Working rutines for residents on call. Experiences from Oslo.

Transcription

1 Working rutines for residents on call. Experiences from Oslo. Johannes Godt Dep. of Radiology and Nuclear Medicine Oslo University Hospital Ullevål NORDTER 2015, Oslo

2 Content - Short introduction about OUS- Ullevål. - Resident s schedule - Workload, workflow, localisation - Tasks and procedures on call - Discussion

3 Oslo University Hospital Ullevål -Trauma hospital for south-east Norway and parts of west-sweden - Acute care - hospital for large areas of Oslo - Nation- wide responsibility for biological/chemical injuries - Center for cystic fibrosis and prehospital acut care

4 Dep. of Radiology and Nuclear Medicine- Ullevål, acute care Several conventional x-ray labs 2 fluoroscopy labs Ultrasound (GE), incl. mobile US for ICU units and isolation units

5 6 CT-labs: -Siemens Somatom Flash DualEnergy 128- slice next to trauma bay -2 Philips 64-slice, one next to ER, one for interventional procedures -3 GE LightSpeed 64-slice

6 Imaging modalities on demand MRI (mostly nevroradiology, other: abdominal and musculoskeletal, pediatric radiology) 30 minutes interval Angiography, interventional procedures (hybrid lab next to trauma bay, other angiography labs)

7 1.Floor: New emergency room with trauma bay 2.Floor: Operation theaters 3.Floor: ICU unit X * X= former acute care CT *= former trauma bay

8 Non-trauma ER RIS/PACS workstation CT Trauma bay Hybrid lab Isolation room Connection to helicopter platform

9 Weekdays 2 residents on call - working schedule * Weekends Friday Saturday 9.30 Saturday Saturday Sunday Sunday Monday 8.00 * Daytime: Responsible for trauma and mobile ultrasound

10 2 residents: a team on call At least one more experienced resident (2-3 years of training) in the team Reporting all emergency diagnostic imaging, incl. trauma, stroke diagnostics Transferred imaging from outside hospitals (not only trauma) MSK on demand (depending on workload) Performing ultrasound exams and minor intervention procedures

11 Aker sykehus Urology, vascular surgery, psychiatry CT and x-ray examinations Radiographers or referring physicians contact radiologist on call Ullevål Ultrasound: Patient transfer to Ullevål

12 3. resident on call- weekdays Mainly ultrasound, including mobile US at ICU-units - Supposed to participate in interventional procedures, i.e. angiography / drenages - Not on holidays / during summer period

13 Multi-disciplinary approach Example 1: Trauma Radiologist is a member of the trauma team FAST ultrasound, x-ray thorax/ pelvis evaluation

14 Multi-disciplinary approach Example 2: Stroke team Cooperation neurologist on call- radiologist Thrombolysis team alarm Radiologist present at lab when CT examination starts

15 Multi-disciplinary approach Example 3: Acute care internal medicine Radiographers with alarm «medisinsk pasient» Radiologist on call gets chest x-ray right into RIS- PACS with «red flag»-line Often respiratory or cardiac problems On demand: ultrasound performed in emergency room

16 Other common diagnostic issues CT and x-ray after treatment for myocardial infarct / PCI Diagnostic imaging of neonates and children- close contact to pediatricians

17 Outpatient clinic in downtown Oslo ( Legevakten ) -Run by Oslo municipality -Performing x-ray and some CT exams -Chest / abdomen/ MSK x-ray reports on demand -When ultrasound needed (DVT) pat. to Ullevål

18 Head/ neck CT examinations at Legevakten : reported by radiologist on call Ullevål Major pathological findings: Radiologist informes nevrosurgeon on call. Patient transfer to Ullevål.

19 Senior radiologists present/on call ( «Bakvakt») Abdominal/oncological radiology Abdominal and oncological intervention Neuroradiology Pediatric radiology Thoracical, vascular and interventional radiology

20 Senior radiologist: Abdominal-oncological Monday-Friday: Weekend/holidays Present On call Present On call Supports residents in abdominal/oncologic radiology- if necessary general radiology - Morning conference for surgeons, trauma team and int.medicine next day

21 Senior radiologist abdominal/ Signs out reports oncologic radiology Reports abdominal MRI Assists with primary reporting when high workload

22 Senior radiologist: Abdominal/ oncological intervention - Responsible for CT-, Ultrasound- or fluoroscopy- guided interventions mainly in abdomen and pelvis - Assists resident on call in minor interventional procedures, when needed - Present on demand.

23 Senior radiologist on call: Monday-Friday: Weekend/holidays Neuroradiology Present On call Present both Sat and Sun, On call otherwise - Reporting MRI of the CNS and spine - Morning conference for neurosurgeons next day including saturday - Signing out CT reports from residents Weekdays : Responsible for thrombolysis team

24 Senior radiologist on call: Monday-Friday: Weekend/holidays Pediatric radiology Present On call Present 2h Saturday On call otherwise - Present on demand for neonatal cerebral US Morning conferences in pediatrics next day - Signing out CT reports from residents - Reporting pediatric MRI on demand

25 Senior radiologist on call: Thoracical, vascular and interventional radiology Monday-Friday: Weekend/holidays - Responsible for vascular intervention - Signing out reports from residents - Present after demand, many emergency procedures Present On call otherwise Present both Sat and Sun On call otherwise

26 Examples for acute careinterventions - Trauma: Coiling / embolisation when severe bleeding. Close cooperation with trauma surgeons. Hybrid lab/operation room next to trauma bay. - GI-bleedings, TIPS, aortic stents - Non-oncologic nephrostomy

27 Oktober Exams required from ER CT MR DX UL

28 Examinations requested from the ER Totalt 2014 Totalt CT

29 Conclusions and discussion - Close contact with clinicians is crucial in Emergency Radiology -Number of requested diagnostic imaging differs througout 24 hours Discussion?