined
Maximum census 16 – not to be exceeded unless system-wide disaster
Hematology
Floor census ~16 – above which “non-essential” admissions can be declined
Maximum census (may go up to 20, though should only take acute leukemia patients or similarly urgent matters that absolutely need the hematology team services and would be poorly served elsewhere – not to be exceeded unless system-wide disaster)
Decision and Supervision procedures
Admissions and Transfers
System alerts
If system is “surge” or “disaster” level, outside transfers are restricted to those diagnoses that are considered essential. This DOES include acute leukemia transfers, i.e. acute leukemia patients can be accepted even when restricted.
For other diagnoses, assess the situation. If you feel patient care cannot be taken care of safely at another facility, then inform them that the system is on diversion status and that you will explore options and get back to them within “x” minutes. Discuss with the attending who if agrees will discuss with the transfer center and the MAA to make a final decision as to whether the transfer can be accepted.
Once a final decision is made, notify transferring attending of the decision. If the answer is no but the transfer is otherwise reasonable, advise them that they can call back to the transfer center and that the request can be reconsidered if the system constraints change.
If system is “high”, realize that if accepted and there is room on the hematology-oncology unit, things will move through quickly--discuss with charge nurse. If there is not room on the unit and none expected, you should contact the MAA to discuss the level of acuity compared with the other pending accepted transfers, especially if you believe the level of urgency is high.
Acceptance of an admission or transfer
Be sure to assess
Level of care needed
Vitals and safety for transfer
Send pager message to notify the service’s attending and to the on-call attending (if not the same person).
Admitting against planned discharges
This is the expectation.
DO NOT WAIT until the discharge is “out the door”
Admit against expected discharges for the day
Helps throughput and provider daily work flow
If discharge falls through, that is OK. Catch up if need to by letting census drift back down.
Night admissions.
DO NOT admit more than 4 night admissions without first discussing with the in-house attending nocturnist.
Remember that the night teams are also admitting to general medicine teams. Their total volume -work intensity must also be considered.
Contact the in-house resident and nocturnist regarding the admission.
If daytime transfer has not arrived at shift change, please make sure to communicate to the night team regarding the accepted transfer-admission
Declining an admission or transfer
Due to census / diagnosis guidelines (see above)
Discuss with attending at the triage supervision meeting
Due to non-census considerations
Notify and discuss with the attending before declining
Discharge from ED
Notify attending if the ED appears to be calling for “permission” or a “recommendation” to send home, if necessary.
We do not do make such recommendations or determinations without seeing the patient. You may offer general comments/thoughts unrelated to the specific patient situation, but you should be VERY careful about such.
BE CAUTIOUS, AS CURBSIDE CONSULTATION IS NOT ADVISABLE SINCE YOU HAVE NOT DIRECTLY AND FORMALLY EVALUATED THE PATIENT, THUS EXPOSING YOURSELF AND THE ATTENDING TO LIABILITY
If true consult is requested, ask them to place the consult in the computer system. It will hen be routed to the fellow covering the consult pager. If that is you, then go see the patient.
No need to discuss with the attending if the call was simply to notify of their plans to discharge
Send communication as indicated to the outpatient provider
Coordination between the Hematology and Oncology should be handled directly and internally (i.e. in general, do not refer the requesting source to call the alternative team though educate them where appropriate)
Coordination with the Palliative Care team should be handled directly if doing so for reasons other than service caps being exceeded. If census is at service cap and think appropriate, you can suggest to the requesting service that they call palliative care team.
If defer someone to the MAA, please contact the MAA to give them a heads up and discuss any hematology-oncology specific matters/concerns.
Consider contacting the MAA with admissions that might be general medicine appropriate particularly if have limited admission capacity on service (regardless of the source). They will be aware of general system capacity and possibly of more acute service-appropriate patients.
Clinic calls
Make sure to send a courtesy notification regarding the message/page and any action taken to the outpatient provider
Supervision
Discuss your triage decisions with the on-call attending the following work day

Call Schedule Schematic

Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
Inpatient
Hematology Week 1 / X / X / Off * / X
Hematology Week 2 / X / X / X / X / Off *
Oncology
Week 1 / X / X / X / X / Off *
Oncology Week 2 / X / X / Off * / X
Consult
VCUHS Week 1 / Consult pager day coverage only / Off
VCUHS Week 2 / Consult pager day coverage only / Off
VA
Week 1 / Off / Consult pager day coverage only
VA
Week 2 / Off / Consult pager day coverage only

X= After hours pager coverage

Clinic Calls

Clinic calls start at 4:30PM on Mon-Fri and 7AM on Saturday/Sundays

Clinic calls end at 8AM Mon-Friday and 7AM on Saturday/Sundays

Consult Services Calls

Consult calls start at 5PM on Mon-Fri and 4PM on Sat-Sun, Holidays

Consult calls end at 7AM daily

Inpatient Services Calls

Service calls start at 5PM on Mon-Fri and 7AM on Saturday/Sundays

Service calls end at 7AM daily

Off* = 24 hours from 7AM-7AM

VIRTUAL PAGER NUMBERS

Hematology Inpatient Ward Fellow (9923)

Oncology Inpatient Ward Fellow (9928)

Hematology Oncology MCV Consult Fellow (9914)

Hematology Onc Consult Fellow VA (9915)

Hematology Oncology Dalton Afterhours (9899)

Hematology Inpatient Ward Attending (9891)

Oncology Inpatient Ward Attending (9892)

Pager Coverage and Night CallPlan AY2016-2017

ADMISSIONS FROM VCU ED, Transfers, and VCUHS clinics:

Oncology (Solid Tumor) Inpatient Service calls VP#9928
Hematology (Benign and Malignant) Inpatient Service calls VP#9923

Consult Calls:

VCU Health Consult calls VP#9914
VAMC Consult calls VP#9915

Clinic Calls:

Monday-Friday not Holiday (8AM-4:30PM/CLINIC CLOSURE):
Covered directly by the respective clinic
After hour calls on Weekdays and calls on Weekends and Holidays
Dalton clinics  VP#9899
VA clinics  VP#9915