Exact Script Templates for Calling Attendings Overnight Without Panic

It’s 2:13 a.m. You are alone in the team room, the cross-cover pager still humming from the last three calls. A nurse has just said the magic words: “You need to call the attending.”

Your heart rate spikes. You look at the chart, you half-type a note, you stare at the phone. You are trying to remember what your senior told you: “Just be concise.” Concise how? Say what first? What if they ask something you do not know?

You are not struggling because you are bad at medicine. You are struggling because no one ever gave you exact scripts for these calls. So you are trying to invent language on zero sleep, with adrenaline running, on a patient you met five minutes ago.

Let’s fix that.

Below are specific, word-for-word templates you can use, modify, and memorize. Not vague “be organized” advice. Actual phrases. Call structures. Checklists. So your next 2 a.m. call feels controlled instead of chaotic.

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Core Call Structure: The 6-Sentence Framework

Forget “winging it.” Every overnight call should follow one simple skeleton. You can adapt it in 10 seconds on any patient.

Use this 6-piece structure:

1. Identity + Urgency
2. Patient Anchor
3. One-Line Situation
4. Relevant Snapshot
5. What You Have Done
6. What You Need

If you learn nothing else, learn this order.

1. Identity + Urgency

Start by telling them who you are and whether this is urgent. Do not start with an apology. Do not start with a ramble.

Template:

“Hi Dr. [Name], this is [Your Name], the [PGY-1/2] on [Service] calling about [urgent / non-urgent but timely] issue.”

Examples:

• “Hi Dr. Smith, this is Alex Lee, the PGY-1 on night float for Med A. I have an urgent issue on one of our patients.”
• “Hi Dr. Patel, this is Jordan, the cross-cover resident for Surgery Blue. Non-urgent, but I wanted to update you and get your input on a patient.”

If it is life-threatening, be explicit:

“This is an urgent call about a potentially unstable patient.”

Do not hide the urgency. That is how attendings miss alarms.

2. Patient Anchor

Next: locate the patient in their brain.

Template:

“[Age]-year-old [sex/gender if documented] with [1-line reason they are admitted]. They are in [unit/room].”

Example:

“This is a 68-year-old man with decompensated cirrhosis and variceal bleed in room 542.”

Short. No full H&P. Just enough so they know which case you are talking about.

3. One-Line Situation

Now: why you are calling in one clear sentence.

Template:

“I am calling because [concise problem] over the last [time frame].”

Examples:

• “I am calling because he has new hypotension and increased oxygen requirement over the last hour.”
• “I am calling because her chest pain has worsened and troponin just came back elevated.”
• “I am calling because we have new K of 6.2 with EKG changes.”

This 1-line situation is the anchor. If you get this wrong, the rest of the call is confusing.

4. Relevant Snapshot

Now give them the minimum data they need to think, no more. This is where people either overshare (full vitals trend, entire lab list) or undershare (“the vitals look bad”).

Use this exact mini-template:

• Current vitals (and trends if relevant)
• Focused exam findings
• Focused recent labs/imaging relevant to the problem

Script template:

“Currently vitals are: T [temp], HR [rate], BP [value], RR [rate], O2 sat [value] on [O2 delivery]. On exam, [2–3 key findings]. Labs/imaging: [only what matters to this issue].”

Example:

“Currently vitals are: T 37.8, HR 118, BP 82/48, RR 24, O2 sat 90% on 4 liters nasal cannula, up from 2 liters earlier. On exam, he looks pale and diaphoretic, lungs are clear, no increased work of breathing, abdomen is distended but soft, with melena in the bedpan. Labs: Hgb dropped from 9.2 this morning to 7.1 now; creatinine 1.8 from baseline 1.2.”

That is enough for an attending to start forming a plan.

5. What You Have Done

If you skip this, you sound passive and less trustworthy. You want to show you are acting, not just paging.

Template:

“So far I have [interventions done] and I am [current actions pending].”

Examples:

• “So far I have bolused 1 liter of lactated Ringer’s, ordered stat CBC and type and cross, called blood bank to prepare 2 units PRBC, and asked nursing to place him on continuous pulse ox and non-invasive BP q5 minutes.”
• “I ordered a stat EKG, gave 4 grams of magnesium for TdP, and asked the nurse to place pads on the patient. I have also called the ICU fellow.”

This tells them: you are not paralyzed. You are buying time.

6. What You Need

Most residents skip this or bury it. Don’t.

