L&D Call Expectations

DUH (Duke University Hospital)

PGY-1 (OB Intern)

Paging:

• •Postpartum Pager: (470) 4636,2,9700990#,,,,,,5,<YOUR PAGER># — set Spok status to “On page” first, then call.
• •In-room phone interpreter line: 1(800)481-3293,,501018518,8543 (call from any iPad on floor or your phone).

L&D Floor / Postpartum Call:

• •Hold PP pager AND go to vaginal deliveries.
• •Write delivery note + admit postpartum patient to the postpartum service.
• •Rounding caps: Block 1 = 6, Block 2 = 8, Block 3 = 10 (excludes DRH and Swing).
• •No PP rounding on DWHA patients on weekdays. On weekends, round on DWHA C-section patients. At night, first call for DWHA C-section patients weekdays after APP finishes rounding and leaves for clinic.

Rounding teams:

• •Weekdays: 2 LD Day Interns, ±1 ED Intern, 1 APP (midwife or NP). DWHA has dedicated APP.
• •Weekends: 1 on-call intern, 1 swing intern, 1 chief (if needed), ±1 ED intern. No APP rounders.

Triage role:

• •Use OBHandP template; OBProgress for further triage progress notes.
• •Look up last ultrasound + anatomy ultrasound before seeing patient.
• •Prioritize asking midwives simple/next-step questions before chief.

Scary Pages (acuity triage from PP pager):

• •High — bleeding, chest pain, SOB; SBP >160 or <90, DBP >110 or <50. Heavy bleeding: ask nurse to meet you in room for bimanual exam, bring bedside US + gloves.
• •Medium — mild vital abnormalities, moderate pain, “patient would like to talk to a doctor.”
• •Low — Tylenol/miralax orders, C-section dressings, pharmacy changes.

PGY-2 (DUH Day Call / Swing Night Float)

DUH Day Call:

• •Begin Onc rounding at 7:30 AM (complete rounds + notes prior).
• •Chief should be in section if one happening during Onc rounds.
• •No scheduled procedures — no prep.
• •Manage GYN consults throughout day.
• •Vitals checks q4–6h; update handoffs; round ~2 PM with brief progress note if active.
• •Pearl: If PPROMer calls out → GO evaluate.

DUH Swing Night Float:

• •Round on patients + give sign-out to oncoming PGY-2 at 5 AM.
• •No scheduled procedures.
• •Manage GYN consults.

PGY-3 (Night Float L&D / Weekend Mole)

Weekend Mole (Sat/Sun 7 AM – 5 PM):

• •Manage Active service (see AP/NF handoff).
• •No Midwife support on weekends.
• •Round Antepartum with APPs (split list). If list >16, ask Chief on Nights to help.

Night Float — Triage:

• •Triage is now OB ED with APP dedicated 24/7. Intern staffs with upper level.
• •Ask attending how they want to be looped in before discharge — preferences vary.
• •Can ask chief to un-double scrub to help with triage / L&D.
• •Have consistent person staffing patients (don’t switch mid-care).
• •Run triage list throughout the night with intern so they’re ready for AM sign-out.
• •For uncomplicated patients, try to discharge in 2 hours.

Night Float — L&D:

• •Try to meet all the patients, including DWHAs. Operative delivery → you’ll already know them.

High-Alert patients (announced on board at 7 AM + 7 PM):

• •TOLAC
• •Concerning Cat II strips
• •Preeclampsia on magnesium (pregnant or postpartum)
• •Breech PPROM
• •Vasa previa / placenta previa
• •Ongoing postpartum hemorrhage protocols / Jada / Bakri / vaginal packing
• •Severe maternal cardiac or fetal cardiac patients with strict monitoring plans

Management tips:

• •Be proactive about managing labor.
• •Consent concerning Cat II strips for C-section.
• •It is OK to back-call SVE.
• •Consider repeat foleys if patient <3 cm.
• •If labs not collected, message nurse to handle it.
• •For acute situations, ask for more people in the room early + often.
• •Make sure orders are correct — especially triage admits / AP to active.
• •Reference L&D protocols from Duke Box.
• •Communicate with Charge Nurse for C-sections, risky AROM, high-acuity patients.

Documentation cadence (progress notes):

• •Q4h strip check (latent labor)
• •Q2h strip check (active labor)
• •Q4h magnesium check note
• •At least 1 progress note per night using template — review MFM note, catch missing items, plan section labor-relevant only.

Working with midwives (6 PM – 6 AM):

• •Set expectations at the start of shift on how they help you.
• •Split the list. You’re responsible for knowing + signing out everyone.
• •Sample scripts: “My goal is for my intern to start an induction and do AROM, so please let them know when you are doing those tasks…” or “I want to walk my intern through vaginal repairs…”
• •Residents at every delivery. APPs can supervise (no attending call needed) — send Delivery Summary to APP.

DRH (Duke Regional Hospital)

Logistics:

• •Resident workroom: 4th floor L&D (across/slightly left coming out of staff elevators).
• •PP/AP/Gyn patients: down the hall on unit 4-3.
• •Sign-outs:
• ◦Saturday: 8 AM → Sunday 8 AM
• ◦Sunday PM sign-out: 5 PM
• •Two physical pagers: OB emergency + regular OB/GYN resident pager.

Responsibility matrix (who you cover):

Consult protocols:

• •Respond to page/consult within 30 minutes.
• •Ask if patient is established with a group. CHOB or DWC → contact ED to have those providers see the patient.

Tips:

• •Call back consults within 30 min. If in OR, have the nurse call ED back to say you’ll call back, or simply wait. Some attendings will want to call back from OR; some feel it can wait (if patient is unstable, ED needs to stabilize first anyway).
• •See consults ASAP — even if you just get the history. Don’t let them pile up. Can ask attending to do the first few exams with you.
• •Ask for help: attendings, uppers, midwife. Get attending of the day’s number after sign-out + ask if they want to see every consult with you, or hear about it after.

Family Medicine coverage (weekends Sat 6 AM – Sun 6 AM, no FM attendings on call):

• •The OB resident on call staffs all Family Medicine OB patients — the FM resident functions as your intern.

DRAH (Duke Raleigh Hospital)

Role: Primary operator; hold the pager for Raleigh day/night. No fellow in your cases (unless MIGS/Urogyn) — these are largely YOUR cases.

• •Don’t conduct workups that would delay transfer.
• •While awaiting transfer: can collect CBC + Coags → notify GYN for awareness if fibrinogen <200.
• •Heritage + Durant Road OB divisions see patients who want to stay in Raleigh / Wake Forest, or they can go to Durham / 1J.

Night call:

• •Expectation as PGY-2: touch base with attending for all consults.
• •Good practice: first time working with an attending, ask their expectations.
• •Patient admitted overnight → send AM rounding note to AM attending on call schedule.

VA (Veterans Affairs)

Not applicable — VA has no obstetric service. The VA pager (919) 970-0207 is held 24/7 by the VA resident for the entire rotation, but it’s GYN consults, not OB.

Cross-hospital escalation principles

• •DUH PGY-1: midwives first for simple questions, then chief.
• •DRH (PGY 2–4): call back consults within 30 min; see consults ASAP; ask attending of the day how they want to be looped in.
• •DUH PGY-3 night float: ask for more people in the room early + often; communicate with Charge Nurse for C-sections, risky AROM, high acuity.
• •DRAH (PGY 2–4): touch base with attending for all consults; first time with an attending, ask their expectations.