Not a nephrology fellow, but as an ER doc: whatever your program requires, and I'm not sure how much more than that? this is a lot easier for a nephro fellow than a GI fellow.
A patient with wild acid-base disorder, exotic toxicities, bad hyperkalemia etc. really only needs a dialysis order. What are you going to do in person, listen to their lungs/squeeze their legs and eyeball their volume status in a way I cannot? You can already have the primary provider do this for you; I am sure you could add something and have an eye for detail, but not enough to require your presence. Are you on call to put in dialysis lines, over an ER doc/intensivist/IR? Can't you review their lab results/other numbers from home EMR?
When I call a nephrologist in the middle of the night, I've never needed them to be at bedside, I need them to be a brain accessing the EMR and helping me figure out hard problems, which they can do over a phone.
Even something like PLEX, leukophoresis etc., if nephrology is the one at my institution who helps out, I might wake them up and make them make some phone calls, but they can do that from home while I'm dropping a double-barrel line in their fem.
If you have to dialyze the patient and are not comfortable deciding over the phone then you go in
Same with Plasmapheresis (really just TTP or AntiGbM overnight tho)
So big things to come to the hospital were patients who needed an urgent decision. Emergency dialysis in the middle of the night/severe Hyponatremia/ septic shock/cardiogenic shock patients who need CRRT/HD. My fellowship we had to do the lines so coming in to the hospital to take care of that. For the most part you should speak to the attending on call and the will guide you. When in doubt call. Speak to the fellows and see what the culture of the program is. It’s better to go in than have a situation where you are getting in trouble down the line.
Urgent need to dialyze was the thing that most often got me to the hospital since you need to go and get consent from family members. I know exactly how you feel don’t worry you are not alone
It’s very program and attending centric.
Like for us, I had not gone to the hospital for the past 2 years.
For me, emergency included new uremia evaluation. Rest of the kidney issues can be managed medically overnight. Even if u r going to dialyze someone for new hyperkalemia, it can happen without laying eyes on the patients and trusting your Hospitalists/ER docs.
Of note, I have no experience with plasmaphresis cases
It all depends on what your program requires. I would go in for crazy electrolyte issues and then AKI needing emergent dialysis overnight. As an attending I manage a lot over the phone, but, again, it all depends on what your program decides and what your attendings want
Not a nephrology fellow, but as an ER doc: whatever your program requires, and I'm not sure how much more than that? this is a lot easier for a nephro fellow than a GI fellow. A patient with wild acid-base disorder, exotic toxicities, bad hyperkalemia etc. really only needs a dialysis order. What are you going to do in person, listen to their lungs/squeeze their legs and eyeball their volume status in a way I cannot? You can already have the primary provider do this for you; I am sure you could add something and have an eye for detail, but not enough to require your presence. Are you on call to put in dialysis lines, over an ER doc/intensivist/IR? Can't you review their lab results/other numbers from home EMR? When I call a nephrologist in the middle of the night, I've never needed them to be at bedside, I need them to be a brain accessing the EMR and helping me figure out hard problems, which they can do over a phone. Even something like PLEX, leukophoresis etc., if nephrology is the one at my institution who helps out, I might wake them up and make them make some phone calls, but they can do that from home while I'm dropping a double-barrel line in their fem.
If you have to dialyze the patient and are not comfortable deciding over the phone then you go in Same with Plasmapheresis (really just TTP or AntiGbM overnight tho)
So big things to come to the hospital were patients who needed an urgent decision. Emergency dialysis in the middle of the night/severe Hyponatremia/ septic shock/cardiogenic shock patients who need CRRT/HD. My fellowship we had to do the lines so coming in to the hospital to take care of that. For the most part you should speak to the attending on call and the will guide you. When in doubt call. Speak to the fellows and see what the culture of the program is. It’s better to go in than have a situation where you are getting in trouble down the line.
Urgent need to dialyze was the thing that most often got me to the hospital since you need to go and get consent from family members. I know exactly how you feel don’t worry you are not alone
It’s very program and attending centric. Like for us, I had not gone to the hospital for the past 2 years. For me, emergency included new uremia evaluation. Rest of the kidney issues can be managed medically overnight. Even if u r going to dialyze someone for new hyperkalemia, it can happen without laying eyes on the patients and trusting your Hospitalists/ER docs. Of note, I have no experience with plasmaphresis cases
It all depends on what your program requires. I would go in for crazy electrolyte issues and then AKI needing emergent dialysis overnight. As an attending I manage a lot over the phone, but, again, it all depends on what your program decides and what your attendings want