Pediatric Resident Roles and Responsibilities

McMaster Children’s Hospital

PCCU Trainee Expectations

Pediatric Resident Roles and Responsibilities:

·  There is an expectation that the PCCU residents maintain open communication with their supervising PCCU fellow regarding all patient care issues

·  PCCU residents are expected to have examined their patients, know the relevant patient data (vital sign profiles, fluid balance, labs and imaging results, meds etc.), and synthesize a problem list and management plan. This needs to be accomplished prior to the start of rounds.

·  Rounds will start at 0915 in unit.

·  Plans are to be enacted through the day with appropriate follow up. Resident to coordinate and communicate with ancillary and consulting services.

·  Ensure daily updates are provided to family, and when appropriate to the primary care provider

·  Update the electronic patient work sheet to allow an orderly efficient handover

·  Junior trainees must be supervised by the PCCU fellow in all bedside procedures

·  PEDS 1000/”PICU RESIDENT” (Log in to Vocera as “PICU Resident”)

o  Carries Peds 1000 Pager (PACE, ED consults, Trauma fan outs, Code Blue)

o  Logs in to Vocera as “PICU Resident”

o  Daytime Responsibilities of “PICU Resident”: all discharges and admissions to PCCU, troubleshooting in PCCU during bedside rounds, responds to all PICU emergencies, depending on patient volume and activity in the PICU may also carry patient assignments (discharge dictations are to be completed by the resident on PICU rotation who best knows the patient on the day of discharge)

o  There is an expectation that if required to leave the PICU to respond to a Peds 1000 page, the Vocera device and thereby the role as “PICU Resident” should be call forwarded over to a resident colleague prior to leaving the unit. If another resident is not available to accept the Vocera device and role of “PICU Resident” than there must be communication with the PICU Fellow or PICU MRP to discuss an alternative plan for PICU coverage

o  Given the expected acuity and workload of this role, ideally it should be assigned to the Senior PCCU resident on rotation in discussion with the PCCU Fellow or PCCU MRP (allocation of the role should be equitable between residents at a similar level of training)

·  Daytime PCCU Resident:

o  Carries patients assignments and as such is responsible for all aspects of assigned patient care throughout the day including troubleshooting prior to bedside rounds, presentation during bedside rounds, ordering/arranging/follow up of tests, investigations, consultations, etc., documentation of daily progress note and event notes in patient chart, communication with family, etc.

·  After hours On-Call PCCU Resident:

o  The PCCU resident on-call after hours will be responsible for both the Peds 1000 pager as well as the Vocera “PICU Resident” role

o  In addition, there is an expectation that the PCCU resident will follow up on all daytime activity of all patients in the PCCU (as per PCCU handover) and will conduct a night time bedside round on all PCCU patients along with the PCCU fellow

o  The night time resident is responsible for documentation in patient chart of any significant event, deterioration or change in plan of care that may occur overnight

o  The night time resident is also to update the electronic patient work sheet with timely data.

o  All activities of the On-Call PCCU Resident should be clearly communicated to and supervised by the PCCU Fellow and/or MRP on call.

All communications regarding patient care should be directed to the PCCU Fellow On-Call; if need for further clarification, the Fellow should be directed to communicate further with the MRP if required

Pediatric Critical Care Fellow Role and Responsibilities

·  Daytime “PCCU Senior Fellow” (Login to Vocera as “PICU Fellow”)

o  Pager assigned as “PCCU Fellow”

o  Logs in to Vocera as “PICU Fellow”

o  The Senior Fellow assigned to the PCCU during daytime hours will be the “On-Call PCCU Fellow” and as such will be responsible for all aspects of care for all patients in the PCCU, supervision of PCCU Junior Fellows and PCCU residents for patient care decisions and bedside procedures, leadership of PCCU bedside rounds, leading family meetings, teaching of PCCU Residents

o  The PCCU Senior fellow should have knowledge of all PCCU patients sufficient for patient care decisions and patient management

o  The PCCU Senior fellow takes on a supervisory role for more junior trainees and as such, there is an expectation that they engage with junior trainees in all discussions or decisions around patients being followed by the trainee. The fellow should allow residents to have as much “ownership” of their patients as is safely possible. The responsible resident should write all non-urgent orders.

