LSU Emergency Medicine Residency Handbook 2013-14

Revised April 2014, M. Haydel, MD

LOUISIANASTATEUNIVERSITYHEALTHSCIENCECENTER –

NEW ORLEANS

EMERGENCY MEDICINE RESIDENCYPROGRAM

POLICIES TO SUPPLEMENT LSUHSC HOUSE OFFICER

MANUAL &ROTATION GUIDE

Contents

INTRODUCTION

POLICIES – ACGME

ACGME Core Competencies

MILESTONES

PGY1 YEAR

PGY2 YEAR

PGY3 YEAR

PGY4 YEAR

Resident Duty Hours and the Working Environment

Duty Hours - Emergency Medicine

POLICIES - LSUHSC

Ethics Code - LSUHSC Emergency Medicine Residency

Code Of Professional Conduct

Honor Code

Grievance Policy - Academic

LSU QUALITY OF CARE STATEMENT

Job Description - EM House Officer

House Officer I

House Officer II

House Officer III

House Officer IV

Resident Supervision

HOUSE OFFICER CONTRACT

COMPENSATION

INSURANCE

Health Plans

Disability Insurance

Medical Practice Liability Coverage

LEAVE:

Vacation Leave

Sick Leave

Maternity/Paternity Leave

Educational Leave

Military Leave

Leave of Absence

Family Leave

Pay Scales - LSUHSC House Officer

Emergency Fund for Residents

Campus Assistance Program

Fitness For Duty And Substance Abuse Policy

FATIGUE and FITNESS FOR DUTY

Work Related Injury/Illness

Dress Code

LIBRARY - LSUHSC

WELLNESS CENTER

HOUSE STAFF CLEARANCE FORM

POLICIES – Section of EM

Mission Statement

GOALS and OBJECTIVES

Role of the Residency in the Emergency Department

EM Residency Applicants

Residency Promotions

Supervision of Residents

Transition of Care Policy

Hand Off Tool

Liaison & Oversight Policy

Dismissal Policy

OMBUDSMAN

REVIEW OF TRAINING PROGRAMS

Satisfactory Academic Standing

Evaluations

Monthly evaluation of Residents by Faculty

Annual evaluation of Faculty by Residents

Evaluation of Rotations by Residents

Evaluation of Program by Residents

6 month Evaluation of each Resident by Advisor

Yearly Eval and Final Exit Evaluation of Resident by Program Director

Faculty Advisors

Evaluation of Resident Documents Policy

Procedure and Patient Experience Documentation

Procedures And Resuscitations

Ultrasound

New Innovations

Educational Stipend

Travel Forms

Mailboxes/ Email

Beepers

Vacation

Yearly Schedule Requests

ED Schedules

TARDINESS

Disaster Call

Disaster Call Scheduling

Disaster Call & Duty Hours

Code Grey – Hurricane Guidelines

Advanced Life Support Programs Policy

Moonlighting Policy

Call Room

Conference Attendance Policy

Journal Club

Journal Club Literature Critique

Patient Safety Presentations

Medical Records

Research Requirement

Chief Resident Responsibilities

Chief Resident Questionnaire

Residency Curriculum

Model For Emergency Medicine

Reference Book Loan-Out Policy

Medical License

Louisiana License, Training Permit & STEP 3:

State Licensure

DEA number

NPI number

Notary

Guidelines to Rotations/Goals & Objectives

LSU Public Hospital Emergency Department

ED: Specific Competency-based Goals & Objectives

ANESTHESIA & US

ANESTHESIA and US at ILH

LALLIE KEMP EMERGENCY DEPARTMENT

EMS- New Orleans EMS

CHILDREN’S HOSPITAL ED

MICU

OB Ochsner

OCHSNER ED

OLOL Pediatric ED

OCHSNER ED

OCHSNER ED-Pediatrics

SLIDELL ED

PEDIATRIC INTENSIVE CARE UNIT ROTATION

TOXICOLOGY

TRAUMA ICU

VA URGENT CARE CENTER

WEST JEFFERSON ED

WEST JEFFERSON PEDIATRIC ED & FASTTRACK

ELECTIVE

INTRODUCTION

Welcome to the LSU Emergency Medicine Residency Program. This LSU EM Policies Manual is meant to augment the LSUHSC School of Medicine, Office of Graduate Medical Education, House Officer Manual. The House Officer Manual is updated each year and is available on the LSUSHC website at:

A hard copy of the EM Policies manual is available in the emergency medicine offices and online at the LSU EM website.

