TCH Call Guidelines
TCH General Call 2019
Surgical services add cases after hours/weekends by via the clinical coordinator (405) 417-2225. The clinical coordinator will facilitate communication between the surgeons and the on call anesthesiologist, they can also inform the anesthesiologist of upcoming cases. They will, also, call in the circulating RN and scrub tech once it is determined that the case will proceed to the OR. The anesthesia attending is responsible for communication with the on-call resident, Back-up CRNA, or call back-up attending (CB) if needed. The team must be in the OR within 30 minutes of being contacted.
Non-emergent but urgent cases (not emergencies for which you would need to proceed despite NPO status) after-hours/weekends are first come-first serve. We cannot guarantee a scheduled time for cases after-hours/ weekends. This includes attempts to "schedule” an early a.m. start in the OR before the scheduled first-case start on week days or the first urgent case start at 08:00 on weekends as this can potentially bump cases without the other surgeon’s agreement. The pediatric surgical services have agreed to adhere to this policy. If a surgeon wishes to bump another surgeon’s urgent case, this must be arranged between the surgery attendings. This communication can also be facilitated by the clinical coordinator. If the case is a case outside the OR (OUMC or remote site) your backup (CB) may need to be called in.
Weekday TCH general call:
TCH anesthesiology attendings are on 24 hour call M-F 07:00 - 07:00. After the OR cases are completed and patients signed out of PACU/stepdown, we take "home” call including overnight pain call for pediatric inpatients. CB is available for emergent cases if there is an on-going case and the OUMC attending 271-0721 cannot supply another resident/CRNA.
Weekend TCH general call:
TCH anesthesiology attendings are on call Saturday and Sunday day (0700 – 17:00) or night (17:00 – 07:00) The weekend day attending takes the next Thursday call with the post call Friday and the night attending takes that post-call Monday off. If an attending has a preference for 24 hour call, please let Dr. Vollers know. Attendings may arrange to do 24 hour call on Saturday or Sunday. If so, the Saturday attending will typically have the upcoming Thursday call and the Sunday attending will be post-call Monday. If adjustments are made to your weekend call, notify the page operator (405)271-3636 and clinical coordinator (405)417-2225.
Weekend Backup attending for Friday 07:00 – Monday 07:00 will round on acute pain service patients and take pain call Saturday 07:00 – Monday 07:00.
On weekends, cases generally start at 8am (patient in-room time). If you have not been made aware of any cases for your weekend call day, contact the clinical coordinator (405) 417-2225 by 06:30 to find out what cases are booked for the day.
Please call your relief attending on weekends/holidays, or the board runner on regular OR days, to make them aware at least one hour before relief time if you are in the OR and want to be relieved on time.
Holiday attendings will alternate 24 hour call and backup days. The call attending will also round on pain patients and take pain call overnight.
Pharmacy/Pyxis
The OR satellite pharmacy is not open 17:00 – 06:00 weekdays and weekends. We must get medications that are not in the OR pyxis from the Anesthesia workroom pyxis. All other medications must be obtained from the Main pharmacy on the 5th floor ext. 50144.
You can waste in PACU Pyxis with PACU RNs, but MUST return meds to the Pyxis from which they were obtained.
Resident Duty Hours
A resident/fellow must have 10 hours off between shifts. If you must keep a resident who is not on general call past 20:00 (including transplant call resident) make sure the Anesthesiology Administrator on call (AAOC) and resident are made aware before 19:00. The resident should not stay past 19:00 if they are on any call the next day. If they are not on any call the next day and must stay after 20:00, they cannot start in the OR the next day until 10 hours after leaving. Ex// If the resident leaves at 21:00, he/she cannot return to work until 07:00 for a 08:00 start.
You may need to call the board runner and/or Anesthesiology administrator on call to make sure that OR will have adequate coverage the next morning. If a resident who is not on general call is kept or is called back and stays past 22:00, we should give him/her the following day off/post-call because the "5 hour strategic napping rule” comes in to effect.
Notify the AAOC if a non-general call resident is kept beyond 20:00 at TCH.
What to do when the OR calls at night/weekend
Golden four questions to ask when a surgeon calls to book a case:
1. Is the child NPO?
2. Is it an emergency/urgent? (if not obvious)
3. Does the child have any other health problems?
4. Who’s the attending surgeon?
It is best if a surgical attending calls as the surgical attending must verify that they are aware of the case, are ready to start the case, and will be readily available when the case starts. If a resident or clinical coordinator calls you please request that they provide you with the attending surgeon name/number so that you can contact them. If the resident does not supply a number for the attending. You can page them via the page operator (405)271-3636. Historically, we have accepted case bookings from the general surgery fellows and some chief residents, but the attending must confirm that they are aware of the case, the time they wish the case to start, the case is urgent enough to call in the call team and/or emergent enough to violate NPO status if necessary, and he/she will be on campus and able to present to the OR when requested during the case. The Pediatric Anesthesiologist may request that the Attending Surgeon be present to
assist if emergent care is anticipated at the time of induction. (see TCH Add-on and Emergency Case Rules from Dr. Letton)
Once you have accepted the case, please call the clinical coordinator (405)417-2225. The clinical coordinator will not call in the OR RNs/techs and PACU staff until contacted by Surgery or Anesthesiology attending.
All parties (anesthesiologists, RNs, scrubs, surgeons) are expected to arrive at the hospital within 30 minutes of being called. In general, we are able to have the patient in the OR within 1 hour after being called in.
There are no anesthesia techs afterhours/weekends, therefore, the resident is expected to turn over the OR after each case. However, if you have many cases going or a very labor intensive case (such as liver transplant, cardiac case, etc.), there is always a tech on-call (on the OR Call Schedule e-mailed by TCH RN), and you can call him/her to come in and help.
