I. Interns and residents are required to participate in the provision of emergency services by the Small Animal Clinic. Emergency duty is assigned by the Head Resident using a rotation schedule that is approved by the faculty. Generally, emergency duty is distributed so that interns have more than residents, and 1st- year residents have more than 2nd-year, etc. Third-year medicine residents, neurology residents, and all surgery residents provide back-up emergency duty on a rotating schedule that is shared with the senior clinical faculty. They are expected to be responsive to emergencies and to handle cases and meet clients in a professionally acceptable way.
A. Intern and Medicine Resident emergency Duty Responsibilities
1. House Officer(s) (HO) on Primary Emergency Duty (Primary HO) will remain on the VMTH premises throughout the entire shift.
a. Currently all Interns, 1st and 2nd year Medicine, Oncology, and Cardiology Residents will share Primary Emergency Duty. Duty is assigned on a rotating schedule. Individual shifts may be exchanged between house officers if both involved persons and the Chief resident agree to the swap.
2. Shift times (receiving):
[Note: Specific shift hours may be adjusted by the IRAC and Chief Resident.]a. Weekdays:
(1) Day intern receives 7:30 a.m. to 5:00 p.m.
(2) Night intern receives 4:00 p.m. to 7:30 a.m. then rounds all cases with the Back-up Residents.
- Case work-ups in progress will be transferred to the Back-up Residents or an appropriate service as early as possible so the night intern can go home when it is practical to do so.b. Weekends and Holidays (VMTH closed)
(1) Day Intern or Resident receives 7:30 am to 5:00 pm. Night intern receives from 4:00 p.m. to 7:30 a.m.
(2) The daytime house officer will maintain primary responsibility for all cases admitted during their shift until the next regular workday.
(3) Normally, the back-up medicine resident will round with the Friday and Saturday night interns at 7:30 a.m. on each respective morning.
(4) Medicine case transfer to IM residents will occur on weekends and some holidays, where caseload exceeds the capacity of the attending HO(s).
3. Resident back-up duty: The first resource for Interns on Primary Emergency Duty is the appropriate Back-up Resident. The Intern may call a Back-up Resident for assistance whenever additional guidance or assistance is needed with clients or case management, or when the case load exceeds personnel capacity and additional personnel are needed to triage and admit patients.
a. The Medicine Resident on Sunday day duty will be Medicine Resident back-up for that entire week (Monday - Sunday) and assist with case transfers on Monday morning. If no resident is assigned Sunday duty, a resident will be designated as a back-up for the week.
The Medicine Back-up Resident should be called for general information assistance, case management, and guidance related to cases that appear non-surgical and non-neurologic. Residents called in for backup duty are expected to respond promptly and without complaint, and to come to the hospital if their assistance is needed.b. Surgery Residents will be assigned on a day-to-day basis to do Surgery Back-up.
(1) The resident assigned to soft tissue will be here at 7:45 to meet with the intern to see if there are case transfers to any of the surgery services. In the event that there is not a resident assigned to soft tissue, either the intern assigned to the service or the senior clinician will meet with the emergency intern at 7:45.
(2) The surgery resident will work with the medicine resident to determine the most suitable location for a transfer if there is some question as to whether the case should go to medicine or surgery.
(3) The surgery resident will then distribute the surgical transfers to the appropriate service at 8:00 am (ie, directly to the service or technician for soft tissue, orthopedics, or ophthalmology).
(4) If the attending surgery senior clinician (ie, Drs. Hulse, Dziezyc, or Millichamp) does not feel the transfer to their technician or service has been appropriate, then they may choose to transfer the case to the service that they feel is most appropriate for the case.
c. The appropriate Back-up Resident will be the first person contacted by interns when they require assistance. The Back-up Resident may then contact, or have the intern contact, the appropriate Senior Clinician Back-up.
