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Education

Postgraduate Education

The Senior Admitting Resident (SAR) On call responsibilities

Key Facts

• The SAR is not primarily responsible for any inpatients.
• The SAR is responsible primarily for consultations requested from the following services:
  • Medical Consults
  • Endocrinology
  • Infectious Diseases and HIV
    • After hours (after 5 pm weekdays and weekends), HIV consults from the ER should be seen by Team Medicine (and NOT the SAR resident). Under exceptional circumstances, the Team Medicine residents may request the SAR resident to perform a consult should they be overwhelmed with consults in ER. It is expected that the SAR resident will come in when these unusual situations arise.
  • Rheumatology
  • Dermatology
  • Allergy/Immunology
• Consults from General Internal Medicine can be discussed directly between the Team Medicine resident on call and the appropriate staff physician. The formal consult can usually be delayed until normal working hours. Consults from the medical subspecialty services (e.g., Gastroenterology, Cardiology, Respirology, etc.) are the responsibility of the SAR.
  • The medical specialty staff may request the SAR resident to perform a full consult should additional information be required or for education purposes.
• For consults that appear to be non-urgent, you may ask the consulting physician if the consult can be delayed until the following day.
• It is ESSENTIAL that appropriate signover occurs:
  • On Mondays through Thursdays: the Medical Consults and Endocrinology services should leave a copy of their signouts in the SMH Housestaff Lounge (first floor, Bond Wing, Room 050) by 1700h for pickup by the SAR resident on call.
  • On Fridays: the Medical Consults and Endocrinology services should leave TWO copies each of their signouts in the SMH Housestaff Lounge
  • The SAR resident on call is responsible for ensuring verbal signover at 0900h on the post-call day. As per hospital policy, confidential patient information should not be sent via e-mail.

An overview of the SAR call system

The SAR on-call system allows for overnight and weekend consultation coverage of various internal medicine subspecialty services at St. Michael's Hospital. The SAR call pool is comprised of housestaff (from PGY1 to PGY3) rotating through any one of the services that belong to the SAR pool (Endocrinology, Rheumatology, ID/HIV and Medical Consults), as well as those residents on Allergy/Immunology, Geriatrics, Haematology, Medical Oncology, Research, and Elective rotations.

On weekdays, coverage begins at 1700h and continues until 0800h the next day. On Saturdays, Sundays, and statutory holidays, coverage begins at 0900h and continues until 0900h the next day.

You may do calls from home. On-call frequency will generally not exceed 6 per 4 weeks, or 8 per 5 weeks. PGY-1 and Anesthesia trainees are only responsible for SAR call on weekdays. The Chief Medical Resident is the back up at all times should there be any concerns or in the event of an overwhelming number of consults. Residents will be requested to cross-cover Team Medicine for no more than 2 to 3 calls per month.

The SAR is not primarily responsible for any inpatients. A separate call pool assumes care for inpatients on HIV and Haem/Onc from 1700h to 0800h on weekdays and from 0900h to 0900h on weekends and holidays. The physician-on-call can be reached through Locating. Pager numbers can also be obtained from the 2 Queen nursing station.

Please note that residents should NOT answer calls from a staff physician's personal patients. These calls should be directed to the staff physician in question through locating.

After a consult is completed, the SAR should contact the staff on call for the appropriate service in order to review the case.

If you receive a call from the General Internal Medicine Clinical Teaching Unit for a consult after hours or weekends, you may request that the resident contact the staff directly to discuss the case and defer the formal consult until regular working hours.

The services for which the SAR is responsible include the following(the SAR pool):

• Medical Consults: The General Internal Medicine staff physician assigned to this service each month can be reached through locating (5431). If you are unable to get a hold of this staff physician, the back-up is the attending on call for Team Medicine.
• HIV/Infectious Diseases:
  • ER consults: The Team Medicine Senior Resident will be consulted for all HIV patients from the Emergency Room. If HIV is full, Medicine will admit to Medicine, but will review with both the HIV and Medicine staff on call. If HIV has an open bed the Medicine senior will review with the HIV staff on call. The SAR is NO LONGER a part of this cycle. The on-call physician covering HIV should be notified in the event of an admission to the HIV inpatient ward.
  • In-patient consults: Note that there are separate staff physicians on call for HIV and ID.
• Rheumatology: Rheumatology does not have an inpatient service and is a consulting service only.
• Endocrinology: Endocrinology does not have an inpatient service, however many inpatients on other services are followed by Endocrinology. Guidelines for a number of endocrine issues are available at www.torontomedicine.ca. Click on the "Resources" tab and then on "Endocrinology". You should have received instructions on how to access this Web site via e-mail; please contact the Chief Medical Resident if you need urgent access and do not know how to log on.
• Dermatology and Allergy/Immunology: Patients who require admission for a dermatologic or immunologic problem are generally admitted to Team Medicine. If the situation is urgent, the medicine resident should speak with the appropriate staff physician. Urgent consults from non-medical services are seen by the SAR; less urgent consults can usually be deferred until the next working day.
• Hematology/Oncology: The SAR resident is NO LONGER involved in this service. Should the SAR be contacted for a Hematology/Oncology consult, the caller should be told to contact the physician who is also on-call for the inpatient ward.