We don’t do sedations/general anesthesia in the ER or on the floor. If the child needs an anesthetic, the case should be booked in the OR.
For all calls it is expected that we stay in the hospital until the PACU/stepdown is empty. We are responsible for these patients, including patients waiting for an ICU bed.
Pediatric airway calls after hours/weekends
After hours/weekends the pediatric anesthesiology attending may be contacted for intubation assistance in the TCH hospital. The pediatric anesthesiology attending should head directly to the patient location for assistance and advise them to contact ENT call attending if not already done. If the pediatric anesthesiology attending is outside of the hospital, she/he should contact the OUMC attending 271-0721 and/or the OB call attending (listed on the anesthesiology department daily schedule email) to see if they are available to bring equipment/assist until you arrive. If you are unable to leave a patient in the OR when called after hours for an airway (i.e. coding a patient), have the clinical coordinator contact the backup attending as well as OUMC attending or OB call attending.
Sedated MRIs after 17:00/weekends:
Call team does not do elective MRIs on nights/weekends. MRIs done on nights/weekends must be an emergency/urgent (i.e. stroke, epidural hematoma, +/- osteomyelitis, or will change treatment decisions immediately). (see MRI communication flow chart)
1. Ordering physician calls anesthesiology attending (who asks the golden four questions + Can the decision be made with appropriate alternative imaging?) Decision making may involve the attending radiologist (neuro for brain/spine, peds for others). Radiology resident on call ext. 37860 or 37823, can forward you to their attending. If MRI tech calls first
2. Once sedation for emergency/urgent MRI is approved by anesthesiology attending, ordering physician then orders MRI via Meditech.
3. Anesthesiology attending will call MRI tech via hospital page operator (405)271-3636 in order to arrange time of scan and determine if elective MRIs are occurring on Saturday.
4. Confirm that MRI tech has arranged for MRI PACU nursing.
Saturday 7am-3pm back-up CRNA
Nursing may have a second crew if 2 general ORs need to be utilized on a Saturday between 07:00 -15:00. We can supervise 2 operating rooms by supervising the call resident and the back-up CRNA during this time. Calling in the second RN crew is to be arranged by the TCH OR RN ADMINISTRATOR ON CALL. The on call anesthesia attending approves calling in our back-up CRNA.
After 15:00 on Saturday or on Sunday, if a second crew is needed in the TCH OR, we must call the OUMC call attending to ask for a resident or our CB in order to staff a second room.
Running two general sites on call
If a TCH general case is in the OR and a pediatric emergency arrives that requires a pediatric anesthesiologist emergently at TCH, ask the OUMC attending if they can supply a resident to run another room, if no resident is available, call in the CB. If the case is emergently going to OUMC OR and the OUMC attending is not able to care for the child, call in the TCH CB attending and decide between you both who will cover which case.
Pediatric level one traumas arrive in the OUMC/adult ED. If they must go immediately to the OR, it will likely be the OUMC OR. Pediatric anesthesiologist typically called to OUMC OR for patient 6 y/o or younger, or complicated patient/case 12 y/o or younger at the discretion of the OUMC attending. If called to an emergency case at OUMC, whether you are call or CB, you must arrive within 30 minutes to the OR to assume the case from the OUMC attending.
If another nursing team is needed for the TCH OR afterhours/weekends or a TCH nursing team is requested at another location, it is arranged by the TCH OR RN ADMINISTRATOR ON CALL after we have approved/arranged anesthesia staffing for the other case.
Transplants
There are 3 separate nursing teams on-call at all times; general OR, cardiac, and transplant. There are 3 anesthesia attendings on-call (CH/CB/Cardiac). There is one anesthesia resident on general call at TCH. If a 2nd resident is needed (due to a cardiac case/transplant/emergent case in addition to a general room), please call the OUMC board runner/call attending (405)271-0721 and ask for another resident. The AAOC can help facilitate this. Sometimes the call attending or CB will need to work solo and/or "share” the resident in order to run 2 rooms afterhours/weekends. You can call in an anesthesia tech on-call in call for complex cases.
We cannot run two concurrent general TCH ORs in the following circumstances:
-Transplant: must have resident available for transplant and CB or CRNA (Saturday 07:00-15:00) for emergency general cases
-Cardiac case using call resident: if resident staffed in the heart case and CB or CRNA for general cases
-OUMC pediatric case on-going: need to call in CB attending there are simultaneous cases at TCH and OUMC)
-MRI: need to call in CB attending if there are simultaneous cases in TCH OR and emergency MRI
-Medically complex/unstable patient that requires single-coverage
There are two Anesthesiology call rooms located in the "outback” near our administrative assistant. One for attending and one for Resident/Fellow. Your red OUMC card should give you access to the call room. If the room needs new sheets/cleaning, contact housekeeping.
Important phone numbers:
OUHSC hospitals: 271-8001 , 1, Extension
Page operator: 271-3636
Clinical coordinator: 417-2225
PICU attending: 271-5261
NICU: 271-5266, NICU East work room: 271-4545, NICU West work room: 271-5213
OUMC board runner/Call attending: 271-0721
TCH OR front desk: 271-4746
Children’s Hospital OR Answering Machine: 271-8088 (for surgeons to post cases to be done during regular hours)
Main Pharmacy: ext. 50144
Day time radiology attending: ext. 35403
After-hours radiology resident: ext. 37860 or ext. 37823.
Blood Bank: 271-6222 or 271-7717
Lab: 271-6161
Interpreter: 417-2978
Maintenance: 271-4190
Housekeeping weekend super: 417-1417