Paging system

• Press 2 to choose “user options”
• Enter your “user ID” which is the seven-digit number of the pager you would like to sign onto, followed by #
• The system will then tell you who is currently covering the pager, then give you a menu to choose from
• Press 5 to choose “coverage”
• Enter your personal seven-digit pager number followed by #

Epic Template Notes

Weekend signout template developed for ALL teams including APPs

Template for sign-out on the “To Do (Nephrology)” section on Epic. To include the following:

***DO NOT include full one liner that includes age, sex, all of diagnoses. This should be VERY BRIEF.

Duke Central Tower (DCT) Consult Service

Pager is 919-206-8575 (click here for info on how to change pager coverage). Geographically restricted to patients admitted to the Duke Central Tower. This will be a mix of patients (ICU and floor consults). It will be staffed by an attending +/- fellow. Attending and fellows will not work on weekends while on the DCT Service. Will not cover maintenance dialysis, those will be on the maintenance service. Will not cover transplant.

• The DCT tower will see patients on 7100 and 7300
• Will not cover maintenance patients in DCT
• will cover unassigned non maintenance patients in the ER when a fellow is on service
• will cover patients on PD
• Attending on DCT who does not have weekend call at Duke will round on DCT on Sunday

Duke Hospital North (DN) Floor Service

Pager is 919-970-9451 (click here for info on how to change pager coverage). Consultative support to patients admitted directly to the general medicine wards at Duke University Hospital North except those on maintenance kidney replacement therapy (they will be on the Dialysis Service) or with a kidney transplant (Transplant Service).

• DCT to cover 7100 and 7300
• Saturday Floor fellow will cover their own floor patients
  • in addition they will cover the DCT patients
  • will do short call on Saturday
  • Attending on DCT who does not have weekend call at Duke will round on DCT on Sunday

Duke Hospital DN Dialysis Service

This is a non teaching service taking care of patients with established hemodialysis.

• The APPs on Duke North Dialysis Service will do completed the initial consult on established maintenance hemodialysis patients admitted through the ER without an assigned bed. After bed assignment they will be transferred to the appropriate team based upon geography.
• Will cover maintenance dialysis patients to all patients not in the ICU

Duke Medicine Pavilion (DMP) Acute ICU Service

Pager is 919-970-7746. Covering all patients in the DMP included 6E and 8E. The service is staffed by a nephrology fellow, medicine resident, advanced practice provider, and any medical students assigned by the School of Medicine. The service evaluates all patients residing in ICUs at Duke University Medical Center requiring nephrology consultation with the exceptions of patients with a kidney and/or pancreas transplants. Problems frequently encountered include acute kidney failure in critically ill patients, nephrotic syndrome, resistant hypertension, complex fluid, electrolyte and acid-base disorders, and patients on maintenance dialysis admitted to the ICU. Interventional and consultative support (including CVVHDF) for patients in the intensive care units at Duke University Hospital except patients with a kidney transplant. Team includes a rounding physician extender (PA or NP). The service is restricted to the Duke Medicine Pavilion (DMP)

An attending physician conducts formal teaching rounds Mondays through Fridays. During teaching rounds, the consultations are presented, the differential diagnoses discussed, and the plans for evaluation and treatment discussed. The cases are therefore used as conduits for teaching. In addition, follow-up plans are discussed for all patients followed by the service. The advanced practice provider on service usually covers all patients residing in the 7West cardio-thoracic ICU.

• APP will cover CTICU (7W) as well as 6E and 8E. However, it is at the discretion of the DMP service attending how to deploy the members of the DMP team if numbers are not equitable.
• John Matuscavage covers 6E, 7W, 8E. Fellow covers 6W, 7E, 8W.​
• Sunday DMP ICU fellow will cover their own ICU patients
  • in addition they will cross-cover the Floor patients unless the attending who is on call was on the Floor the preceding week in which they will cover the DCT.

Duke Transplant Service 

Pager is 919-970-3339 (click here for info on how to change pager coverage).

1. Kidney alone and kidney pancreas patients who are on the abdominal transplant team as primary (Typically within the first year of transplant)
2. SHK patients during index hospitalization
3. Patients awaiting dual organ transplant

1. Kidney alone and kidney pancreas patients who are not on the abdominal transplant team as primary (Typically after the first year of transplant)
2. SHK patients readmitted any time after index without abdominal transplant team as primary
3. SLK patients at any time

The Transplant Service consists of two services 1. On Service and 2. Off Service that assists in the management of all kidney/pancreas transplant patients in the hospital. Transplanted patients are cared for by the Surgery Transplant Service (On Service), which is staffed by a surgical attending, a surgery advanced practice provider, a transplant surgery fellow, an upper level surgical resident and/or surgical intern, a transplant pharmacist, a transplant coordinator, and a transplant case manager.  We provide consultative service to assist with immunosuppression (induction & maintenance), electrolyte & fluid management, dialysis if needed, blood pressure & blood sugar control, kidney biopsies, and other medical problems.  Transplant patients further out (typically a year or more) with primary medical problems, including acute cellular & antibody mediated rejection, are admitted to the General Medicine Service.  We provide consultative assistance in the management of these patients. If you get consulted by ER for disposition of a transplant patient, in general transplants less than a year out should go to transplant surgery (ER must consult general surgery to be accepted by transplant surgeon) unless admission is not related to transplant complication.

