November 26, 2024

Cardiology A call? cardiology B/EP/ccu? triple call? ep? MCS? CCU? HOLIDAY CALL? This should explain it.

Cardiology A Daytime Call

Weekdays: 

  • Cardiology A service coverage starts at 8AM and you cover urgent consults as well 5pm-8pm.

  • If you are on service on the Cardiology A team, you are the admitting fellow 8AM-8PM.

  • Pre-op consults go to Internal Medicine if non-complex and if a cath is not obvious.

  • Cardiology A attending staffs consults. Consults only staffed at night if necessary.

  • Take patient calls for all of Cardiology except for Heart Failure/Transplant (Cardiology B) and Electrophysiology. Review the patient’s chart to determine if they are followed by an advanced heart failure/transplant attending.

  • Transfers can only be accepted by an attending (usually the cardiology triage attending). You CANNOT accept.

  • Attend the daily 1PM "Brief" to discuss possible CCU transfers via zoom

  • Some straightforward admissions may be directed to the Cardiology C (Hospitalist) service as workload and clinical status dictate. See this document for details of triage and patient flow to Cardiology C.

Cardiology Teams and Caps:

  • Cardiology A: 14 patients

  • Cardiology B (Advanced Heart Failure/Transplant): 18 patients

    • Admit patients to this service if they are followed by an advanced heart failure transplant attending.

  • Cardiology C (Hospitalist Service): 8 patients

    • See below for triage guidelines

  • Cardiology D (Mechanical Support Service): 8 patients

    • All patients who have a VAD should be admitted to this service

    • Can be used as an overflow service if others are full

Weekend:  8AM-8PM on Saturday and Sunday

  • You are the cardiology consult fellow for general consult service from 8AM-8PM and the admitting cardiology A fellow 8AM-8PM.

  • Get sign-out from the weekday consult to plan who you need to see on the consult lists. 

  • While all echos remain the official responsibility of the procedure fellow, the cardiology A/consult fellow should read his/her own echos if the procedure fellow is overloaded once first-year fellows begin to take calls in the fall. Echo requests and calls to the sonographer should be directed through the procedure fellow.

    • ECHOS MUST BE READ THAT NIGHT BY FELLOW WITH RESULTS CALLED TO THE SERVICE AND PRELIM NOTE ("Echo Note") IN ISCV.

    • Code to the UW Echo lab doors: Logistics tab —> Door Codes 

    • Code to the HMC Echo lab door: Logistics tab —> Door Codes —> HMC. You can read HMC echos at UWMC from any Xcelera workstation (Xcelera workstations in the UW Echo Lab, Cardiology A team room, CCU team room, UW Consult room, Regional Heart Center Clinic, and UW Cath Labs 2, 3, 4).  

Cardiology B/EP Weeknight Call

  • 5PM-8AM weekdays for all EP calls/consults/device interrogations, cardiology B calls/urgent inpatient issues including possible acute rejection (see below), critical CCU admissions or issues if the on-call attending or CCU nocturnist requests your assistance. 

  • Back up procedure fellow if they need help.

  • Cards B (after 5pm): 

    • Transplant patient phone calls

    • For all patients admitted with possible acute rejection for bedside evaluation. Coordinate and personally interpret STAT echo; coordinate a treatment plan with on-call attending. This is your chance to act as a junior attending. 

  • EP (after 5pm):

    • Device interrogations and device changes.

    • Malignant arrhythmias.

    • EP at Harborview is not covered by the EP fellow. Instead, a device company clinical specialist should be called in for interrogations. 

“Triple"(procedure/consult/echo) Call

  • Weeknights 5pm - 8AM: Cover all procedures, urgent or stat echoes. Also cover urgent UWMC consults 8pm - 8am. 

  • Weekend: Cover all procedures, urgent or stat echoes and UWMC consults Friday evening at 5pm until Monday morning at 8am.

  • The Cardiology B and CCUs fellow should read their own weekend echos if the procedure fellow is very busy, though all echos default to the procedure call fellow. All echoes need to have a preliminary read in ISCV.

  • Likewise, the Cardiology A fellow should read their own echos once they are privileged in late fall, but this is your default responsibility. 

