Pediatric Housestaff

Supervision

 

Supervision Policy for Department of Pediatrics 

Revised October, 2010

1. Supervising medical staff physicians will adhere to the ACGME requirements pertaining to the level of supervision for residents in a training program. Supervision may be exercised through a variety of methods. Some activities require the physical presence of the supervising faculty member (direct supervision). For many aspects of patient care, the supervisor may be a more advanced resident or fellow or mid-level provider, e.g. NNP. Other portions of care provided by the resident can be adequately supervised by the immediate availability of the supervising faculty member or resident physician, either in the institution (indirect supervision with direct supervision immediately available); or by means of telephonic and/or electronic modalities (indirect supervision with direct supervision available).  In some circumstances, supervision may include post-hoc review of resident delivered care with feedback as to the appropriateness of that care (oversight).


2. To ensure patient safety and quality patient care while providing the opportunity to maximize the resident educational experience, supervising medical staff physicians need to be available to the resident in person or by telephone 24 hours a day when on clinical duty.

3. When a resident is involved in the care of the patient, the responsible supervising staff physician must maintain personal involvement in that patient’s care. The supervising staff physician is fully responsible to oversee the care of the patient and directs the appropriate intensity of resident supervision based on the nature of the patient’s condition, the likelihood of major changes in the management plan, the complexity of care, and the experience and judgment of the resident being supervised. All patient care services must be rendered under the oversight of the responsible supervising staff physician, a supervising provider or be personally furnished by the supervising staff physician or provider.


4. The residency program leadership will consistently ensure that residents know which supervising medical staff physician is on call and how to reach this individual.


5. Supervising medical staff physicians will demonstrate compliance with any residency review committee citations related to this supervisory function.


6. Residents may only exercise privileges for patient activities and procedures for which his/her supervising physician or supervising provider has been appropriately credentialed.

7. Supervising medical staff physicians are responsible for determining when a resident is unable to function at the level required to provide safe, high quality care to assigned patients. They have the authority to adjust duty hours downward to ensure that residents that are overly fatigued do not place patients at risk.

8. Individual residents must be aware of their limitations and not attempt to provide clinical services or do procedures for which they are not trained. They must know the graduated level of responsibility described for their level of training and not practice outside of that scope of service.

9. Each resident is responsible for communicating significant patient care issues or changes in patient condition to the supervising medical staff physician and such communication must be documented in the medical record, inclusive but not limited to, significant decline in patient condition, a rapid response call to patient bedside, request to discharge patient against medical advice, patient transfer to the ICU, patient/family request for DNAR order, patient need for any invasive procedure,  patient death.

10. Failure to function within graduated levels of responsibility, communicate significant patient care issues to the supervising physician, or appropriately document the level of supervising physician oversight may result in the removal of the resident from patient care activities.

 

Graduated Levels of Responsibility

The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident must be assigned by the program director and faculty members. As they advance in their training program, residents should be given progressive responsibility for care of patients. The determination of a resident's ability to provide care to patients without a supervising physician present, or to act in a teaching capacity is based on the resident's clinical experience, judgment, knowledge, and technical skill. It is the decision of the supervising physician as to which activities the resident will be allowed to perform within the context of the assigned levels of responsibility.


1. The Residency Program Director defines the levels of responsibilities for each year of residency training by preparing a description of the types of clinical activities residents may perform. Graduated levels of responsibility will be in accordance with ACGME and JCAHO guidelines and this documentation will be made available to the LPCH Medical Staff Office annually. These activities are delineated for each resident on:  http://mso-web-01/msonet/

 

2. In compliance with ACGME standards, PGY-1 residents should be supervised either directly or indirectly with direct supervision immediately available.

Documentation of Supervision of Residents


The medical record must clearly demonstrate the involvement of the supervising medical staff physician in resident patient care. Documentation of supervision must be entered into the medical record by the supervising physician or reflected within the resident progress note or other appropriate entries in the medical record (e.g., procedure reports, pathology reports, imaging reports, consultations, discharge summaries).

 

Definitions:

Levels of Supervision and Responsibility:

     Direct supervision: the supervising physician is physically present with the resident and the patient
Indirect supervision with direct supervision immediately available – the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide direct supervision.

     Indirect supervision with direct supervision available – the supervising physician 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
Oversight – The supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

 

Supervisors:

     Supervising Medical Staff Physician- The attending level physician responsible for patient care

     Supervising provider-  A more advanced resident,  fellow or mid-level provider who can offer oversight for activities and procedures for which that advanced level resident, fellow or provider is credentialed to perform independently           

 

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