Disclaimer: This document does not replace or substitute for the experience of the senior residents and staff. Your backup resident has jurisdiction over your call and should be called with any concerns or questions. The backup resident must be called regarding any patients needing admission to an otolaryngology service or regarding trauma patients admitted to the trauma service with maxillofacial injuries. This is not a complete list by any means. Have a low-threshold for calling the backup call person, especially early in the year.

General call guidelines (University of Iowa Otolaryngology)

1. The next morning, tell the backup call person what consults, etc. you took care of that night.
2. Staffing: All admissions should be handled with the backup resident, who will contact the staff. For consults that don’t need backup assistance, i.e. intubated patients with trach consults, routine lacerations on trauma patients, nosebleeds, etc., call the staff ASAP the next morning prior to rounds or discuss with the staff the night before when you can staff patients with them. Patients need to be staffed prior to leaving at noon. Once you staff the patient and come up with a plan, you are responsible for signing out to someone on the appropriate team. If you admit someone from call, you are responsible for rounding on them until you staff the patient and signout to the team.
3. Review trauma cases and imaging with the senior residents.
4. If you tell a person to come to the ER, always call the ER and let them know patient is expected.
5. Prioritize call duties. Keep a running list of what you need to do. Triage non-urgent consults if you are in the ER. If you are running behind and ER staff are getting irritated, call for your back-up to come in and help.
6. Your back up is available at any time. If your back-up is uncooperative notify the Chief resident immediately. The back up should see any patient that needs to be admitted or taken to the OR.
7. Flap checks should be done q3hrs. If you have any concern regarding a flap call your senior or the fellow immediately. If you are convinced something is wrong (No Doppler, flap is dark purple, you notice copious amounts of blood from the suture line) you can call someone. They will NEVER get angry with you for calling regarding a worrisome flap.
8. For ED consults who are not admitted, list the ED staff as co-signer.
9. When directing a patient to ROD clinic for follow up, email the schedulers with the day you want the patient to follow up. If you add someone to ROD the very next weekday, it is also helpful to notify the resident who will be ROD that day that the patient will be coming to their clinic.
10. Document all phone calls with a brief note in the chart. 
11. If you are called about inpatients on any oto service, document anything that happens overnight. The next morning, make sure someone on the service knows that there were problems or issues overnight.
12. Cleaning scopes: Wipe scope with Intercept, then place a red biohazard tag in the box with your name, date, and time wiped down. Set the scope in the box on the counter at the 2JCP nursing station, sign the scope book log with patient information, and let someone on the floor know it is there so it can taken for cleaning.

Trauma

• Be aware of whether you are on Trauma call or not. Facial lacerations should be referred to OMFS or plastics when they are on trauma call. Even if off trauma call, isolated frontal sinus fractures, nasal fractures, and temporal bone fractures go to otolaryngology. Even if on Trauma, all isolated mandibles go to OMFS. Occasionally we will handle mandible fractures if part of a pan-facial trauma case. Check with the senior if in doubt.
• Any orbital fractures or lacerations involving the eyelid or area close to the eye should have ophtho consult. Be sure to document vision with a vision card.
• Responsibility for clearing c-spine falls to trauma service (if pt is being evaluated by Trauma surgery), ER if not, or NSG/OrthoSpine if Trauma surgery has consulted them. Oto plays no role in this except to ensure that the c-spine is clear before surgery on the head/neck is undertaken. C-collars can stay in place for simple laceration repair.
• Beware of the “patient who just has oto issues”---Trauma surgery is pretty good about this. If trauma is not involved and you are consulted by the ER, ask the ER staff physician to ensure that other body systems have been evaluated. Examples: chest pain, back pain, neck pain, extremity pain. If you are called by a resident in the ER, ask if they have staffed the patient.
• See Facial Trauma section in Common Oto Problems for more info

Admission

• Backup resident needs to see the patient and discuss with staff on call before the patient is admitted. Call Admission/Transfer Center (ATC) at 4-5000 to let them know about the admission so that they can find a bed. Ask your backup re: any questions about antibiotics, steroids, appropriate area for patient (ICU vs floor).
• Medicine consult: Page Surgical Co-management at 3887. Medicine consult coverage is always available for issues on patients admitted to Oto. For any other required consults, call the operator and ask for the pager for that service. For head and neck patients who have seen Surgical Comanagement, call the staff directly who has seen the patient.
• Bed placement (4-5000) should be called as early as possible when admitting a patient. Please inform the operator of airway or isolation precautions.

Going to OR

• H&P/Consent in chart
• Call OR: 3-6400, speak with charge nurse. Notify of any special requirements that you have (age-specific laryngoscopes, flexible bronchoscope, foreign body instruments, etc)
• Page Anesthesia resident at 3911 to notify the on-call anesthesia resident
• During regular weekday hours, emergency cases (class 1 or 2, i.e. within 1 or 2 hours) are added by contacting OR charge nurse at 36400. All other add on cases need to be added by our OR schedulers. Start by reaching out to Crystal at 62204. Notify ROD of add-on cases to assign a resident if case will go during the day.

Phone consents

• Call consenting party first and discuss risks, benefits, and alternatives. Explain the operator will call back shortly on a recorded call
• Call the operator to arrange phone conference
• On the recorded call, identify yourself, the patient, name and relationship of the consenting party, procedure name, and ask if consent is given
• When done, call the operator again and inform them that the consent is done. Consent will be on EPIC.

Call center calls (48884-8)

• All outside calls should first go through the call center.
• These calls are often patients or their families calling with questions or prescription refills.
• If the patient describes concerns that should be evaluated by a physician, offer to see them in the ER, or if they live a distance away and the issue could be handled by a non-otolaryngologist, you can refer them to the local ER. Acute post-operative concerns are often referred back, many hours later, so consider just seeing them directly.
• Phone calls must be documented.

Transfer calls

• These often come from the “Integrated Call center” or ICC. If Oto is not on trauma call, and the transfer call involves a facial trauma patient, refer the caller to OMFS or Plastics depending who is on trauma call. For trauma patients who need to be transferred here, the ER should be the accepting service if it is possible that they have other injuries. Have the call center connect the call to the ER.
• It is the transferring physician’s responsibility to secure the airway. ALWAYS document the discussion with dictation. ALWAYS discuss transfer with your senior prior to accepting patient. For patients with bleeding, be sure they have 2 large bore IV’s in place.
• If a patient is being transferred with critical airway issues, you may need to bypass the ER and go straight to the OR. Discuss this with your backup resident.
• If the patient is not an Iowa resident, the call center will determine if they can come to UIHC. 
• You cannot directly admit any patients to the floor. Any transfer needs to go through the ER unless they are need to be transferred to the ICU; in that case, have the ICU admitting resident accept the transfer.

Airway emergencies

• Many airway emergencies are best handled in the OR where you have personnel and equipment as well as good lighting.
• Call or have someone page backup (in some cases may also need to call staff)
• Call or have someone page anesthesia resident (3911). They have drugs and equipment that you may need. They also intubate people often. You may also need to call anesthesia staff/ICU staff/PICU staff (critical care trained)
• You can also call a rapid response or a code. This will get you many helpful people (RT, anesthesia, surgeon for central line)
• Remember A-B-Cs
• A bag-valve-mask device with high-flow O2, especially with a NP or OP airway can be a very good airway. Do not immediately rush to an ETT or surgical airway.
• Look at the patient, not just the sat monitor
• Heliox can be used to improve laminar airflow in patients with narrow airway lumens. RT can get this for you. Frequent starting point is 70% helium/30% oxygen via facemask but this can be varied. Can only obtain heliox in the ICU’s.