Evening and holiday call is from 5:00 PM until 8:00 AM and weekend call is 24 hours a day, from 5:00 PM Friday until 8:00 AM Monday. All evening call in anatomic and clinical pathology is at-home call by beeper. Residents or fellows on call must be reachable either at home or by assigned beeper at all times. It is not necessary for the resident to remain in the hospital all night when they are on call. However, on call residents are expected to be in-house during certain hours on weekends and to come into the hospital whenever an issue requires on-site attention.
All on-call residents are expected to verify that their pagers are working by paging themselves. It is also the responsibility of the on-call residents to assure that they are properly trained in any on-call responsibilities BEFORE their first day/evening of call.
Residents on-call are expected to know who the attending(s) on-call is/are, and how to reach him/her.
During the last week of each month, the page operator will be provided with a call schedule for the following month including beeper numbers and home phone numbers. It is important that any changes in call be arranged prior to this time so that an accurate schedule can be provided.
The details of resident responsibilities when on call are listed below:
Autopsy Weekend Call
Two residents, typically AP-1 residents, are on call for autopsies each weekend. They cover autopsies performed at Yale-New Haven Hospital (includes both YNHH autopsies and Bridgeport Hospital autopsies) and at the VA Connecticut Healthcare System's West Haven campus. Prior to the weekend, the on-call resident should contact both the attending on-call for surgical pathology and the attending(s) on call for autopsies and reach an understanding as to how events over the weekend should be handled.
The "first call" resident is responsible for the first case EACH DAY. The "second call" resident is called in only if there is more than one case on a given day. Subsequent cases are assigned alternately to the two residents.
Residents are expected to be available to be in at work by 9:30 AM when they are on call. On-call residents should call the morgue shortly after 9:00 AM to see if there are any cases and to verify with morgue staff how they can be reached. If there is no case going on early in the morning, on-call residents are expected to remain available to arrive expeditiously at the hospital until 2:00 PM that afternoon. Cases for which all of the necessary paperwork is not available by 2:00 PM are routinely held over until the next day. However, in rare instances, an autopsy may need to be performed even after this "cut-off" time. The attending on call or the Director of the autopsy service will make this decision.
Surgical Pathology "Weekend Cutter"
On a rotating basis, AP-1 and AP-2 residents serve as the "weekend cutter". Some of the surgeries on Friday run late, past the time of the last specimen delivery to pathology. These specimens are brought to pathology on Saturday morning. Additional specimens from Saturday surgeries may also arrive on Saturday. Finally, specimens may be dropped off from physician offices on Saturday morning. These specimens cannot be allowed to simply sit around until Monday. The same rules apply for holidays. The weekend cutter is responsible for taking care of these cases.
The weekend cutter is responsible for fully grossing in all of these specimens, to the extent to which they do not require extended fixation. In the vast majority of cases, these specimens will all be accessioned before 8AM, but may include an occasional Saturday morning case. The weekend cutter should be in by 8AM and gross specimens as long as is needed to complete the work. If they complete the grossing before the 12 noon cut-off time, they should call the OR to make sure there are no cases about to send down specimens for cutting. If there are none, the weekend cutter can leave as early as 11AM, but not earlier. It is not necessary to remain around past 12:00 noon on the "outside" chance that something else might show up.
One of the histotechnologists in from 7-11 AM will be assigned to wait until the weekend cutter finishes grossing in the specimens received before noon, and will take responsibility for loading those cassettes on the processor. On many occasions, this may all be completed by 11AM, so no additional time will be needed. However, there will typically be the need for this person to stay until about 12 or even 1 when the resident finishes cutting. As a courtesy, the weekend cutter should be conscious of the fact that they are keeping someone from going home. The weekend cutter should cut continuously until the cutting is complete, and not wander off for lunch with the plan to come back and finish later, all the while keeping the histotech from going home.
Any specimens which arrive after 12 noon or which arrive after the weekend cutter has appropriately discharged his/her duties and has left become the responsibility of the senior on call resident. This responsibility involves "stabilizing" the specimen (placing in formalin, perhaps pinning out) but not fully grossing in the specimen unless there is a medical indication which requires special handling.
On official YNHH holidays, the clinics, physician offices, and ORs are closed, so there is no regular specimen drop-off. Also, on those days, no histology staff is available to accession the cases or load the cassettes into the processor. Therefore, if the holiday day is contiguous with a weekend, the resident on weekend cutter duty will only have to come in on the Saturday, not the contiguous holiday.