Sign Over

Since the SAR is often completing consults on patients that he/she will not follow on subsequent days, it is vital that the service that ultimately follows the patient be notified of new consults that were completed on the previous night/weekend. Thus, it is the SAR's responsibility to contact the service(s) in question and advise them of new patients. This should be done by 0900h on the post-call day.

Similarly, services covered by the SAR should provide verbal or written sign-out to the SAR by 1700h daily should there be any relevant issues regarding patients they are following. This is particularly important for the Medical Consults and Endocrinology services which typically carry a heavy volume of patients on whom multiple issues may arise after regular working hours.

For Monday - Thursday: Medical Consults andEndocrinology must leave ONE typed sign-out list in the SMH Housestaff Lounge (1st floor, Bond wing, Room 050) by 1700h for pick-up by the SAR resident.

For Friday: Medical Consults and Endocrinology must leave TWO typed sign-out lists with the Security office in the SMH Housestaff Lounge by 1700h for pick-up by: (1) the SAR resident who is on call for Friday evening and (2) the SAR resident on for the upcoming weekend.

Resident Safety

When taking calls from home, a number of issues can arise with regards to resident safety. There are several parking lots located around the hospital. The Queen Street lot (directly across from St. Michael's Hospital, on the south side of Queen) is closest to an entrance and should be used. Security can be contacted should a resident wish to be accompanied to and from his or her vehicle. Retain all parking receipts; reimbursement is arranged through Amina Dharamsi at the Medical Education office (Bond 1-060). The Department of Medicine will also reimburse taxi fees incurred while on call on weekdays and weekends if called in between 2100h and 0700h. Please ensure that the taxi receipts note the date, time, and also the start and stop destinations. Receipts may be submitted for reimbursement to Amina Dharamsi. The total reimbursement available per month is $70.

In House Facilities

If a resident wishes to stay in-house, facilities are available at 38 Shuter Street. To obtain a call room key, simply present your ID badge to Security (across from the Tim Horton's on 1 Cardinal Carter) who will then issue you a key.

Post-Call Policy

If you end up working in hospital past midnight, you are not expected to work a full day on the following day. It is your responsibility to inform the staff physician on your service and/or whose clinics you have been assigned to that you are "post-call" and will be leaving the hospital. Please note that staff will often "double-book" their clinics with the expectation that a resident will be present. We therefore suggest that you notify your attending(s) as early as possible in the month that you may not be available for an afternoon clinic on a post-SAR call day.

Schedule Changes

If you would like to exchange calls with another resident after the schedule has been finalized, please note that it is your responsibility to inform Locating of this change. This must be done by going to Information Services on 4-Shuter and adjusting the name of the resident on the schedule for all the services in the SAR pool. We recommend doing this as soon as a switch has been agreed upon since call schedules with residents'pager numbers are disseminated throughout the hospital 48-72 hours prior to the call day in question. Nurses and clerical staff will often bypass Locating and use this schedule to contact a resident and there will be much confusion if the name indicated is not the actual person on call. Please also inform Betty Ann Lemieux at Ext. 4176 or lemieuxb@smh.toronto.on.ca.

Team Medicine Cross Coverage

Finally, if you are covering call for Team Medicine, please note that call room access on 14 CC requires a validated ID card. On the first day of your SAR rotation block obtain a yellow ID Access Code Request form from Betty Ann Lemieux's office. Take this form to the Main Security Desk (1 Cardinal Carter) and your card will be validated for the duration of your call. There are also spare keys at the Nursing Station on 14 CC. You should meet the team at the 14CC Nursing Station at 1700 h for weeknight coverage and 0900 h for weekend coverage.

If there are any questions or concerns, please contact Dr. Irfan Dhalla (the Chief Medical Resident) at anytime through locating at 864-5431.

Revised June 2006 (no e-signout version)