Emergency Department & ER On-Call
The 24-hour emergency shifts are split into two 12-hour shifts – 8AM to 8PM (daytime) and 8PM to 8AM (night-time). Each doctor will be scheduled for at least one daytime shift and one night-time shift per week. During the daytime shift, you are responsible for manning the ER in-house from 8AM to 5PM. The period from 5PM to 8PM and then 8PM to 8AM is duty out-of-hospital. Your tasks in the ER will include:
- Taking call from the community health centres
- Clinical concerns from Public Health
- Clinical concerns from the group homes
- Managing and calling med-evacuations
- Admissions from Inuvik, the communities and/or patients returning from the south
- Lead the Code 99 Team
- Calls from both Acute and Long Term Care departments
- First line obstetrics if you provide obstetrical services
It is acceptable to arrange “clinic” in the evenings and on weekends for non-urgent patients. Most patients call the ER before presenting, allowing the nursing staff to triage. Evening clinics tend to work best around 2030 hours and on weekends around 1500 hours. These are not mandatory or automatic and only for non-urgent patients. Please see the sick people when they present and even the not-so-sick if they insist on being seen.
The nursing staff or you may put patients off until morning for non-urgent assessment. If you were not up all night, follow these patients yourself if they follow-up in a reasonable time frame (before 1200 hours). It allows for continuity and since you are paid for your post-call day mainly to work until noon to “clean up” from the previous 12-hour shift. The same goes for follow-up patients from the day before. If you cannot follow-up yourself, personally handover your patients to the physician working the daytime ER that day. Remember to let the nurses know you have done a handover!
If significant changes in the condition or management of Acute Care Ward patients takes place overnight, advise the admitting physician at the next most appropriate time (ideally immediately in the AM). Remember that the admitting doctor is available to you for consultation by phone or in person at any time.
Specialist Call
Just as it sounds: this is a 24 hour call shift. In addition, specialists (includes GP surgeons and GP anesthetists) will do the morning OR cases, pre-ops and afternoon clinics. OR cases are not scheduled in the afternoons or evenings under normal circumstances.
2nd On Call
This physician is on-call for:
- Medevacs
- Back up in the ER
- On the Code 99 Team
- OR assists if requested
- Baby resuscitation at delivery and sections
- ACU GP consults
The 2nd call physician has the right to make the decision as to whether or not they will attend on the medevac or stay behind to cover the ER, thus sending the ER doctor on the medevac. The 2nd call position is paid only if the physician is called in to attend to a patient. In this case, services are paid at the hourly rate (daily rate ÷ by 8 hours). Be sure to complete a 2nd Call Callback Sheet to record the hours worked for compensation.
Obstetrics Call
Duties of the physician on-call for obstetrics:
- Out-of-town obstetric patients during Monday AM clinic
- Coverage for all patients presenting that week. Exceptions include: patients who have requested a specific doctor to deliver, back-up coverage for ER physician if performing obstetric services.
- Medevac – potential to deliver in the communities, on the medevac airplane and premature labour patients
- Attendance at C-sections for mother or for baby
NOTE: A PHYSICIAN SHOULD ATTEND ON ALL FLIGHTS WHEN THERE IS EVEN THE POTENTIAL FOR DELIVERY BEFORE RETURN TO INUVIK. THIS DECISION SHOULD BE MADE BY THE ER DOCTOR AND OBSTETRICS DOCTOR ON-CALL IN CONSULTATION WITH THE MEDICAL DIRECTOR.
Post Call
Post call days are meant to give you a chance to clean up and do rounds following your night on ER Call. Use this time to do acute care rounds, follow-up on patients from the night before, in ER, in communities by telephone and finally for administrative work such as charts.
This is not a day off – post call is a paid day. If you had a rough night, the afternoon is an opportunity to get some well-deserved rest. However, take the time to handover any troublesome patients to the doctor on-call on the ER. Don’t forget to let the acute care nurses know of the handover and avoid getting unnecessary wake-up calls from the ward!