POLICIES – ACGME

ACGME Core Competencies

The following 6 Core Competencies for ACGME accreditation purposes.The residency program requires that its residents obtain competence in the six areas listed below:

Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Among other things, residents are expected to:

Gather accurate, essential information in a timely manner.
Generate an appropriate differential diagnosis.
Implement an effective patient management plan.
Competently perform the diagnostic and therapeutic procedures and emergency stabilization.
Prioritize and stabilize multiple patients and perform other responsibilities simultaneously.
Provide health care services aimed at preventing health problems or maintaining health.
Work with health care professionals to provide patient-focused care.

Residency Experience: each clinical rotation and every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, ACLS/PALS/ATLS and teaching medical student anatomy labs.

Residency Assessments: Direct observation and documentation of Monthly and Yearly evaluations, simulation cases, oral board cases, Follow-up cases 360 evaluations.

2. Medical Knowledge: Residents must demonstrateknowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.Among other things, residents are expected to:

Identify life threatening conditions, the most likely diagnosis, synthesize acquired patient data, and identify how and when to access current medical information.
Properly sequence critical actions for patient care and generate a differential diagnosis for an undifferentiated patient.
Complete disposition of patients using available resources.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, asynchronous learning modules, US, Tox, all orientations, ACLS/PALS/ATLS and teaching medical student anatomy labs.

Residency Assessments: National In-service Exam, Monthly and Yearly evaluations, 360 evaluations, oral board cases, simulation cases and journal club.

3.Practice-Based Learning: Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their patient care practices.Among other things, residents are expected to:

Analyze and assess their practice experience and perform practice-based improvement.
Locate, appraise and utilize scientific evidence related to their patient’s health problems.
Apply knowledge of study design and statistical methods to critically appraise the medical literature.
Utilize information technology to enhance their education and improve patient care.
Facilitate the learning of students and other health care professionals.

4. Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families and professional associates.Among other things, residents are expected to:

Develop an effective therapeutic relationship with patients and their families, with respect for diversity and cultural, ethnic, spiritual, emotional and age-specific differences.
Demonstrate effective participation in and leadership of the health care team.
Develop effective written communication skills.
Demonstrate the ability to handle situations unique to the practice of emergency medicine.
Effectively communicate with out-of-hospital personnel as well as non-medical personnel.

5. Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.

Residents are expected to demonstrate a set of model behaviors that include but are not limited to:

Treats patients/family/staff/paraprofessional personnel with respect.
Protects staff/family/patient’s interests/confidentiality.
Demonstrates sensitivity to patient’s pain, emotional state and gender/ethnicity issues.
Able to discuss death honestly, sensitivity, patiently and compassionately.
Unconditional positive regard for the patient, family, staff and consultants.
Accepts responsibility/accountability.
Openness and responsiveness to the comments of other team members, patients, families and peers.
Arrives for scheduled shifts on time, fit for duty and appropriate attire.

6. Systems-Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.Among other things, residents are expected to:

Understand access, appropriately utilize and evaluate the effectiveness of the resources, providers and systems necessary to provide optimal emergency care.
Understand different medical practice models and delivery systems and how to best utilize them to care of the individual patient.
Practice cost-effective health care and resource allocation that does not compromise quality of care.
Advocate and facilitate the patients’ advancement through the health care system.

MILESTONES

It is anticipated that residents will reach certain milestones in their training as remonstrated by the following General Competency Goals and Objectives for level of training.