Template:

“I am calling to ask for [specific ask].”

Examples:

• “I am calling to ask for your guidance on whether you would like to come in, transfer him to the ICU, or proceed with urgent endoscopy overnight.”
• “I am calling to ask if you agree with escalating pressors and placing a central line, and whether we should broaden antibiotics now.”
• “I am calling to ask for your input on whether you want to proceed with stat CT head and CTA, and if we should reverse anticoagulation.”

Be explicit. Attendings want to know what decision you are actually asking for.

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General Script: Non-Crash Overnight Call

Here is the full assembled script for a typical “serious but stable” situation.

“Hi Dr. Smith, this is Alex Lee, the PGY-1 on night float for Med A. I have an urgent issue on one of our patients.

This is a 68-year-old man with decompensated cirrhosis and recent variceal bleed in room 542.

I am calling because he has new hypotension and increasing oxygen requirement over the last hour.

Currently vitals are: T 37.8, HR 118, BP 82/48, RR 24, O2 sat 90% on 4 liters nasal cannula, up from 2 liters earlier. On exam, he looks pale and diaphoretic, lungs are clear, no increased work of breathing, abdomen distended but soft, and he has melena. Labs: Hgb dropped from 9.2 to 7.1 since this morning, creatinine is 1.8 from 1.2 baseline.

So far I have given 1 liter of lactated Ringer’s, ordered stat CBC and type and cross, called blood bank to prepare 2 units PRBC, and asked nursing to monitor him on continuous pulse ox and frequent BPs. I have also notified the ICU fellow that he may need a higher level of care.

I am calling to ask for your guidance on whether you want to come in, transfer him to ICU now, and whether to proceed with urgent endoscopy overnight.”

You can literally read that. Out loud. On the phone. No one will complain.

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Crash Call Script: When Things Are Actively Bad

If the patient is unstable or crashing, the structure condenses but the order stays similar. Priority: say “unstable” early.

Script:

“Hi Dr. [Name], this is [Your Name], PGY-[level] on [Service].

I am calling about an acutely unstable patient.

[Age]-year-old with [short problem]. They are currently [BP/HR/O2, mental status].

I have [called a rapid / called a code / activated ICU], we are [intubating / bagging / starting pressors], and I wanted to update you and get your input on next steps, including [ICU transfer / procedure / goals of care].”

Example:

“Hi Dr. Patel, this is Jordan, PGY-2 on Med ICU. I am calling about an acutely unstable patient.

This is a 74-year-old woman with septic shock from pneumonia. She is now hypotensive to 60s over 30s on max norepinephrine, heart rate 130s, on 100% FiO2, and has new altered mental status.

We have already called a rapid, are adding vasopressin, have given 2 additional liters of fluid, and are preparing for intubation. I wanted to update you and get your input on further escalation, including adding a third pressor and potential transfer to the cardiac ICU for mechanical support if needed.”

The attending does not need a monologue. They need: unstable, what you are doing, what big decision you are calling about.

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Planned But Time-Sensitive Calls (Not Emergencies)

You also need a calmer script for stuff like:

• New positive blood culture
• Rising troponin without shock
• New CT finding
• A consult question that cannot wait until morning

Script:

“Hi Dr. [Name], this is [You], the [role] on [Service]. This is a non-emergent but time-sensitive update.

[Age]-year-old with [1-line problem].

I am calling because [new finding]. Currently they are [stable vitals, key exam].

I have [actions taken so far].

I wanted to ask [clear question / decision].”

Example:

“Hi Dr. Nguyen, this is Sam, the PGY-1 on night float for Med B. This is a non-emergent but time-sensitive update.

We have a 59-year-old man admitted for NSTEMI.

I am calling because his repeat troponin has increased from 0.8 to 3.2, and he has new mild chest discomfort, 2 out of 10, without EKG changes. Vitals are stable and exam is unchanged.

I have repeated the EKG, given another dose of nitro, and checked basic labs.

I wanted to ask whether you want to escalate to heparin drip now and call cardiology tonight, or whether you prefer to continue monitoring until morning.”

Attendings almost never get mad at this. What they hate: finding out in the morning that someone sat on this for 8 hours.

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Situation-Specific Scripts You Can Steal

Let us go through the common categories residents panic about.

1. Hypotension / Possible Sepsis

“Hi Dr. [Name], this is [You], PGY-[X] on [Service]. I have an urgent issue.

