Call Schedule

RRC Requirements

The RRC permits no more than four call-free rotations during the three years of pediatric residency training. Call-free rotations may not occur on inpatient services. All other rotations may have call either in-house (required for inpatient and intensive care rotations) or by pager/phone.

The RRC also requires a resident back-up schedule or alternate plan to provide coverage in the event that the assigned resident is unable to fulfill the assigned responsibilities.

Resident Call Schedule

1. In-House Call [HC] (pdf) – in-house call is required for services with acutely ill inpatients (ward and intensive care rotations). On-call duty will occur with a monthly average of every third to fourth night for PL1 residents and every fourth to fifth night for upper level residents. Call may be less frequent for outpatient or elective rotations and may be in-house or by pager/phone.
2. Mommy Call [MC] (pdf) – by phone or pager while at home.
   Purpose: To provide residents with the experience of telephone healthcare and patient triage for pediatric patients.

Format

1. When PL-1s are on mommy call, the upper level resident on back-up call will be available for consultation. During the first 6 months of the PL-1 year, all patient calls must be discussed with the upper level resident on back-up call before disposition as to patient management.
2. Staff support will be provided by the Pediatric Hospitalist on-call for that day.
3. All calls should be received through the ONCALL nurse and should relate only with patient telephone triage. In the event that you are contacted regarding a patient’s lab, x-ray, or culture results, ask the caller to contact the ordering physician. If the ordering physician cannot be contacted, then the call should be directed to the admission pager 2350. Similarly, complaints of toxic/non-toxic ingestions should be forwarded to the Poison Control Center through the ONCALL nurse so that proper epidemiological data may be obtained. However, should you accept patient information regarding any of the above, you are obligated to follow the encounter through to completion (i.e. interpret the information, provide patient disposition and communicate management information to the primary care provider).
4. Residents are not permitted to counsel/treat patients who have never been seen at a Scott & White Facility. These patients should be advised to seek care at the nearest emergency center.
5. Each telephone patient encounter should be documented on the forms available in the nurse’s stations in the pediatric clinic. These forms are part of the patient’s medical record, so proper documentation, including the patient’s name and DOB, is essential. The telephone number of the caller should also be included in case a callback or follow-up is necessary.

Feedback

1. Upon completion of their mommy call assignment, the pediatric residents (all levels) will meet with their continuity care pediatric staff at their next scheduled continuity clinic, or as soon thereafter as possible, to discuss their experiences and to review their decisions for accuracy and appropriateness.

Training

1. Residents will be provided with self-instructional text on telephone triage.
2. In addition, didactic training on telephone pediatric healthcare and patient triage will also be provided as part of the Continuity Care curriculum.
3. Back-up Call (BC) – an on-call back-up schedule system is required to provide coverage in the event that a resident is unable to perform the assigned responsibilities.
4. Residents on back-up call must remain within 25 miles of Scott & White Hospital with pager on and ready to cover the hospital or clinic rotation responsibilities of the unavailable resident.
5. To maintain the required on-call back-up system, a resident will be assigned to MC and BC at the same time. Combining BC and MC may sometimes require a resident to jointly cover both MC and BC thereby increasing his workload and patient responsibilities. However, by combining the two on-call systems the number of days a resident will be required to be on BC call will be substantially decreased.
6. A PL1 resident on BC call will be backed-up by a senior level resident at all times. If an upper level resident becomes unable to perform his patient care duties and on-call responsibilities while a PL1 resident is on joint MC and BC, the senior level resident on BC will be responsible for filling in the applicable PL2 or PL3 resident vacancy.

• See sample Call Schedule (pdf)
• See sample Conference Schedule (pdf)

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