Appendix J – Facial Trauma Call Policy
Craniofacial Trauma & Oral Medicine (Dental) Call Policy Stanford Hospital & Lucile Packard Children’s Hospital The Plastic Surgery Division and Otolaryngology/Head & Neck Surgery Department provides Stanford Emergency Department call coverage for Maxillofacial Trauma and Dental related problems. 1. Stanford: Otolaryngology (ENT) takes call on even days. Plastics takes call on odd days. a. SCVMC: ENT takes call on odd days. Plastics takes call on even days. b. VAPA: ENT takes call on even months. Plastics takes call on odd months. 2. Call switches at 6am at SHC. 3. Consult is assigned at the time the service is initially paged (not when the patient arrives in the ER/ICU or when the resident answers the page). 4. DAYTIME Oral Medicine & Maxillofacial Surgery Consults: The service will see all dental/OMFS consults during normal business hours (8a-5p, M-F); the plastics/ENT resident should direct referrals and calls to OMFS during this time. The smartpage schedule designates the daytime dental resident (if available) and dental attending with contact information. 5. NIGHTIME Regarding dental trauma (tooth luxations/avulsions with isolated alveolar bone fractures) or odontogenic infections: the ED should consult smart page to determine if a dental resident is on call (dental resident is on call approximately 20% of the time.) If no dental resident is on call then the designated plastic surgery or ENT resident should be paged. The back-up attending dentist will be contacted by the Plastic Surgery/ENT/Dental designated resident as needed for consultation. 6. On their designated call days, ENT or Plastics will consult for cutaneous facial infections, TMJ dislocations, and ear lacerations. Plastics may defer to ENT for facial infections that are salivary gland, sinus- or ear-related. 7. Non-surgical infection admissions may be admitted to Internal Medicine, and ENT or Plastics will follow as needed. If internal medicine will not admit the patient with an infection of dental or possible dental origin then the patient should be admitted to the ENT or Plastic surgery service who is on for craniofacial trauma/dental for that day. 8. ENT is to see all deep space infections, ear hematomas, and temporal bone trauma. If a temporal bone trauma patient has other facial trauma and Plastics is on call, then Plastics is to address the other facial trauma. 9. ENT or Plastics may repair eyelid lacerations or retain the option to consult Ophthalmology for complex eyelid lacerations. 10. Consults that can be safely managed as an outpatient: nasal fractures (open or closed), mandible fractures (without airway concern), orbital floor fractures without entrapment or vision changes, maxillary sinus fractures. If patients are admitted for another reason with these injuries they can be seen on a non-urgent basis during the day. 11. If the ER or the patient has a specific request for Plastic Surgery and it is an EVEN day (ENT); or if there is a specific request for ENT on an ODD day (plastic surgery) the resident who is called 152
