Our department follows the institutional policies and procedures of NewYork-Presbyterian Hospital for “Universal Operating Procedures” as detailed in Policy #P233, titled “Patient Care Policy”, in the New York-Presbyterian Hospital “Hospital Policies and Procedures Manual”. Our department complies with “Graduate Medical Staff Supervision” policies, as well as the following “Trigger Protocols” detailed in the NewYork-Presbyterian Hospital “Graduate Medical Education Policies and Procedures Manual” that define common circumstances requiring faculty involvement.
During fellowship, the trainee acquires deep medical knowledge, patient care skills, and expertise applicable to the care of critical neurologic injury in adults. The neurocritical care fellow is allowed graduated responsibility throughout the two-year fellowship. The fellowship utilizes an apprenticeship-like model where the fellow works alongside each attending, who can evaluate their medical knowledge, clinical skills and their ability to engage with patients and their family. The fellow is supervised discussing diagnoses, creating management plans, stabilizing the critically ill patient, demonstrating procedural skills, and developing treatment recommendations with patients and families. Each fellow will have a level of supervision commensurate with their training level and capabilities; this level of supervision may be enhanced based on factors such as patient safety, complexity, acuity, urgency, risk of serious adverse events, or other pertinent variables.
While the specific role of each fellow varies with the clinical scenario, prior experience, the patient’s illness, and clinical demands, the privileges of progressive autonomy and responsibility, conditional independence, and supervision in patient care are assigned by the Program Director and Clinical Competency Committee. The progressive autonomy that comes with advancement in level of training is determined solely by the Program Director and Clinical Competency Committee after review of evaluations and discussion of performance based on the ACGME Milestones and Core Competencies. Progressive autonomy will be documented and distributed semi-annually after each meeting of the Clinical Competency Committee.
The Program Director has entrusted the authority to determine appropriate responsibility within each clinical setting to the teaching faculty who supervise the fellow’s patient care interactions, within the framework of progressive autonomy described above. Attendings may delegate portions of care to fellows based on the needs of the patient and the skills of the fellow; the severity and complexity of each patient’s condition and patient safety issues are considered when determining each fellow’s responsibility. Regardless, the attending physician reviews all medical decisions.
The following levels of supervision are utilized for clinical activities.
- Direct Supervision: the supervising physician is physically present with the fellow during the key portions of the patient interaction.
- Indirect Supervision: the supervising physician is not providing physical or concurrent visual or audio supervision but is immediately available to the fellow for guidance and is available to provide appropriate direct supervision.
- Oversight: the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.
On both Columbia University Irving Medical Center and Weill Cornell Medical Center campuses, the members of the Division of Critical Care and Hospitalist Neurology will provide the best possible medical care to all patients regardless of race, ethnicity, sex, sexual orientation, gender identity, or economic class fully respecting their informed decisions. Patients will have access to the full array of our medical resources and expertise, including physicians, nurses, and additional support personnel, as well as our technology. At all times, all patients will have an identifiable, accountable attending physician, supported by an easily identified group of collaborating nursing professionals. All patients seen in the practices by the fellow are seen by an attending physician with at minimum a brief attestation to document supervision. The attending supervises all necessary procedures at the level designated for each individual fellow in their DOP.All inpatients and outpatients will have an attending physician listed as the physician in charge of the patient’s medical treatment, who takes ultimate responsibility for the patient’s care and supervises the fellow. This attending physician information is available to the patient and the clinical staff. Fellows and attending physicians inform patients of their respective roles in each patient’s care.
An attending physician will be involved in patient treatment to the degree necessary to assure consistently high standards of patient care. This attending physician will be responsible for and must be familiar with the care provided to the patient.
The neurocritical care fellow trainee is responsible for timely communication to the attending physician of any significant issues in the patient’s care. The neurocritical care fellow is supervised at all times by his/her designated neurocritical care attending. When called, the attending physician has the responsibility of deciding if their presence is required for optimal management of their patients. Attending neurocritical care physicians maintain a climate that encourages communication regarding patient care issues up the chain of command 24 hours a day and 7 days a week. As necessary, an attending neurocritical care attending is available to see patients at the hospital 24/7 for emergency stabilization and care. An identified on-call attending physician will be available by phone and will be able to return, if not already in the hospital, to directly supervise the fellow. In case of difficulty in reaching an attending physician, Dr. Soojin Park (Program Director) is available via cell phone 24/7 to handle any emergency situations, to supervise residents/fellows, and to see patients, as needed. The NYPH established guidelines (see below) identify specific criteria that should trigger a phone call by a fellow to an attending physician that includes “at patient or family request.”