Updated June 2017
When to Notify the Attending Physician:
In general, the expectation is to page the attending physician within 20 minutes of the following events. More urgent scenarios should be paged ASAP, denoted by an asterisk (*)
GENERAL REQUESTS
• Any trainee feels a situation is more complicated then he or she can manage without more support
• Nursing or the patient requests that the attending be contacted
TREATMENT/DISCHARGE
· Admission – (1) It is always acceptable to staff an admission overnight. (2) If patient is stable and senior resident feels that current care is safe and comprehensive, then FMS attending can be notified in the morning following admission
· Any significant change in treatment plan or ordering of procedure not already discussed with attending
• Patient leaves AMA or elopes
• Unexpected discharge
OB: Admission/Discharge, AROM, IUPC placement, significant change in electronic heart-rate fetal monitoring, failure to progress, complete dilation, epidural placement, or induction/augmentation with Pitocin.
CHANGE IN CLINICAL STATUS
• Transfer to another level of care (i.e. IMCU, SICU, CCU, ICU)*
• Rapid Response, Code BART, Code Blue*
• Unexpected patient death*
• Expected patient death
• Hemodynamic instability*
• Development of significant neurological or mental status changes*
ADVERSE EVENTS OR UNEXPECTED INTERVENTIONS
• Significant patient fall or other injury
• Any medication or treatment errors*
• Unplanned blood transfusion*
• Significant post-procedure complications*
• Emergent consult*
ROLES
Residents are physicians in training. They learn the skills necessary for their chosen specialty through didactic sessions, evidence-based reading and providing patient care under the supervision of the Medical Staff (the attendings) and senior trainees. As part of their training program, residents are given progressively greater responsibility according to their level of education, ability and experience.
PGY-1
Scope of Care
The PGY-1 may provide care for inpatients, outpatients, or patients in the emergency department. They are responsible for the care of patients under the guidance and supervision of the attending and senior trainees. They are the point of first contact when questions or concerns arise about the care of their patients; however, when questions or concerns persist, supervising residents and/or the attending should be contacted.
Direct Supervision
The PGY-1 will require direct supervision by an attending or a qualified senior resident for the following unless deemed independent. Direct supervision is defined as having the supervising attending or qualified senior resident be physically present with the resident and patient. A senior resident is considered qualified to supervise if they have met the same criteria required to be considered independent.
· Invasive procedures – deemed independent by specific criteria noted in the procedural supervision policy
Indirect Supervision
The PGY-1 will require indirect supervision by an attending or qualified senior resident for the following episodes of care. Indirect supervision is defined as having a) attending or qualified senior resident be physically within the site of patient care and immediately available to provide direct supervision or b) immediately available by telephone and/or electronic means, and available to provide direct supervision.
· Hospital Admission – deemed independent after achieving level 2 or above in PC-1 and PC-2 ACGME sub competencies (if 2+ evaluations below a 2.0 after start of the academic year then resident will need to be deemed independent by faculty group consensus).
· Order Placement – will always have indirect supervision available by an attending or qualified senior resident if needed.
PGY-2/3
Scope of Care
The PGY-2/3 may serve as part of a team providing consultative services, or care for patients in the outpatient setting or emergency department under the supervision of senior trainees and Medical Staff. For inpatients, they are responsible for the day-to-day management of the patient care team under the attending's supervision, coordinating the actions of the team and interacting with nursing and other administrative staff. Along with the attending they provide for the educational needs of any junior residents and students as well as supervision if qualified.
Supervision
The PGY-2/3 will require the same supervision by an attending or qualified senior resident preceptor for the previously mentioned episodes of care for PGY-1 if they have not been deemed independent. If deemed independent the PGY 2/3 will have Indirect Supervision by the attending physician at all times.
Nursing Protocols
· Nurses are expected to page the intern on Green Team as the initial point of contact for any questions. If the page is not returned in the expected time frame per protocol (STAT, Priority, etc) then they should page the senior resident on call. If again there is no response in expected time-frame then the attending should be contacted.
· Attending physician will be available at the request of nursing staff or patient request. Nursing staff are expected to contact the Green Team to request the attending physician.
Responsibilities and Patient Care Activities
Residents are part of a team of providers caring for patients. The team includes an attending physician and may include other licensed independent practitioners, trainees and medical students. Residents may provide care in both the inpatient and outpatient settings. They may serve on a team providing direct patient care, or may be part of a team providing consultative or diagnostic services. Each member of the team is dedicated to providing excellent patient care.
Residents evaluate patients, obtain the medical history and perform physical examinations. They develop a differential diagnosis and problem list. Using this information, they develop a plan of care in conjunction with other trainees and the attending. They document the provision of patient care as required by hospital/clinic policy. Residents may write orders for diagnostic studies and therapeutic interventions as specified in the medical center bylaws and rules/regulations. They may interpret the results of laboratory and other diagnostic testing. They may request consultation for diagnostic studies, the evaluation by other physicians, physical/rehabilitation therapy, specialized nursing care, and social services. They may participate in procedures performed at the bedside, in the operating room or procedure suite under appropriate supervision. Residents may initiate and coordinate hospital admission and discharge planning. Residents discuss the patient's status and plan of care with the attending and the team regularly. All residents help provide for the educational needs and supervision of any junior residents and medical students.
The specific role of each resident varies with their clinical rotation, experience, year of clinical training, the patient's illness and the clinical demands placed on the team.