Lines of Responsibility

Responsibilities unique to each individual rotation are outlined in the curriculum section for that rotation.

  1. Inpatient Services (UIHC consults, UIHC CVICU, UIHC heart failure/ transplant, UIHC Electrophysiology, VA inpatient cardiology, VA outpatient cardiology)
    1. Supervising Physician: The staff physician is responsible for the assignment of patient care and for supervision of the fellow’s management of the patients on the inpatient and outpatient services. The staff physician will review the rotation expectations at the beginning of the rotation. The attending physician will provide verbal feedback and a written evaluation at the end of each rotation. The attending physician will conduct daily management rounds which will include brief bedside focused discussions. The staff physician will be readily available and easily contacted by the fellow to discuss patient care or other issues related to the rotation.
    2. Cardiology Fellow: The cardiology fellow is responsible for the daily management of all patients on the cardiology service to which the fellow is assigned. The UIHC CVICU and UIHC heart failure / transplant fellows will review overnight issues and new admissions with the house staff on the cardiology team prior to morning rounds. The consult fellows will receive and triage all consult requests and begin the initial management of these patients. The fellow will assist the house staff in performing necessary procedures. The fellow will either provide adequate documentation of patient care or ensure that house staff notes are complete and accurate. The fellow will supervise all house staff members on his or her assigned team.
     
  2. Outpatient Continuity Clinic (UIHC Cardiology Clinic, VA Cardiology Clinic)
    1. Supervising Physician: The attending physician will supervise the management of all cardiology clinic patients. All new patients and follow up patients will be presented to the attending physician and written documentation of the encounter will be placed in the chart. The attending physician will provide verbal feedback and a written evaluation twice a year.
    2. Cardiology Fellow: The cardiology fellow is responsible for evaluating, managing, and providing follow-up care for his or her assigned cardiology clinic patients under the supervision of the staff physician in the clinic. The fellow is responsible for providing appropriate documentation on all patient encounters. The fellow is expected to answer clinic staff and patient phone calls in a timely fashion.
     
  3. Laboratory Rotations (UIHC Cath Lab, VA Cath Lab, UIHC Echo Lab, Nuclear Lab, UIHC EP)
    1. Supervising Physician: The staff physician is responsible for the supervision of all procedures performed in the individual cardiology laboratories. The staff physician will assign specific fellow duties based on the individual fellow’s level of training and expertise. The staff physician will outline the rotation expectations at the beginning of the month. The staff physician will provide verbal feedback and a written evaluation at the end of the month. The staff physician will monitor the fellow’s performance of procedures and review the fellow’s interpretation of all diagnostic tests. The staff physician will provide concise focused teaching sessions during weekly conferences or during performance and interpretation of laboratory studies. The staff physician and/or the fellow will discuss testing results with the patient and the patient’s family and provide appropriate documentation.
    2. Cardiology Fellow: The cardiology fellow will perform all required pre-procedure duties (ensure appropriate consent obtained, review labs, write pre-procedure orders, etc). The fellow will supervise all non-invasive testing and remain in the lab area to be available for emergencies. If the fellow must leave the area, the lab staff must be notified who is the appropriate contact person for emergencies. Fellows will perform invasive procedures under the supervision of the attending physician in accordance with their level of training and expertise. The fellow is responsible for any necessary post-procedure care. The staff physician and/or the fellow will discuss testing results with the patient and the patient’s family and provide appropriate documentation.
     
  4. Call:
    1. Supervising Physician: A list of staff physicians on call for the various services including consults, intensive care unit, cath lab, heart failure/ transplant service, electrophysiology, VA consults) will be distributed at the beginning of each month. The attending physician must be easily reached by either pager or phone to staff overnight consults, discuss critically ill inpatients, or to come in to directly supervise invasive procedures (TEE, cardiac catheterization, etc).
    2. Cardiology Fellow: Each night, there is one fellow on call for UIHC and VA (also called F1 call) and another fellow on call for UIHC CVICU and heart failure /transplant service. Interventional cardiology call is covered by the subspecialty interventional cardiology fellows. The cardiology fellow on call is responsible for providing consultation to all services (including ER, inpatient medical and surgical services, VA inpatient medical and surgical services and UIHC and VA outpatients) except the CVICU / heart failure service. The UIHC cardiology fellow on call will come in and evaluate any urgent consults or critically ill inpatients and discuss the management plan with the staff physician on call. The UIHC CVICU call alternates between the fellows on the CVICU and heart failure transplant fellow. Weekend call coverage for F1 call is provided mostly by first year and second year fellows. Weekend call coverage for CVICU and heart failure is provided by CVICU and CHF fellow and other cardiology fellows based on the fellow call schedule. The fellows will perform any urgent non-invasive procedures and provide the initial interpretation under the supervision of the attending physician. The fellow will perform emergency invasive procedures in accordance with his or her level of training and expertise under the direct supervision of the staff physician. The fellow will provide adequate documentation to fully relay the management plan and any procedure results to the team responsible for the patient’s care.
     
  5. Non-Teaching Patients:
    In the event of a life-threatening emergency, the cardiology fellow will be responsible for the care and stabilization of “teaching” and “non-teaching” patients alike. If there is a difference of opinion over the management plan for “non-teaching patients”, the patient’s attending physician will be responsible for all subsequent evaluation, management decisions, and order writing that is necessary. Currently, “non-teaching” patients are only those who are post-procedure (either from the EP or from the interventional laboratory) or are low risk patients (e.g. rule out acute coronary syndrome, completion of a prolonged course of antibiotic or those receiving oral anticoagulation). These patients are managed by the cardiology nurse practitioners who are supervised by a hospitalist. The weekend and weeknight coverage is provided by the hospitalist and/or the designated staff physician.

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