Supervision and Duty Hours
The Anesthesia Critical Care Medicine Fellowship Program ensures that it provides appropriate supervision for all residents/fellows, as well as a duty hour schedule and a work environment that optimizes quality patient care, fortifies the educational trajectory of house staff members, and addresses all applicable program requirements. On-call duties are necessary components of the UIHC clinical care systems and educational programs; these duties are managed to ensure adequate periods of rest with appropriate levels of supervision to deliver safe, effective patient care.
The clinical activities of all residents/fellows are supervised by teaching staff and/or more advanced house staff members in such a way as to ensure that residents assume progressively increasing responsibility according to each resident’s level of education, ability and experience. The teaching staff determines the level of responsibility accorded to each resident. On-call schedules for teaching staff and more advanced house staff members are structured to ensure supervision is readily available to those on duty.
The ICU team rounds every morning. During these rounds the faculty, fellows, residents and other health care providers discuss the patients and jointly formulate a plan of care. Thereafter, the on-service faculty is always immediately available either by phone or physical presence to discuss new issues or events and will be physically present in the unit as fellow experience and patient acuity demands. A second rounding period occurs in the afternoon in which all ICU teams gather to discuss patient issues and to hand-off care to the on-call team. After afternoon rounds, the on-call faculty members will remain physically present until they feel patient acuity and fellow experience are sufficient to allow them to leave the facility. Thereafter, they are always immediately available via phone and/or pager for consultation and can return to the institution in short order as events require.
During the beginning of the program, faculty members closely supervise the fellows during all patient care activities and procedures. As the fellow progresses in skill development and knowledge, responsibility increases and supervision may become less direct as patient and procedure complexity allow. Fellows are allowed to take more leadership roles in the patient’s medical care and function more independently as they progress through the program, but are always supervised by faculty.
The Anesthesia Critical Care Medicine Fellowship program demonstrates that the appropriate level of supervision is in place for all patients cared for by all residents. Every ICU patient has an attending intensivist assigned who is responsible for the medical care of the patient and who supervises and teaches house staff and fellows involved in the care of that patient. Each ICU team is continuously covered by a faculty member who is either physically present or accessible at any time by means of the pager and/or telephone system. These levels of supervision include:
- Direct Supervision – The supervising physician or dentist is physically present with the resident and patient.
- Indirect Supervision
i) with direct supervision immediately available – The supervising physician or dentist is physically present within the hospital or other site of patient care, and is immediately available to provide direct supervision.
ii) with direct supervision available – The supervising physician or dentist is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide direct supervision.
Fellow schedules are expected to comply with ACGME work hour mandates. Fellows are required to enter their duty hours into the institution’s electronic evaluation and tracking system (MedHub). This program automatically flags potential duty hour violations. The fellows verify the hours worked weekly and if a violation is logged, the fellow must document the reason for the violation, including voluntary presence past normal duty hours for a single patient’s care. This information is reviewed by the Program Coordinator. Any concerns are communicated to the Program Director and/or Associate Program Director. The Associate Program Director will review the violations to determine the reason(s) for the violation and, if necessary, initiate corrective actions, in association with the Program Director.