by Alicia Billington, MD, PhD (@MedicalAdvocacy), and Alexandra Girardot, DO
July 1st is a date etched into the minds of every hospital staff member across the nation. This is the date new physicians don their fresh, long white coats for the first time and enter the hospital as interns. For senior residents this date signals a transition to greater responsibilities with call, increased emphasis on educating lower-level residents, and assuming leadership roles within the team. As plastic surgery services across the nation gear up for new residents on the front line with patients we would like to offer our thoughts on how to tackle plastic surgery call.
1. Get a good sign-out
Knowing your patients is KEY. Focus on their diagnosis, procedures and indications, and key medical issues/comorbidities that your team is following. If you are expected to follow up on a lab or imaging ask, “If this, then what?” Prior to leaving or seeing consults, check on fresh post-op patients to obtain a baseline exam or obtain post-op photos for comparison in the event exam changes occur overnight. Discuss any pending concerns with nursing staff to avoid unnecessary calls.
2. Make a list and check it twice
Print an updated list before your call begins. There is always an influx of pages at nursing shift change. Be ready. Come up with a list system that works for you and stick with it. Organization is key to keeping your sanity on busy nights. Add any to-dos and jot notes of issues overnight for AM sign-out. Update the team list/handoff with any new consults prior to rounds.
3. Have good resources
For basic questions regarding medications, Epocrates is an excellent resource to determine dosages and frequencies. This is a free download. Save the following numbers in your phone to avoid calling the operator multiple times: ER, Pharmacy, Laboratory, Radiology, Plastic Surgery Unit, OR Front Desk, Central Supply. Remember that pharmacists are an excellent lifeline; they can tell you what resistance profiles they see in your particular hospital population, which drugs are on back-order, etc. Up to Date is a great, quick source with current evidence-based medicine practices that can assist in the treatment for many consults in the ED or how to work up common floor issues. The AO website is a must-have resource for facial trauma. Orthobullets is an excellent resource for Hand and a light and easy book to throw in your bag while on Hand Call is the “Manual of Hand Surgery” by Hammert et al.
4. Reading scans
Call is an opportunity to become an expert at reading scans. Make a list of all of the fractures you recognize prior to checking the radiology report. You may be surprised at what you do and don’t see! Once you have a list, try to determine if the fractures follow a certain pattern (i.e. NOE, Le Fort). When first learning to navigate imaging, it is a great idea to stop by the radiology reading room and go over scans with a radiologist. Finally, sit down with an upper level resident or attending in plastic surgery the next day to review together in person.
5. What’s in my bag?
Having a small bag of key essentials not easily found in the ED will save you significant time and headache when called into the ED. Our department provides a special stock of supplies for on call residents. Here is what we carry:
- Facial Lacerations: Variety of suture- 4-0, 5-0 Monocryl, Vicryl, 5-0, 6-0 Fast Gut, Prolene, Chromic Gut, Dermabond, 25-27G infiltrating needles, Steri-strips, 2 packs sterile gloves
- Facial trauma: Sterile nasal speculum, sterile scalpel handle for nasal reductions, Denver and Doyle splints, pocket sized Snellen Eye Chart
- Burn: Suture removal kit (Multi-purpose tray), Lund-Browder Chart
- Call ahead: Ask for photos of lacerations/burns to be placed in the chart for review prior to seeing the consult. Place a nursing communication order for whatever you may need along with your pager number to alert you that everything is ready prior to driving in or coming from another consult. Make custom quick orders that include things like local anesthetic, Silvadene/Bacitracin, irrigation, Afrin nasal spray, Uro-Jet lidocaine jelly, laceration tray, blank consent form, patient stickers etc., for common consult needs to avoid wasting time.
6. Calling the attending
Write out the key facts. Come up with your plan and be confident. Have the patient’s chart and imaging up and available to review in case they have additional questions. Keep it simple but include all necessary details. If it is high acuity and the attending may need to come in emergently, let them know early in the discussion. Depending on your attending’s preferences, multiple low acuity consults can be staffed all at once instead of bombarding them with intermittent calls throughout the night. Ask your seniors prior to starting call which attendings prefer pages, calls, texts and save preferences in your phone contacts.
7. Ask for help
There’s an important saying in medicine: “Never worry alone.” If you don’t know what to do and need help or feel uncertain about something never be afraid to ask. It is always better to be scolded for asking for help than to not ask for help when you need it. (Although you should never be in trouble for asking for help!) Make sure you have everyone’s contact numbers before your call starts and know who to call first. Find one or two upper level residents in your program that can serve as a lifeline in case of emergency. Know that everyone was once in your shoes and remembers how stressful it can be early on. Having a non-judgmental resource in times of high stress can make the difference between a good and bad night on call.
Call is an excellent opportunity to learn and grow as a resident. Some of the most important lessons in residency will come from 1:00 AM phone calls and consults. Taking call can be daunting, but these tips and tricks will help you succeed. We wish the best of luck to the PRS Class of 2025!