Call Resident
The on-call resident provides weeknight (5PM-7:30AM), weekend, and holiday inpatient and emergency room dermatology consultation for Saint Louis University Hospital, Cardinal Glennon Children’s Hospital and Wohl Psychiatric Hospital. Consults are to be handled in the same manner as consults that are called between the hours of 8am and 5pm on weekdays. On weekends the on call resident will see any consults called that day. Saving consults for the consult resident on weekends or weekdays is not acceptable. A completed consult note signed by or discussed with an attending must be in the chart on the day of the consult. When a consult is discussed over the phone with an attending, a sentence stating that the consult was discussed with the attending physician on-call should be put within the Assessment/Plan section of the consult note.
A 3rd year resident is also assigned as back up call at all times during the entire year. For any situation in which the on-call resident is called into the hospital they should call the 3rd year that is on-call and discuss the case with them. Based on the information at hand, the 3rd year resident can decide to go in to evaluate the patient or recommend further work-up to be completed by the on-call resident. If either the primary call resident or the back-up resident is uncomfortable with the case, the back-up resident will absolutely evaluate the patient directly. If the on-call resident and the back-up resident are both comfortable with the case, the primary on-call resident will call the on-call attending physician to discuss the case. If the on-call attending physician is unable to be reached within 30 minutes, the on-call resident should contact the Program Director or Associate Program Director.
The micrographic surgery and dermatologic oncology fellow should be called about surgery patients Monday-Saturday prior to contacting the on-call attending. The Mohs attending can be called on Sundays for surgery patients as appropriate. The attending can decide whether the 3rd year resident should go in to evaluate the patient (if they haven’t already) and finally whether the attending himself/herself should go in. In any situation where the attending ends up having to go into the hospital, the 3rd year resident should have already evaluated the patient.
If photos are taken of consult patients, these photos must be taken using Haiku, and uploaded to both the patient’s chart as well as the “Consult Pictures” folder on the Common Drive. Photos sent to attending physicians must be sent via SSM e-mail or Haiku and not by text message.
An on-call bag with supplies is kept either in the resident room at the SAP building or in the resident locker at CSM clinic. The call bag is to be carried with you so that you have supplies ready at bedside when you get a consult. The call bag CANNOT be left in the Central Distribution room. Again, it is to be carried with you during call hours and stored in resident room or locker after hours. It is the on-call resident’s responsibility to monitor the bag for supply and order refills from central supply. It takes approximately 2-3 days for new supplies (ie biopsy kits, suture, etc) to come in. Supply refills will be left in the Central Distribution room at the Lower Level of the SLU hospital (at the corner of Exceptional and Presence Street) for the consult resident to pick up. It is the consult resident’s responsibility to pick up supply refills as soon as they come in and restock the biopsy bag. It is imperative that the call resident pick up the supply the SAME day it is delivered and take it back to the resident room to restock. Extra supplies can be kept in the resident room.
Biopsy specimens should be hand-carried by the resident to the dermatopathology lab and should not be left on the floor or tubed down to pathology. For weekend biopsies, the Dermpath pool in Epic should be messaged to alert them there is a rush case . For frozen section biopsies, the path resident on-call should be paged. Biopsies and cultures should be performed and carried down to the lab on the Lower level of SLUH or ground floor of CGCH and not tubed down. Please be sure to include your initials, date, and time on all labels placed on cultures. See appendix G for further biopsy protocols.
If you cannot reach a certain extension when returning a page, make sure to check with both the SLUH (314-257-8000) and CGCH (314-577-5600) hospital operators to see which hospital may have been attempting to reach Dermatology—make sure to include area codes when calling back a page. Batteries for pagers are found on the inpatient floors. When on call or consults, the pager should never be turned off, set to silent or forwarded.
In addition to inpatient and Emergency Department consults, the on-call resident will answer calls from the SSM Access/Transfer Centers. See Appendix G for the Access/Transfer Center algorithm.
The on-call resident will also respond to patient inquiries phoned to the hospital and/or clinic. If a patient has an electronic record, urgent/emergent medication refills can be done when on-call; however, if non-urgent, the patient should be directed to contact the clinic during normal business hours or to send a MyChart message requesting the refill. Recommendations should not be made over the phone directly to patients not previously seen in our clinic (except to suggest evaluation by the ER or to set up an appointment with dermatology). All patient phone contacts are to be documented and the note placed in the patient’s electronic chart. These should be forwarded to the appropriate attending.
Junior residents will rotate on-call duties on a weekly basis and a schedule will be provided. Call weeks go from Friday afternoon to the following Friday morning. Call coverage is Monday through Thursday from 5PM to 8AM the next day. Weekend call coverage is Friday at 5PM until Monday at 8AM. The on-call resident covers holidays and certain other times (i.e. academic meetings).
On Sunday evenings and evenings following a holiday, the call resident should email the consult and on-call teams (including the consult and call attending physicians) with a list of current patients and things that need to be followed up on. If Dr. Siegfried has been involved with any patient care over the weekend or holiday, she also needs to be included on this email. See Appendix G for handoff procedure.
See Appendix EE for Mohs Bleeder Protocol.