Surgical Pathology Weekday Evening Call
The AP-3 resident on the frozen section rotation is automatically the resident on call Monday through Thursday evening. The on-call resident should check with the operating room before going home to see if there are any surgeries still in progress which may require a frozen section. Any rush biopsies which come out after 5:00 PM, or other pending clinical issues, are also the responsibility of the resident/fellow on-call.
Any emergency specimens or other "new" specimens which arrive after hours MUST be accessioned into CoPath before they are processed. The CAP specifically requires that all specimens must be given a unique accession number when received in the lab. Failure to do so could result in the tissue or slides being later associated with the wrong case.
Surgical Pathology Weekend Call
Weekend call begins at 5:00 PM on Friday and continues until 8:00 AM Monday. After 5:00 PM Friday, all on-going and add-on surgery cases, rush biopsies, or other pending clinical issues are the responsibility of the on-call resident or fellow, recognizing there may be professional-based reasons for patient care issues in which it is appropriate for the day frozen section resident to continue a case past 5:00 pm.
On Friday afternoon, the on-call resident/fellow should contact the AP-1 on-call residents for autopsy, the attending(s) for autopsy (to determine whether or not they want to be called for every case), the Saturday grossing resident (who might need supervision), and the on-call attending for surgical pathology (beeper number, home phone number, type of cases for which he should be called). The on-call resident/fellow should also determine who the histotechnologist on call is and how they can be reached. If there have been any changes in the posted monthly on-call schedule, contact the hospital page operator (203 688-3111) to be sure they know you are on-call and have your correct beeper number.
On Saturday, the person on-call is expected to cover the Hot-Seat phone from 9:00 AM until 1:00 PM, during which time all biopsies from the previous day should be read and necessary phone calls made.
On both Saturday and Sunday, the person on-call should be available, as needed, to provide advice and/or technical assistance to the residents on-call for autopsies. This includes autopsies at the VA hospital. Call the morgue at approximately 9:15 AM each day to check on the status of that service.
As with late specimens which arrive late on weekdays, any emergency specimens or other "new" specimens which arrive on weekends MUST be accessioned into CoPath before they are processed.
On Monday morning, any case related issues from the weekend have to be followed up or appropriately transferred to another resident/fellow. If current service duties permit, the on-call person should attend the presentation of weekend autopsy cases. Otherwise, contact the AP-3 resident on the autopsy service and discuss any pertinent issues with them so that they can properly follow up on the case.
Laboratory Medicine Call
Residents are strongly encouraged to develop their skills as a CP consultant and thus have certain responsibilities besides the laboratory rotations. The most important of these is taking general evening and weekend call for all of the laboratories and blood bank, which is rotated among all residents currently on CP rotations. This results in call approximately one night each 7-9 weekdays, and approximately one weekend each month. The resident on call is responsible for emergency consultations and problem-solving for all of the labs at Yale, the VA Hospital, and the Shoreline Medical Center from 5 PM to 8 AM on weekdays and from 5 PM on Friday to 8 AM on Monday during weekends. This usually entails staying in the laboratories until 6-7PM on weekdays or from about 8 AM to 3 PM on weekends, after which call may be taken from home. Most problems are handled by telephone, but we encourage our residents be visible on the wards to facilitate their training and their comfort level as consultants. Backup is available at all times from the chief resident, laboratory medicine fellows, and the laboratory medical directors.
A pool of on-call pagers is located in the resident room in laboratory medicine. It is the responsibility of the on-call resident to acquire one of these pagers and have it on at all times during the period when they are on call. You must also carry your own personal beeper - the one assigned to you at the beginning of the year. The reason for this is that if the on-call beeper malfunctions or is lost, an alternate means exists for someone to get in touch with you. The department has provided a cell phone for use during on-call hours. It can be used for any call-related activities. It is normally kept in the filing cabinet in the resident's office; residents should be sure to hook it back up to the charger after any use.
Between 5-6 PM, all of the residents in the core lab rotations should either find or page the on-call resident to signout any "active cases". This is particularly true for the Blood Bank and VA rotations, which often have patients that the on-call resident should know about.
Post-call, if there are any "active cases" remaining, then it is your responsibility to sign them out to the resident covering that laboratory. This is normally done between 8:00-8:30 AM, prior to the morning's didactic session. Following weekend call, the resident is responsible for presenting cases at the Monday Morning Report.