  • Please refer to the consult responsibilities, these same rules apply.

TO GET A CASE STARTED @ UW

  • Make sure it is appropriate unless it is a STEMI, and then just start driving when you get the STEMI page. Ideally, you are the first one there to perform the initial assessment, which is a valuable educational opportunity. Consent the patient and get the patient to the lab. Recognize that the interventional fellow will also be activated. To avoid work duplication, once you've seen the patient, contact the interventional fellow to coordinate your plan.

  • For elective cases:

    • Call the "North call interventional attending on call”, discuss the case, and set a time

    • Call the "cath lab lead technician on call" and ask them to be ready at a certain time.

    • Notify the interventional fellow if the case may involve PCI. They are not responsible for coming into RHC only cath lab activations  

    • Come in, consent the patient, review the labs and story, do the case, and call the team with results. 

TO GET A CASE STARTED @ HMC

  • Make sure it is appropriate unless it is a STEMI, and then just start driving when you get the STEMI page. Ideally, you are the first one there to perform the initial assessment, which is a valuable educational opportunity. Consent the patient and get the patient to the lab. Recognize that the interventional fellow will also be activated. To avoid work duplication, once you've seen the patient, contact the interventional fellow to coordinate your plan.

  • For elective cases:

    • Call the "South call interventional attending on call”, discuss the case, and set a time

    • Call the HMC operator at 206-744-3000 and ask them to page or transfer you to the lead angiography technician. Ask them to be ready at a certain time. 

    • Notify the interventional fellow if the case may involve PCI.    

    • Come in, consent the patient, review the labs and story, do the case, and call the team with the results. 

ECHO:

ECHOS MUST BE READ THAT NIGHT BY FELLOW WITH RESULTS CALLED TO THE SERVICE AND PRELIM NOTE ("Echo Note") IN ISCV.

  • Code to the UW Echo lab doors: Logistics tab —> Door Codes    

  • Code to the HMC Echo lab door: Logistics tab —> Door Codes —> HMC. You can read HMC echos at UWMC from any Xcelera workstation (Xcelera workstations in the UW Echo Lab, Cardiology A team room, CCU team room, UW Consult room, Regional Heart Center Clinic, and UW Cath Labs 2, 3, 4). 

  • Your responsibility is to triage all overnight and weekend echo requests. Please see HMC and UW echo triaging guidelines below.

  • If you cannot get a hold of the sonographer scheduled:

    • At UWMC:

      • Ask the hospital operator to page the "Backup cardiac sonographer or echo technician". There is always a back-up sonographer listed at UWMC.

    • At HMC:

      • Ask the hospital operator to call the cell phone of "Carolina Melendez-Rodriguez, echo lab supervisor". Since there is no backup sonographer at HMC, the echo lab supervisor would come in to do the echo overnight and she keeps her phone     on overnight. 

  • You are not responsible for reading or triaging pediatric echocardiograms. If you are paged about a pediatric echo, please get in touch with the sonographer to perform the echo. The sonographer will upload the study into ISCV and push it to the SCH server. See “Pediatric Echo Workflow” for more details if questions arise.

CARDIOLOGY B WEEKEND/MCS WEEKEND NIGHT CALL

  • Call is from 5pm Friday to 8AM Monday.

  • You will receive email sign-out from the weekday fellow

    • Identify patients requiring cardiology B consultation over the weekend.

    • Touch base with the APPs Saturday morning to determine the rounding assignments for yourself (if they are nearing service cap)

      • Bias complex patients and those followed actively by multiple services (e.g. Cardiology B + EP) to the APPs

  • Determine rounding time and strategy with weekend attending.

  • Accept in-person sign-out from the nocturnist at 8AM on Saturday and Sunday.

  • Preround/round on your assigned patients on Saturday and Sunday.

  • Discharge patients as necessary. Email pre-dc@uw.edu and post-dc@uw.edu as appropriate with discharge details and needs for follow-up.

  • Attend the 1 pm Cardiology meeting and discuss/accept CCU transfers.

  • Evaluate potential ED admissions in person.

  • Coordinate admissions/transfers with the attending Saturday/Sunday 8AM – 8PM, directing as clinical presentation and workloads dictate.