Continuity of care is provided in the Abdominal Transplant Clinic (Duke Clinic, 2C) in which post-transplant patients and pre transplant, return patients are seen in the morning, while and pre transplant, new patient evaluations are seen on Tuesday, Thursday and Friday afternoons. In these clinics, the Nephrology Transplant Fellow will see patients alongside and with the help of the Transplant Nephrology Attending.

The Focus of the post-transplant, return visits is to:

• understand the impact of wanted (reduce rejection risk) & unwanted (infection & other side effects) effects of immunosuppression
• gain experience with wound care & healing
• manage medical problems seen in post-transplant patients (side effects of medications, diabetes, blood pressure, mental health & other social issues, etc).

The evaluation of pre transplant patients (both new & return) will focus on

• understanding the factors that impact a patient’s ability to safely undergo a kidney &/or pancreas transplant at our center

Weekend

• Will cover short call on Sunday

How to access the patient calendar on Epic

Steps to see Patient Calendar:

1. Go to Summary Tab
2. Click Index-MD
3. Under Additional Reports, choose Patient Calendar

Responsibilities of the Nephrology Fellow on Duke services include:

• Provide consultation for all patients in Duke Hospital. Prompt service, either alone or in conjunction with the resident or medical student, should be given to consultation requests from the intensive care units and from the Emergency Department.  In general, patients in the intensive care units and in the Emergency Department should be evaluated within one hour and presented to the attending physician within four hours of the consultation request.
• Provide timely hemodialysis therapy. Patients who require hemodialysis should be identified as early in the day as possible (after consultation with the nephrology attending or fellow) and their names and locations given to the charge nurse. Hemodialysis orders should be written so that hemodialysis may commence by 8 AM.
• All hemodialysis orders at Duke must be written in Maestro. It is the responsibility of the fellow or resident to obtain written consent for hemodialysis on each patient admitted who needs dialysis. Patients must be consented to receive dialysis at the beginning of each hospitalization. This written consent must be on patient’s chart before dialysis can be initiated. Hemodialysis may not be initiated unless hemodialysis orders have been written.
• Fellows and medical residents may place temporary hemodialysis catheters in the femoral vein and internal jugular veins under the supervision of the attending. Once proficiency has been documented, the fellow may place lines independently.
• Supervision of the resident. As time allows, the fellow should review consultations performed by the resident before formal presentation to the attending physician.
• Supervision and teaching of the medical students. The fellow should evaluate all consultations performed by the medical students before formal presentation to the attending physician.
• Provision of adequate follow-up for patients following discharge from hospital. Patients may be seen in the Duke Outpatient Clinic by an attending physician or by a fellow. In the event that a patient is followed by a nephrologist elsewhere, the fellow will be responsible for calling the nephrologist to describe the patient’s hospital course and any need for further intervention. To set up outpatient nephrology clinic, email Tracie Bach (tracie.bach@duke.edu) especially if you are trying to schedule with a particular nephrologist
• After hours and weekend “on call” duty for Duke Hospital and the VA as scheduled
• Examination of the urine sediment in all cases of acute kidney injury. Examination of the urine sediment may or may not be indicated in cases of chronic kidney disease.  This skill should be taught to the resident and medical student.
• Attendance at Journal Club on Thursday mornings 8:30 AM – 9:30 AM.
• Attendance at Grand Rounds on Friday mornings 9:00 AM – 10:00 AM.
• Attendance at Core Curriculum Lecture Series on Wednesdays from noon to 1:00 PM
• Review of all kidney biopsy specimens obtained by the fellow with the pathologist and attending nephrologist.
• Attendance at teaching rounds Mondays through Fridays.
• Attendance at attending rounds on weekend days according to the schedule.

Transplant Rotation Responsibilities (updated 1/16/2026)

High level changes: 1. fellows can leave on-service rounds at 1 hr 30 min. to see off-service patients/ new consults. 2. fellows are not expected to write notes on patients they didn’t physically see with the rounding team.

Prerounding (on and off service):

• Fellows are expected to chart review Off-service patients prior to 8:15 a.m. (the start of on-service rounds) and physically evaluate patients with acute needs including time-sensitive decisions such as dialysis, biopsy, or other as pre-determined with the attending.

