On Call Duties
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 inhouse 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 psychiatris t 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 back-up 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 Franciscan’s, 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 back-up 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.
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).
Duty Hours, Handoffs, Resident Fatigue and Patient Safety: See Policy and Procedures section in Evaluation and Administration.