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On-Call Duties: Years 1 and 2
Franciscan Children’s Hospital
On-call duties at the Franciscan Children’s Hospital span a
two-year period. On-call for Monday through Thursday night is shared
by all 16 first and second-year residents. Each resident will have
an on-call responsibility one-in-16 nights on Monday, Tuesday, Wednesday,
and Thursday. Their responsibilities include carrying the beeper
from 5:00 p.m. to 8:00 a.m. Residents are required to call the Unit
at 5:00 p.m. to see if a new admission has arrived. They will be
called in to do new admissions who arrive between 5:00 p.m. and
11:00 p.m. on these days. Between 11:00 p.m. and 8:00 a.m., admissions
will be done by the in-house attending pediatrician. For each admission
performed by the in-house pediatrician, the on-call resident will
be called to review clinical findings, overnight treatment and orders.
Similarly, the in-house pediatrician will cover any emergencies
from 11:00 p.m. to 8:00 a.m. and call the on-call resident as needed.
If the in-house pediatrician needs a child psychiatrist to come
into the hospital between 11:00 p.m. and 8:00 a.m., one of the attending
child psychiatrists will be called. Residents will not be required
to come into the hospital during these hours. Residents will be
called for any problems with one of their own inpatients 24 hours
daily. There is an on-call staff member carrying a beeper to back
up the child psychiatry resident on-call every night of the week.
Residents are on-call every weekend of the year. This duty is divided
among all 16 residents such that each resident will cover approximately
four weekends per year. During the weekend, residents
will come to the Franciscan Children’s Hospital on Saturday
and Sunday morning to round on all the inpatients. Residents will
call the charge nurse prior to coming in to inform staff when they
will arrive. Generally, rounds will occur 9:00–11:00 a.m. The
resident will review each case with the charge nurse, write necessary
orders and see each child on the unit. The resident-on-call for
the weekend will be responsible for all admissions and emergencies
from 8:00 a.m.–11:00 p.m. on Saturday and Sunday. Residents
are not required to stay in the hospital but will be reached by
beeper. As on weekdays, coverage for admissions and emergencies
from 11:00 p.m.–8:00 a.m. will be provided by the in-house
staff pediatrician. For all admissions done by the in-house pediatrician,
the cases will be reviewed by phone with the on-call resident. Also,
as on weekdays, if a child psychiatrist is required to come in between
11:00 p.m. and 8:00 a.m., the attending child psychiatrist will
do so. As on weeknights, there is an on-call staff member carrying
a beeper to back up the child psychiatry resident-on-call every
weekend.
McLean Acute Residential Unit
(ART)
During weekend call, residents will admit any new patients to the
McLean Partial Hospital and Residential Programs. These adolescents
will first be admitted by the general psychiatry resident in the
McLean Clinical Evaluation Center (Admission Unit). The child psychiatry
resident-on-call must see each new admission within 24 hours. Hence,
following rounds at the Franciscan Children’s Hospital, the
on-call resident will call the McLean Partial Hospital and Residential
Program. If an adolescent was admitted Friday night, the resident
will formally admit the adolescent after Saturday morning rounds
at the Franciscan. Similarly, if a patient is admitted Saturday
night, the on-call child psychiatry resident will admit the adolescent
after Sunday rounds at the Franciscan. Any admissions to the McLean
Partial Hospital and Residential Program on Sunday will be admitted
by the resident on the Program during the day on Monday. The same
staff member carrying the beeper to back up the resident at the
Franciscan will do so for any weekend admissions at McLean Hospital.
MGH Acute Psychiatry Service (APS)
The rotation on the APS is under the direction of Dr. Laura Prager,
Director of MGH Child Psychiatry Emergency Services. All child and
adolescent cases seen in the APS are reviewed by Dr. Prager and
the chief residents, under her supervision. Dr. Prager works with
the Chief
of the APS.
During weekday and weekend call, child and adolescent residents
will cover the Acute Psychiatry Service at Massachusetts General
Hospital by back-up beeper call to the general psychiatry resident
at MGH. The following outlines the APS Child Psychiatry evening
and weekend coverage:
APS Child Resident Evening and
Weekend Coverage
1 For APS emergencies at night and on weekends, the FIRST CALL person
backing up the general resident on duty will be the child psychiatry
resident. A call list will be administered to the APS.
2 There will always be an attending backup staff person on the list
distributed to the APS and child resident.
3 If the APS general resident needs someone to come in Friday 5:00
p.m. to Monday 8:30 a.m. (weekends), the child resident goes in.
4 If the APS, in consultation with the child resident, needs someone
to come in Monday through Thursday evenings, the child attending
is prepared to go in. Usually, if there is a thorny problem, the
child resident, after speaking with the APS resident, should call
the child attending. If a child needs to be seen that evening in
the APS, the child resident and the staff person can discuss how
to handle the situation. If the child resident is tied up with admissions
at Franciscans, the staff person goes into the APS. If not, the
resident goes into the APS to evaluate the case. On weekends and
holidays the child resident, if called by the general resident,
will be the first to go in, if necessary. As on weeknights, the
staff backup should always be called for consultation.
5 For Pediatric Emergencies:
- If the emergency is on a pediatric ward and is URGENT, the APS
general resident, being the only psychiatrist in house, goes to
the ward. Then, the above sequence is followed.
- If the emergency is on a pediatric ward and is URGENT, the
APS, general resident being the only psychiatrist in house, goes
to the ward. However, for most “emergencies” in a pediatric
ward, including the NICU and PICU, the first call should go from
the operator to the child resident, not the APS resident. Then,
the child resident may choose to call the backup attending for
assistance. As above, if someone needs to go in on Monday through
Thursday nights, the attending is prepared to go in if the child
resident is swamped. On weekends, the child resident goes in.
APS should not be involved in pediatric ward emergencies unless
a psychiatrist is needed immediately.
- For follow-up: If a child needs to be seen on the wards after
emergency evaluation or phone intervention or if a child and family
need to be scheduled for a follow-up evaluation, there should
be ONE number that all the residents and/or attendings call to
make this known during evenings and weekends. This number will
be determined by the OPD director, such that a voice mail message
can be delivered to an intake staff person in the OPD. The message
can be retrieved the next day and appropriate calls for triage
can be made.
6 Daytime coverage for the APS involves an emergency coverage schedule
including a child resident on the Consultation Service and an attending
in–house and available for on-site supervision.
Holiday Weekends
Residents will treat Monday holidays as Sundays for their coverage
of Franciscan Children’s Hospital, the McLean Acute Residential
Unit (ART) and MGH Acute Psychiatry Service (APS).
The following chart presents an overview of training experiences
in Year 1 and Year 2:
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