Overnight Telephone Call Tips

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To get to call center, just either call 212-524-1438, and give Acct # 143801 OR call 212-659-8551 and wait through recordings and then you will connected and let them know you are the provider on call. Always easiest to ask them to just text you messages to your work phone.
There is always an attending on back-up call. They will usually email you early in the week to give you their contact information -- if not, you can ask the call center to page them to your number.
The evening you are on call you should get an email with the open urgent slots for tomorrow at IMA -- to use those, just need to reply-all to the email with the patient's information.

Remember that your main goal is to TRIAGE, not necessarily to diagnose. Your 4 options are always: Reassure (no medications), Empiric Treatment of benign condition, Referral for next-day urgent visit at IMA, or Recommendation to go to the ED.
To refer to urgent visit at IMA tomorrow, reply all to email sent with urgent availability. If you didn't get an email about urgent visit availability, just email your firm's front desk to request an urgent visit for the next day.
To refer to the ED: If patient is capable of going on their own, can just advise they take transportation to get there or call 911. If you are especially worried, you can call ambulance for them -- 631-777-5600

So, when they call they are explicitly told that if the call is for routine matters, they should hang up and call back the next day. Still, sometimes routine refills sneak through. I tend to just refill them since it takes less time than it would to call the patient back and give them a hard time. If you can't sort out what patient is on, just call them back and tell them to call in AM for an urgent visit.

First step is to see if it was addressed already by ordering provider; if so, NTD
No clear algorithm, so case-by-case basis but in general:
If K+ 5.0-5.5, can manage as outpatient unless significant AKI. Would stop K+-raising agents, dose kayexalate
If K+ 5.5-6.0, decision would be urgent visit the next day vs. ED. If AKI, need to do ED evaluation. If 5.5-6.0 and normal renal function, could consider stop K+ raising agents, dose kayexalate, come into clinic the next day for EKG and repeat assessment.
IF K+ > 6.0, probably no way around referring to ED overnight.

First step is to see if it was addressed already by ordering provider or RN; if so, NTD
Main question is if there is any significant bleeding; if there was, patient was probably already sent to the ED for evaluation.
Assuming no bleeding, if INR < 4.5, just tell patient to hold dose overnight and ordering provider can make changes in the AM
Assuming no bleeding, if INR 4.5 to 10, would advise patient to hold coumadin dose until they hear otherwise, if closer to 10 can consider one-time, low-dose vitamin K (2.5mg). Advise to go to ED if any bleeding. Should come into IMA in 24-48 hours for repeat INR, and then decision on when to restart coumadin can be made.
Assuming no bleeding, if INR > 10, would advise patient to hold coumadin dose until they hear otherwise, give low-dose vitamin K (2.5 or 5mg). Advise to go to ED if any bleeding. Should come into IMA in 24-48 hours for repeat INR, and then decision of when to restart coumadin can be made.