This is a [age]-year-old with [primary problem] in [location].

I am calling because they have new hypotension and concern for sepsis over the last [time frame].

Current vitals: T [temp], HR [rate], BP [value], RR [rate], O2 sat [value] on [O2]. Exam: [mental status], lungs [key], abdomen [key], extremities [warm/cool], [any focal infection site]. Labs: [lactate, WBC, creatinine, cultures if known].

So far I have given [fluids X liters], started [antibiotics], drawn [cultures], and [called rapid/ICU if done].

I am calling to ask if you agree with [more fluids / starting pressors / ICU transfer], and whether there is anything else you would like done now.”

2. Chest Pain / Troponin Issues

“Hi Dr. [Name], this is [You], PGY-[X] on [Service]. I have a time-sensitive concern.

This is a [age]-year-old with [known CAD/NSTEMI/PE workup] in [location].

I am calling because they have [new/worsening] chest pain and [troponin change / EKG change].

Vitals now: [list]. Exam: [distress or not, lungs, heart, JVD, LE edema]. EKG shows [no change / new ST depression / new ST elevation in …]. Troponin went from [value] to [value] over [time].

I have given [ASA, nitro, morphine if used, oxygen], repeated EKG, checked basic labs.

I am calling to ask if you want to [start heparin / call cardiology now / send to cath lab / transfer to higher level of care].”

3. Arrhythmia

“Hi Dr. [Name], this is [You], PGY-[X] on [Service]. Urgent call.

[Age]-year-old with [short problem] currently in [unit].

I am calling because they developed [new AF with RVR / sustained VT / bradycardia] with [hemodynamic status].

Vitals: HR [rate], BP [value], O2 [value], mental status [alert/confused/unresponsive]. EKG shows [description]. Electrolytes: [K, Mg, Ca].

I have [given IV metoprolol / amiodarone / magnesium / started ACLS protocol / called rapid/code].

I am calling to ask if you would like to [escalate to cardioversion / transfer to ICU / start specific antiarrhythmic / involve cardiology now].”

4. Neuro Change / Possible Stroke

“Hi Dr. [Name], this is [You], PGY-[X] on [Service]. I have an urgent neurologic change.

This is a [age]-year-old with [reason in hospital] in [location].

I am calling because they have new [focal deficit / altered mental status] starting around [time].

Vitals: [list]. Neuro exam: [GCS, focal weakness, speech, pupils]. Labs: [glucose, anticoagulation status].

I have checked a fingerstick, ensured airway is protected, and activated [stroke alert / rapid response] and ordered stat CT head.

I am calling to ask if you want to [come in, escalate to neurology or neuro ICU, reverse anticoagulation] and if there is anything else you want done now.”

5. Goals of Care / DNR Decisions Overnight

This one scares people the most, and rightfully so. Script:

“Hi Dr. [Name], this is [You], PGY-[X] on [Service]. I am calling about a goals-of-care issue.

This is [age]-year-old with [major diagnoses], currently in [location], admitted for [reason].

I am calling because they have [worsening clinical status: e.g., progressive respiratory failure, multiorgan failure] and currently are [full code / unclear code status], and I had a discussion with [patient/family] about their wishes.

Their current status: [brief vitals, organ support, prognosis snapshot].

In my discussion, [they expressed X / family expressed Y: e.g., “they do not want chest compressions or intubation”].

I am calling to ask for your input and confirmation on changing code status to [DNR/DNI / limited code], and to ensure you agree this aligns with the medical situation and their expressed wishes.”

You are not expected to solve the ethics of medicine at 3 a.m., but you must clearly communicate what you saw and heard.

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Quick Pre-Call Checklist: 60 Seconds Before Dialing

The worst calls happen because the person called too early, too unprepared, or too scattered.

Before you dial, run this 60-second mental checklist:

1. Know the vitals.

   • Current BP, HR, RR, O2 sat, temp.
   • Is this new or chronic? Compare to earlier.

2. Look at the last note.

   • Why are they admitted?
   • Any clear plan for “if X happens, do Y”?

3. Check key labs/imaging relevant to problem.

   • For hypotension: Hgb, lactate, creatinine, WBC.
   • For chest pain: last troponins, EKG.
   • For neuro change: glucose, anticoagulation.

4. Do the immediate obvious things.

   • Hypotension? Start fluids unless contraindicated.
   • Hypoxia? Increase O2, get RT, check airway.
   • Suspected sepsis? Get cultures, start abx if already planned.
   • Neuro change? Fingerstick glucose, activate stroke alert if indicated.