On service expectations:

• On services multidisciplinary rounds start at 8:15 a.m., fellows should plan to round with the nephrology attending On-service for as long as possible, but no less than 1 hr 30 min; total time may depend on new consults or need to see the Off-service patients.
• Attending will predetermine (with the fellow) which On-service patients need to be seen (they will not be required to see all of them). The attending will make decisions on which patients the general fellow will see when a transplant service fellow is simultaneously rounding (the general fellow should still see a few On service patients even when transplant service fellow is on).
  • Any On service patient seen by fellow with surgery attending as the primary needs a fellow note
  • Fellows are not expected to write any notes on patients who they did not see with the team on rounds.
  • Fellows are not expected to go back and see On-service patients, just to create a note (if they were at clinic for example)

Off service expectations:

• Can break off on service rounds after 1.5 hours to physically see all off-service patients, except those who are determined NOT needing a visit that day.
  • Every patient, including dual listed patients should be seen at least once in the week by the fellow and attending.
  • Notes should be written on every Off-service patient on Monday and Friday at the very least to facilitate weekly provider transitions. This excludes dual listed patients which can have a weekly note.
  • It will be up to the discretion of attending how frequently individual Off service patients need to be seen.
  • Fellows are not expected to “double round” on established stable patients. Patients can be seen simultaneously or seen separately with table rounding at the discretion of attending.

General expectations for the fellow:

• Fellows should reach out to the oncoming on service attending before the start of the week-long rotation to discuss expectations, clinic schedule and conference schedule.
• Total census (on and off) seen by fellow should be limited to ~20 or less.
• Any patient seen by fellow should have a note sent to attending for co signature.
  • Attendings should provide feedback to fellows about note quality and overall feedback
  • Fellows should attend all conferences mandated by the fellowship program unless extenuating circumstance (clinical emergencies)

Attending expectations:

• The attending should limit nonclinical activities on rounding weeks
• Be available by phone or pager 24/7.
• Expectations should be made clear by Monday morning before the start of the rotation.
• Attending should be flexible with rounding structure as workflow allows. This may include starting with the higher number rooms to facilitate seeing patients that will better enhance the learning experience

Sign out

• A sign out should be generated by Sunday night for the oncoming team.
  • On service sign out should be communicated with the oncoming fellow and attending at the discretion of the outgoing attending (eg email, most recent note attestation)
  • Off service sign out should be communicated by the outgoing fellow or continuing fellow to the oncoming attending and oncoming fellow and should include patient needs, when they were last seen, frequency at which they were being seen

(Rough Starting Guidelines – subject to change by fellows/attendings on service)

• Sunday Night:  The Transplant Fellow sends an email to the General Fellow dividing patients with the following general philosophy:
  • Transplant Fellow – covers most (not necessarily all) of the ‘on-service’ patients on Mondays (exchange between fellows is certainly welcome for continuity or to equalize the census.
  • General Neph Fellow – covers most (not necessarily all) ‘off’ service patients on Mondays (as above, exchange of patients is welcome)
• New consults:  These get distributed equally 1:1, alternating Gen-Fellow/Txp-Fellow, allowing for modifications based on the relative census and who is in clinic, and with emphasis on distribution philosophy above.
• Clinic days:
  • Fellow in a morning clinic ‘pre-rounds’ on their patients (those that need pre-rounding, others may be seen by the fellow after clinic) and lets the other fellow know if there are any issues that need coverage while they are in clinic.  After clinic, the fellows connect to run the list and distribute remaining/pending consults.
  • Fellow in afternoon clinic sees all their patients and ’signs out’ any issues that need coverage in the afternoon.  After clinic, the fellows run the list to prepare for the next day.
  • The Fellow without clinic covers new consults, follows up on issues they receive in sign-out, and any issues that arise while the other fellow is in clinic.  As above, fellows to run the list after clinic.
• Day Time Questions and/or Calls Overnight:
  • General Fellow’s first call is the Transplant Fellow with questions during the day and at night….
  • The transplant fellow then calls the attending for input…
  • The Txp Fellows gets back to the General Fellow with an answer/plan.
  • The General Fellow is ALWAYS welcome to call the attending directly (ALWAYS) if they are uncomfortable going through the Transplant Fellow (or if the Transplant Fellow is occupied).
• Saturdays when the Transplant Fellow is Rounding:
  • On the Saturday when the transplant fellow is in the hospital, the transplant fellow signs on to the transplant call pager until they leave Saturday afternoon.
  • The Transplant Fellow takes primary responsibility for the ‘off-service’ patients (note writing, etc.) and attends rounds as possible.
  • The Transplant Fellow sees new transplant consults that come in early in the day.

Note:  These are starting guidelines.  If there is mutual agreement, Fellows and Attendings can come up with a different work-flow if it works better day-to-day or week-to-week. The fellows’ roles should be articulated clearly.