  • Coordinate echo requests with the procedural fellow and sonographer on call. Read your own echos and put a prelim read in ISCV.

  • Coordinate cath requests with the procedural fellow on call.

  • Sign out to the APPs when all of your clinical duties are complete for the day.

  • Take call from Community Care Line for heart failure patients from 5pm Friday – 8AM Monday.

  • After leaving the hospital each night, take home call for high acuity issues not requiring CCU evaluation/transfer (new admission with possible rejection, field question from the nocturnist about care plan, management). Low threshold to come in for face-to-face evaluation for high acuity patients. 

  • For all patients admitted with possible rejection, coordinate and personally interpret STAT echo, and coordinate a treatment plan with on-call attending.

  • Sign out to the weekday fellow on Sunday night (typically by phone/email).

EP WEEKEND CALL

  • Call is from 5pm Friday to 8AM Monday.

  • Accept sign-out from the weekday fellow Friday night (either in person or via phone/email). Identify patients to be seen on Saturday and Sunday, as well as patients scheduled for procedures on Monday.

  • Coordinate rounding time with EP attending. Preround and round on active EP service patients. Write notes only on active patients for whom it is clinically indicated.

  • Take call from Friday at 5pm – Monday at 8AM for EP community care line, HeartCare alerts, CIED interrogation requests and new EP consultations. Staff daytime consultations the same-day. Return to hospital for urgent consultations/interrogations as clinically indicated if called at night and staff with EP attending.

  • Ok to defer non-urgent CIED interrogation/reprogramming requests to the following day if clinically appropriate.

  • Sign out to weekday EP fellow Sunday night (typically via phone/email).

  • Access to RhythmStar: Refer to Logistics tab —> RhythmStar

 

CICU/CCU/mcs WEEKEnD DAY call

  • Call is 8AM - 8PM Saturday and Sunday

  • Accept sign-out from the CICU weekday fellow, CCU weekday fellow, and MCS weekday fellow Friday afternoon (phone/email or in-person).

    • You will be joining CICU rounds and MCS rounds. Preround and round on active MCS consult patients. All MCS consult patients who are in an ICU need to be seen and have a daily progress note from the MCS team. Otherwise, write notes only on active patients for whom it is clinically indicated.

    • Huddle with the Cardiology D team on Saturday and Sunday morning to determine which VAD patients need to be seen (new issues may have arisen overnight).

    • The CICU attending will cover the MCS list during the weekend. Clarify the timing of MCS rounds relative to CICU rounds with the weekend attending.

    • Your responsibility in the CICU and CCU is to support APPs, provide appropriate cross-cover to CCU patients, and admit patients with APPs. You will not have any primary coverage responsibilities.

  • Follow up on immunosuppression drug levels across the service and adjust dosing with help of attending and/or team pharmacist.

  • See new consults (CTICU, CCU or Cardiology D) and staff with MCS attending accordingly.

  • Sign-out to CICU and MCS weekday fellow Sunday night (typically via phone/email). Sign-out to the CCU weekday fellow if significant clinical events occurred. 

WHAT TO DO ON A HOLIDAY

  • If you are listed on call on cardiology A, you will cover cardiology A and all consults (urgent and non-urgent) 8AM - 8PM as if it were a weekend day. The cards A co-fellow who is not listed on call has a day off.

  • Triple call, Cardiology B, EP, MCS and CCU are all treated the same is if it were a weekend day. See the above guidelines. 

  • If you are on UW/HMC echo, research, any VA rotation, UW/HMC cath, cards B (and not on call), CCU (and not on call), cards A (and not on call), nuclear, UW MCS, UW EP (and not on call), you have a day off. 

Attendings On Call On Any Given Night:

  • University consults: Cards A attending

  • Harborview consults:  CCU attending on-call, will also do an urgent TEE if needed with you.

  • Caths: One interventionalist between U and Harborview.

  • VA: CCU attending

  • Echo: One echo attending between U and HMC – HMC echos can be read from home

  • Cards A: Cards A attending

  • Cards B:  Cards B attending

  • CCU: CCU attending

  • EP: UW EP attending. The VA does NOT have EP coverage, use VA CCU attg.

Changing Calls: Fill out call change form on website home page.