5. Write your 1-line situation.

   • Literally on scrap paper: “Calling because [X in Y time frame].”

6. Decide your ask.

   • “I think we should [ICU transfer / heparin / CT now] – agree?”

If you cannot answer basic questions (“What is their BP?” “What is their baseline?”), the attending will notice. Preparation buys you respect.

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How to Handle Questions You Cannot Answer

You will get asked something you do not know. That is guaranteed. There is a right and wrong way to respond.

Wrong:

• “Uh, I’m not sure, but I think…”
• Long guessing monologue.

Right pattern:

1. Admit you do not know.
2. Say if you can get the information quickly.
3. Offer to call back briefly.

Script:

“I do not have that in front of me, but I can pull it up right now.”

— pause, click fast, answer —

If you actually need more time:

“I do not know that offhand. Let me check the chart and confirm with the nurse, and I will call you back in 5 minutes with the exact information.”

You do not get graded down for “I don’t know but I will find out.” You get graded down for guessing confidently and being wrong.

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Managing Your Own Panic: A Simple Flow

Use this as your internal flow when the pager goes off and you feel your chest tighten.

Overnight Call Preparation Flow

Step	Description
Step 1	Pager goes off
Step 2	Assess patient at bedside or via nurse
Step 3	Stabilize immediate ABC issues
Step 4	Gather vitals, key labs, last note
Step 5	Write 1 line - why calling
Step 6	Decide what you think needs to happen
Step 7	Use 6 sentence call structure
Step 8	Call attending
Step 9	Repeat back plan and orders
Step 10	Document brief note and update nurse

You do not have to be calm. You just have to act in a predictable pattern. The pattern will carry you when your brain is fried.

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Comparing Call Styles: Scattered vs Structured

Aspect	Scattered Call Example	Structured Call Example
Opening	"Hi, sorry to bother you, um, this is about Mr..."	"Hi Dr. X, this is Y, PGY-1 on Med A. Urgent issue."
Patient anchor	Long history dump	1-line age + reason for admission
Situation statement	Vague: "He is not doing well"	Clear: "New hypotension and increased O2 need in 1 hour"
Data	Random labs, partial vitals	Focused vitals, exam, only relevant labs
Actions taken	Not mentioned	Specific: "I have given 1L LR, ordered CBC, called ICU"
Ask	Implied, unclear	Explicit: "I am calling to ask if you want to..."

You want the right column. Every time.

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How to End the Call So Nothing Gets Missed

The call is not over when they stop talking. It is over when you have closed the loop.

End each call with:

1. Repeat-back of the plan.
2. Clarification of thresholds.
3. Clarification of follow-up.

Script:

“Just to repeat back the plan: I will [do A, B, C], and if [X] happens, I will [Y]. I will call you back if [clear threshold, e.g., BP stays < 90, troponin continues to rise, neuro status worsens].”

Example:

“So I will give another liter of fluid, start broad-spectrum antibiotics, get stat blood cultures, and call the ICU fellow for possible transfer. If his MAP stays under 65 after this liter or his lactate worsens, I will call you back.”

It sounds overly formal when you read it here. On the phone at 2 a.m. it sounds like competence.

Then go document a quick note:

• “Discussed with Dr. X by phone at [time].”
• Pertinent details.
• Agreed plan.

Takes 60 seconds. Saves your ass when anyone reviews the chart.

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Final Tighteners: How to Practice This So It Sticks

Do not wait for the real 3 a.m. emergency to use this for the first time.

Here is how to make it automatic:

• Pick 3 common scenarios: hypotension/sepsis, chest pain/troponin, neuro change.
• For each, write your own 6-sentence script on an index card or note on your phone.
• Before each night shift, glance at them once. 10 seconds each.
• In sign-out, ask, “Is there anything tonight you want me to call you immediately about?” That gives you a mental “attending expectation list”.

Over time, you will modify my scripts into your own language. Good. That means they are working.

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Key Takeaways

1. Use a fixed call structure every time: who you are, which patient, why you are calling, focused data, what you have done, what you need.
2. Prepare for the call: know the vitals, last note, key labs, and have at least one immediate intervention started.
3. Close the loop: repeat back the plan, know thresholds for calling back, and document the conversation.

You do not need to be fearless overnight. You just need a script and a structure that work even when you are exhausted.