4. Senior Clinician Back-up duty: The Surgery, Medicine, and Neurology Sections will assign a Senior Clinician or 3rd year resident to do Senior Clinician Back-up for one week shift (Monday to Sunday).
a. Senior Back-ups may attend the morning case rounds with the Primary HO and Resident Back-ups as they feel appropriate.
b. If it is unclear what service is most appropriate to receive a case, the Night Intern and Resident Back-ups will consult with the Senior Back-ups.
5. ICU Responsibilities:
a. When possible, the Primary HO will round individually with the primary clinician of each ICU case at the beginning of each night or weekend shift.
b. The ICU technicians will contact the Primary HO, prior to calling the Primary Clinician, when there is a question or concern of minor importance about ICU patients (i.e., out of Ranitidine @ 6:00 a.m.). However, the ICU tech will contact the Primary clinician regarding any emergencies, or significant treatment changes (i.e., dog accidentally bolused large amount of fluids).
c. If the Primary HO cannot be reached immediately (due to other case responsibilities) the ICU technician may page the Primary Clinician without speaking to the Primary HO.
d. The Primary HO will have authority to make minor treatment alteration without contacting the Primary Clinician (e.g. fluid therapy additives, replace IV catheter, etc.).
6. Case Receiving and Management oversight:
a. Night Students will be the initial contact for clients calling the SAC. The student will take a brief history and get telephone contact numbers.
(1) If the client chooses to come the student will get an ETA and notify the Primary HO and the ICU that a case is expected.
(2) The ER Service accepts all emergencies. An emergency is any case that the owner, student, or intern believes to be an emergency. We do not turn cases away. Cases are triaged, with the most critical cases seen first.
(3) The student receiving the call will log all client phone calls regarding emergency cases, and always writes down the client’s home phone number as well as their cell number first.
(4) The Primary HO should provide feedback to the students on their performance, and may report performance to the student’s current Senior Clinician or the Senior Back-up if there are accomplishments or problems that should reflect on the student’s grade.
(5) The Primary HO will talk to all referring DVMs directly (within 24 hours of admission of the case).
b. Primary HO’s will:
(1) Review all cases received, as well as significant cases discussed on the phone, with the Resident Back-ups at ~7:30 each morning. These rounds will facilitate review of student and intern performance and facilitate appropriate transfer of cases.
(2) Prepare a Case Transfer Form (sample attached) for each case seen during the night and provide it to the appropriate Resident Back-ups during rounds, or to the service that will be taking the case. Although students can fill these out, the Primary HO is responsible for checking their thoroughness. These will be faxed to RDVMs so must remain professional.
c. Senior Clinicians will review all levels of case management and provide feedback to HO’s and students on performance.
7. Wards oversight: The Primary HO will walk or have students walk through all treatment wards that contain clinical patients at least every 2 hours.
a. The Primary HO may transfer ward patients to IMC or ICU at his/her discretion, but they must inform primary clinician.
b. The Primary HO may provide minimal care during these rounds (e.g. refill water, move to a clean cage, etc.) but will not provide specific therapy (medication administration) unless specifically discussed with the Primary Clinician at the beginning of the shift.
II. Transfer of In-House Cases
A. Night interns transfer all cases to the appropriate service (weekdays & weekends to day house officer).
B. Transfer of appropriate cases should occur as early as possible (at 7:00 am on weekdays and 8:00 am on weekends) on the first regular workday following their emergency hospital admission; i.e. cases admitted Monday night would be transferred on Tuesday morning. This transfer will typically involve direct communication between the emergency duty clinician, the resident or the head of the service receiving the case.
C. Cases requiring surgical management should be transferred directly to the most appropriate service; i.e. soft tissue, orthopedics, or neurosurgery.
D. Cases requiring medical management should be transferred to the most appropriate service if it can be identified; i.e. heart failure patients to cardiology. If an obvious service cannot be identified or if the most appropriate service is unavailable to take the case, the back-up medicine clinician for that shift should take responsibility for the case.
E. The back-up emergency duty residents and senior clinicians (both medicine and surgery) have responsibility for supervising redistribution of cases at the end of periods of emergency duty, if there is disagreement about who should take responsibility for the case.
