Instructions for specific type of scan

• CT scans: call CT, the nurse if ICU. If patient is on the floor, and it's a critical scan, nurses usually help take the patient down. If it's not a super critical scan, you can call transport at 647-3636 and ask them to kindly expedite the dispatch to your patient.  
• X-Rays: ditto as above for CT, but call X-ray. Make sure patient has adequate pain meds to get them through standing if needed.
• MRI:
  • ensure the patient is cleared (do they have a pacemaker) 
  • ensure that they have adequate PRNs ordered for anxiety/claustrophobia/pain/etc
  • ensure that they don't have MRI incompatible continuous EEG leads. If so, call EEG and tell them to please replace. 
• Final reads: 412-648-6463 then press 1 - gets you to the reading room assistant, who connects you with the attending reading a scan. This # works 24/7 per day. You must do this at minimum before passing on a final read to night floater.  

For all of the above, you need to also specify to the night floater, is this the type of scan where you:

• just know if it happens (e.g. Neurology ordered an MRI Brain) 
• make 1 phone call to MRI and see if it happens 
• kill for it and get written up if needed 

Gome signout:

"4g bed 4 needs an MRI pan-spine"

Law & Order signout

- "4g bed 1 needs an MRI Brain before OR tomorrow. She is cleared, I talked to MRI and the nurse, they have a scheduled time for 10pm. He also has PRNs ordered for anxiety. MRI has been told if he's agitated or moving, do not give up and abort, they understand a high quality scan is needed. Call CCM and then night floater to escalate anxiolytics if needed." 

- "4g bed 2 needs an MRI Brain before the OR. They have a pacemaker so you will not see the order since EP needs to clear, but I talked to MRI whose also talked to EP and they have a scheduled time at 11pm" 

• You place consult 
• You page the respective service until you reach them. Consults placed after 4pm are generally not paged by the operator until the AM. Hammer page if you must. You give them the night floaters phone # and ask them to contact that person overnight with a text or phone call for the box you requested. You also obtain the night person's phone number from that service and send it to night floater as part of the sign out. 

Gome sign-out: 

• place a medicine A consult which will not be sent by the operator until AM and tell the night floater "8d bed 55 needs clearance" 

Law & Order sign-out:

• "8d55 needs preop risk strat for OR tomorrow. I placed consult and paged 6886, Dr Gomicus is the medicine attending overnight, his number is (412)-420-6969, I gave him your number too. They will send you a text if cleared and call you if there are any barriers"   

• when was it started and is it high risk or regular (this guides whether or not to expect it overnight) 
• what was last? 
• when is the next? (call nurse and ask)  

• frequency of checks 
• goal (range needed) 
• when was the last one, when will be the next one
• call nurse about the next one 
• who is managing?  
• does chief/attending need a phone call based on value?
• Have an algorithm for what action to take. e.g. turn off fluids if Na+ drops below 135, etc.   

Gome sign-out

• "4g bed 1 needs their sodium over 145, q8 checks" 

Law & Order sign-out:

• "4g bed 2 has q8 checks for a range 145-150. Their last was at 11am, next will be 7pm. We have been doing 3% @25, CCM is managing. Called the day nurse and told her to please send a sodium during handoff"

• have they triggered before? 
• what fluids are they on now? 

Gome sign-out

• "DI watch on 4F bed 2" 

Law & Order sign-out:

• "DI watch on 4F bed 2. They are POD2 from EEA, have triggered twice during the day, Endo managing, PAG needs the usual phone call before every treatment" 

• does the patient have cEEG leads on their head?  
• if not, is this a must-happen tonight or just a know if it happens? 
• call EEG techs and know where the patient is in line and the practicality of having it done overnight?  
• has the person seized yet today or prior? 
• who is managing (CCM, us, neurology?) 

Gome sign-out 

- "4g bed 1: continuous" 

Law & Order sign-out:

- "4g bed 1 needs cEEG. I called EEG and they are 3rd in line on the list, they understand the importance but there's almost no chance it's going to happen overnight. I would make one more phone call so we say we tried overnight but it's likely low yield." 

- " 4g bed 1 has cEEG. They have seized twice today, are on keppra 750 and vimpat 100 bid. CCM/us can manage."

• see your patient post-op 
• if still drowsy, ensure sedation is held until you leave the hospital
• circle back on your way out, text night floater if still needed 

Gome sign-out 

- Drop off patient at 515pm in PACU, still a little drowsy, don't bother to check patient on the way out.  

Law & Order sign-out
- "4g bed 1 is a crani, still a little drowsy when I dropped off half an hour ago. Nurses have been holding sedation. I'm going to see them on my way out and text you if they still need more time off sedation and a further delayed exam or if you can get rid of this box" 

• obtain the CSF 
• ensure everything been ordered (electronically) and should be in the status "in-lab" by the time you sign-out 

• order the UA 
• call the nurse and notify them about order
• know if they are even peeing 
• if not, ask nurse to please do a clean catch straight cath 

• order labs
• call the nurse 
• are they an impossible stick? if so, know this and communicate to nurses the need to get difficult stick team ASAP.  

• Find out what the allergy is (hives vs anaphylaxis) or if its even real at all or chart lore
• call the reading room assistan