EMERGENCY MEDICINE YEAR END COMPETENCIES-being updated to reflect ACGME and ABEMMILESTONES

PGY1 YEAR

These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency.
By the end of the PGY-1 year, EM residents are expected to:

Competency Objective / Core Competency / Assessment Method
Complete all clinical rotations with satisfactory evaluations / PC, MK, ICS / Rotation evals
Attend at least 70% of all mandatory EM conferences. / PF, MK, PBL / Attendance sheets
Demonstrate EM knowledge by scoring at least 70th percentile on the ABEM In-service examination. / MK, PC / ABEM exam
Obtain documents required for medical licensure. / PC, SBP / Resident File
Properly assist in trauma or medical resuscitations with guidance. / MK, PC / Simulations, global evals, oral boards
Demonstrate the ability to execute admission and discharge, once the disposition is determined. / MK, PC, SBP / SDOT, global evaluations
Residents are expected to maintain timely documentation of charts in the ED, medical records and hospital paperwork. / ICS, PC, SBP / Procedure logs, med. recs dept.
Obtain faculty evaluations and document procedures in New Innovations. / PC / Procedure logs, simulations, SDOT
Demonstrate adequate documentation of procedures with at least 1/5 of ACGME targeted procedures in the NewInnov. / PC / Procedure logs
Demonstrate adequate documentation of follow-up diagnoses of patients seen in the ED and complete 10 follow-up/year / PC, MK / Follow up logs, resident portfolios
Demonstrate adequate progress with all specified academic requirements as judged by the program director. / PBL, ICS / Portfolio, lecture evaluations
Identify a potential area of need for the residency required administrative project. / SBP / Semi-Annual eval.
Identify and choose a potential topic for the residency required academic project. / PBL / Semi-Annual eval.
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. / PF / Global evaluations, 360 evaluations
Demonstrate the ability to interact effectively with nurses, ancillary staff, patients and families. / ICS / Global evaluations, 360 evaluations

PGY2 YEAR

These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency.
By the end of the PGY-2 year, EM residents are expected to:

Competency Objective / Core Competency / Assessment Method
Complete all clinical rotations with satisfactory evaluations / PC, MK, ICS / Rotation evals
Attend at least 70% of all mandatory EM conferences. / PF, MK, PL / Attendance sheets
Demonstrate improvement in EM knowledge by scoring at least 75th percentile on the ABEM In-service examination. / MK, PC / ABEM exam
Pass USMLE Step 3. Louisiana License, Training Permit & STEP 3: / MK, PC, SBP / Resident File
Properly perform a trauma or medical code resuscitation with minimal guidance. / MK, PC / Simulations, global evals, oral boards
Demonstrate the ability to execute admission, discharge, and transfers once the disposition is determined. / MK, PC, SBP / SDOT, global evaluations
Residents are expected to maintain timely documentation of charts in the ED, medical records and hospital paperwork. / ICS, PC, SBP / Procedure logs, med. recs dept.
Completes all procedure-related readings, achieve 80% on all post-tests, obtain faculty evals and documentation in RP. / PC / Procedure logs, simulations, SDOT
Demonstrate adequate documentation of procedures with at least ½ ACGME targeted procedures in NewInnov. / PC / Procedure logs
Demonstrate adequate documentation of 10 follow-up diagnoses of patients seen in the ED. / PC, MK / Follow up logs, resident portfolios
Demonstrate adequate progress with all specified academic requirements as judged by the program director. / PL, ICS / Portfolio, lecture evaluations
Complete significant progress on the residency required administrative project. / SBP / Semi-Annual eval.
Complete significant progress on the residency required academic project. / PL / Semi-Annual eval.
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. / PF / Global evaluations, 360 evaluations
Demonstrate the ability to interact effectively with nurses, ancillary staff, patients and families. / ICS / Global evaluations, 360 evaluations

PGY3 YEAR

These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency.
By the end of the PGY-3 year, EM residents are expected to:

Competency Objective / Core Competency / Assessment Method
Complete all clinical rotations with satisfactory evaluations (meets expectations or above). / PC, MK, ICS / Rotation evaluations
Attend at least 70% of all mandatory EM conferences. / PF, MK, PL / Attendance sheets
Demonstrate improvement in EM knowledge by scoring at least 78th percentile on the ABEM In-service examination. / MK, PC / ABEM exam
Maintain licensure. / PC, SBP / Resident File
Properly perform a trauma or medical code resuscitation with minimal supervision. Appropriately sequences critical actions and identifies interventions required to immediately stabilize a patient. / MK, PC / Simulations, global evals, oral boards
Manages multiple patients at various, progressive stages of work-up throughout the shift, making appropriate, timely decisions / MK, PC, SBP / SDOT, global evaluations
Residents are expected to maintain timely documentation of charts in the ED, medical records and hospital paperwork. / ICS, PC, SBP / Procedure logs, med. recs dept.
Demonstrate adequate documentation of procedures with at least ¾ of ACGME targeted procedures listed in NewInnov. / PC / Procedure logs
Demonstrate adequate documentation of 10 follow-up diagnoses of patients seen in the ED. / PC, MK / Follow up logs, resident portfolios
Demonstrate adequate progress with all specified academic requirements as judged by the program director. / PL, ICS / Portfolio, lecture evaluations
Complete [significant progress on] the residency required administrative project. / SBP / Semi-Annual eval.
Complete [significant progress on] the residency required academic project. / PL / Semi-Annual eval.
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. / PF / Global evaluations, 360 evaluations
Demonstrate the ability to interact effectively with nurses, ancillary staff, patients and families. / ICS / Global evaluations, 360 evaluations

