Unofficial Overnight Survival Guide
This is a repository of resident overnight experiences to help troubleshoot commonly encountered issues. This is not an official policy guide. You will still need to use your discretion, work with your attending and refer to the official Northwell Radiology Service Line Policies.
Responsibilities
- Studies time stamped from 8 PM - 7:30 AM
- All ED x-rays must be dictated and prelimed
- All ED cross sectionals must be dictated. Last time stamp is variable, some attendings wont accept cases after a certain time in the morning. At that point, it is your discretion whether a study needs to be dictated to the morning team
- Green studies/ inpatient but ordered from ED are considered ED studies and are dictated/signed by nighthawk.
- All stat list x-rays must be reviewed/initialed
- Stat list x-ray with urgent findings (misplaced lines, tubes, pneumothorax etc) require a phone call to the team, documentation, and prelim using the “prelim and approve” function in powerscribe
- Inpatient chest and body angio studies must be prelimmed (Monitor the A shift lists)
- Dictate inpatient transplant ultrasounds to the nighthawk attending
- Attendings will send studies to VRC as needed. VRC# 866-941-5695
Type of Study | Estimated # per NF shift NS or LIJ |
ED x-rays | 50-150 |
ED cross sectionals | 30-60 |
ED ultrasounds | 20-30 |
Inpatient X-rays (glance at / prelim) | 30-50 |
Inpatient cross-sectional prelim | 3-5 |
Inpatient transplant ultrasound / positive finding (NS > LIJ) | 3-5 |
Peds fluoro studies (typically LIJ) | 0-1 |
Phone calls / interruptions | 10-30 |
Division Specific
Pediatric
- Get approval from peds attending on call
- Have team place the order
- Alert the peds fluoro techs about the study so there is no delay
- Make sure the baby has a feeding tube with a connector for a syringe to inject contrast before coming down
- Omnipaque 150 (so may have to mix 50/50)
- Ask the surgery team/primary team for help holding/adjusting the patient as needed!
- Call peds attending on call once the study is complete so they can review images
- Review images, ensure it is a ileocolic intussusception
- Call the procedure peds attending on call — they come in to perform this.
- Call x-ray tech so they prepare the room and there is no delay.
- Tell team to put in IV, put on monitor, surgery consult, put in order for reduction enema, and coordinate with x-ray.
- Only done at LIJ! If at NS, patient needs to be transferred to LIJ. Once at LIJ, have a peds ultrasound tech confirm an ileocolic intussusception. THEN call peds procedure attending.
- Dislodged g-tubes placed within the last 6 weeks get checked under fluoro.
- Neonatal head ultrasounds
- Newborn brain ultrasounds are NOT dictated by the NF attending/night hawk team
- If a neonatal head US needs to be read overnight (for example, prior to ECMO), it should be reviewed/signed off by the pediatric radiologist on call
Nuclear Medicine
Tips and tricks
- Try having a second station on standby when your primary station inevitably crashes
- Preemptively prelimming stat list x-ray enteric tube/ PICC lines can reduce phone calls overnight
- MRs overnight:
- Get as much information from team as possible regarding the study (patient age, reason for study, contraindications to MR etc)
- Determine whether the study is indicated/not indicated
- Common indications: pregnant appendicitis r/o, cord compression
- Page the on call tech yourself (do not ask clinicians to do this)
- At LIJ: IN-house coverage/MR tech on site M-F 12A-7AM. For Saturday and Sunday overnights, page tech/refer to LIJ MR tech on-call sheet
- At NS: MRI TECH IN-HOUSE COVERAGE Monday-Friday 12A-7A
- If you experience any problems contacting the MRI Technologist on call during the call times, please page the Radiology manager on call at 917-448-9033.
- Refer to NS MR tech on-call sheet.