o  It is the PCCU Senior Fellow role to facilitate all patient flow and bed management decisions in collaboration with the MRP, PCCU Charge RN and PCCU Clinical Manager

o  The PCCU Senior Fellow is responsible for overseeing and maintaining open communication and active collaboration with all consulting subspecialists. This includes Senior Fellow to Receiving Staff MRP handover for all patient transfers out of the PICU

o  The PCCU Senior Fellow will take on an educational role in the unit by providing or facilitating bedside teaching and didactic teaching sessions to junior trainees according to pre-arranged teaching schedule and on an ad hoc basis

·  PCCU Junior Fellow Role

o  PCCU Junior Fellow is expected to follow individual patients in the PCCU as well as have an overall knowledge of all PCCU patients

o  There is an expectation that the Junior Fellow will conduct a thorough examination on their patients each morning, review and respond to the relevant patient data (vital sign profiles, fluid balance, labs and imaging results, meds etc.), and synthesize a problem list and management plan.

o  The PCCU Junior Fellow is responsible for case presentation during bedside rounds

o  In situations where a patient is being followed by both a PGY2-PGY4 resident and by a PCCU Junior Fellow, it is the expectation that the PCCU fellow take on more of a supervisory role, collaborating with the junior trainee to guide patient management and provide teaching or clinical supervision as indicated

o  The PCCU Junior Fellow pager will be responsible for all ER consults, pediatric code blue and trauma team activations. Residents will also participate in this role, as feasible and/or required.

o  The Junior PCCU fellow should collaborate with the Junior trainee and Senior PCCU fellow to ensure relevant patient data, changes in clinical status, clear understanding of care plan and requirement for senior supervision is clearly communicated.

o  All bedside procedures undertaken by the Junior PCCU fellow should be discussed with the Senior Fellow or MRP and level of supervision negotiated according to individual case characteristics

·  After Hours PCCU Fellow On-Call

o  The afterhours PCCU fellow on-call will be responsible for all elements of patient care on all patients under or being followed by the PCCU service

o  It is the On-Call Fellow’s responsibility to work in collaboration with the On-Call Resident, ensure appropriate, open and transparent communication at all times.

o  The On-Call Fellow role is one of supervision of more junior trainees and as such, it is important that the fellow engages the junior resident in all discussions and decisions regarding patient care.

o  The On-Call Fellow should seek out clinical teaching opportunities as they arise for more junior trainees

o  It is essential that any change in patient clinical status or patient care plan be clearly communicated to the On-Call Staff MRP in a timely manner

o  All consultations must be discussed between the On-Call PCCU Fellow and On-Call Staff MRP in a timely manner.

·  “PCCU PACE Fellow” (Login to Vocera as “PACE FELLOW”)

o  Pager assigned as “PACE Fellow”

o  Log in to Vocera as “PACE Fellow”

o  The PCCU PACE Fellow will have multiple roles as described below:

§  Response to all PACE calls

§  Participation in all PCCRT Calls

§  Participation in Intramural transports when medical accompaniment is required

§  Support of PCCU Junior and Senior Fellow when needed (eg: conducting procedures/sedations, troubleshooting, supervision of discharges or admissions during bedside rounds)

§  Participation in morning handover rounds and bedside PCCU Rounds with team when available

§  Assist in new resident orientation to unit systems

Cynthia Cupido, MD Arif Somani, MD

Associate Professor, Pediatrics Associate Professor, Pediatric

McMaster University McMaster University

Medical Director, PCCU ERP (Educational Resource Physician)

PCCU Fellowship Program Director