PGY4 YEAR

These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency.
By the end of the PGY-4 year, EM residents are expected to:

Competency Objective / Core Competency / Assessment Method
Complete all clinical rotations with satisfactory evaluations (meets expectations or above). / PC, MK, ICS / Rotation evaluations
Attend at least 70% of all mandatory EM conferences. / PF, MK, PL / Attendance sheets
Demonstrate improvement in EM knowledge by scoring at least 80th percentile on the ABEM In-service examination. / MK, PC / ABEM exam
Maintain licensure. / PC, SBP / Resident File
Properly perform a trauma or medical code resuscitation. Appropriately sequences critical actions and identifies interventions required to immediately stabilize a patient. / MK, PC / Simulations, global evaluations, oral boards
Manages multiple patients at various, progressive stages of work-up throughout the shift, making appropriate, timely decisions. Supervises and facilitates patient flow in ED. / MK, PC, SBP / SDOT, global evaluations
Residents are expected to maintain timely documentation of charts in the ED, medical records and hospital paperwork. / ICS, PC, SBP / Procedure logs, med. recs dept.
Demonstrate adequate documentation of procedures with at least 100% of ACGME targeted procedures listed in RP. / PC / Procedure logs
Demonstrate adequate documentation of 10 follow-up diagnoses of patients seen in the ED. / PC, MK / Follow up logs, resident portfolios
Demonstrate adequate progress with all specified academic requirements as judged by the program director. / PL, ICS / Portfolio, lecture evaluations
Complete the residency required administrative project. / SBP / Semi-Annual eval.
Complete the residency required academic project. / PL / Semi-Annual eval.
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.. / PF / Global evaluations, 360 evaluations
Demonstrate the ability to interact effectively with nurses, ancillary staff, patients and families. / ICS / Global evaluations, 360 evaluations

Resident Duty Hours and the Working Environment

Duty Hours

Duty hours are defined as all clinical and academic activities related to the residency program, ie, patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. ED rotations: duty hours are limited to 60 hours per week.
Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.
Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call.
MOONLIGHTING must be documented in New Innovations and counts toward duty hours. Moonlighting may not exceed the duty hour limits.

3. On-Call Activities

The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution.

In-house call must occur no more frequently than every third night, averaged over a four-week period.
Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements.
Interns may not exceed 16 hours of consecutive inhouse duties.
Residents many not accept new patients after 24 hours of continuous duty.
At-home call (pager call) is defined as call taken from outside the assigned institution.
The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period.
When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit.
The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue.

4. Moonlighting

Because residency education is a full-time endeavor, the program director must ensure that moonlighting does not interfere with the ability of the resident to achieve the goals and objectives of the educational program.
The program director must comply with the sponsoring institution’s written policies and procedures regarding moonlighting, in compliance with the Institutional Requirements III. D.1.k.
Any moonlightingmust be documented and counted toward the 80-hour weekly limit on duty hours.

5. Oversight

Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment. These policies must be distributed to the residents and the faculty. Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service.
The Disaster Call system for EM residents provides a backup support system when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care.

Duty Hours - Emergency Medicine

Duty Hours on Emergency Medicine Rotations
“There must at least an equivalent period of continuous time off between scheduled work periods. Residents may attend educational activities between work periods, but at some point in the 24 hour period must have an equivalent period of continuous time off between the end of one activity (work or educational) and the start of another activity (work or educational).” ACGME 2007