Graduate Medical Staff Supervision

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  • NEWYORK-PRESBYTERIAN HOSPITAL
    GRADUATE MEDICAL EDUCATION
    POLICIES AND PROCEDURES
    TITLE: GRADUATE MEDICAL STAFF SUPERVISION (effective July 1, 2011)

PURPOSE:

Members of the Graduate Medical Staff (also referred to in this policy as "residents") are valuable members of the patient care team practicing medicine or dentistry under the supervision of a member of the Medical Staff and are typically in training programs accredited by the Accreditation Council for Graduate Medical Education, the Commission on Dental Accreditation, the American Osteopathic Association or an equivalent accrediting agency approved by the New York State Education Department.

POLICY:

  1. MEDICAL BOARD RESPONSIBILITIES:

    • ​​​​​​The Medical Board, on behalf of the Medical Staff, shall:

      1. review the credentials and experience of residents in relation to the care to be provided within the training program;
      2. recommend to the Board of Trustees privileges that are specific to treatment/procedures performed by residents prior to the delivery of patient care services; and
      3. institute written policies and procedures governing medical practice by residents.

  2. CLINICAL SERVICE CHIEF AND PROGRAM DIRECTOR RESPONSIBILITIES:

    • The Clinical Service Chief and Program Director, as directed by the Medical Board, shall:
      1. develop and implement a written delineation of privileges for each resident level of the program using the supervision definitions below;
      2. evaluate and monitor patient care services provided by residents;
      3. identify appropriate supervisors; and
      4. report incidents when a resident or supervisor acts outside the scope of privileges granted and take action as defined in the Medical Staff By-Laws.

  3. DEFINITIONS:

    1. Direct Supervision means the supervising physician is physically present with the resident and patient and can visualize and direct the care
    2. Indirect Supervision with direct supervision immediately available means the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision.
    3. Indirect Supervision with direct supervision available means 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.
    4. Oversight means the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.

  4. COMMON SUPERVISION REQUIREMENTS

    • Chain of command
      All programs are expected to establish a specific chain of command for patient care decisions. Individual programs should define specific issues or conditions that warrant discussion with a supervisor. Supervisors should make an effort to reach out to residents on patient care rather than solely waiting for a resident to initiate a concern.
      All residents should consult with the attending physician regarding the assessment and treatment of a patient's illness. Treatment plans should be determined in accordance with the attending physician's recommendations.
      ​​​​​​​PGY-1 residents must be supervised either directly or indirectly with direct supervision immediately available.
    • Onsite supervision
      ​​​​​​​At times, someone other than the attending physician may provide onsite supervision of routine hospital care and procedures. The attending retains the overall obligation of supervision and must always be immediately available by telephone and readily available to come to the Hospital. Graduate staff members who are in their final year of residency training or who have completed at least three years of training in their program may provide such onsite supervision.
    • Documentation
      ​​​​​​​Supervision must be documented in the patient's medical record on a regular basis.
    • Schedules
      ​​​​​​​Supervision must be clear from resident and attending schedules. Each department will have these available at all times and will provide them as required.
    • Accrediting organization requirements
      Each training program may have additional supervision standards as dictated by the accrediting organization which may be more restrictive than those outlined in this document. If so, the more restrictive standards will apply.

  5. SUPERVISION IN SPECIFIC SETTINGS

    • ​​​​​​​The following will apply in specific settings. When more restrictive supervision requirements are established by other Hospital policies or procedures, the more restrictive supervision requirements will apply.

      • Surgery, Endoscopy, Interventional, and other invasive procedures
        ​​​​​​​Attending physicians must directly supervise the critical portions of surgical, endoscopic, interventional, and other invasive procedures requiring general anesthesia or an operating room setting. If credentialed to do so, a resident may perform non-critical portions of the procedure under “Indirect Supervision with direct supervision immediately available” as defined above. The attending physician must document preoperative examination and assessment, supervision during critical portions of procedures, and postoperative daily examination and assessment.
      • Inpatient supervision
        All inpatients must have a daily note from the attending of record, or the qualified covering attending, within 24 hours of admission or transfer, and for every hospital day thereafter. The note must document appropriate oversight and supervision of the house staff.
      • Emergency Department
        The Emergency Department will have a supervising attending physician present in the Pediatric and the Adult Emergency Rooms at all times.
      • Obstetrics
        An appropriately credentialed attending physician must directly supervise deliveries.
      • Outpatient/Ambulatory Clinics
        An attending physician must provide either direct supervision or indirect supervision with direct supervision immediately available of all patient care and be available in the clinic for consultation and direct supervision as necessary.
      • Off-site Rotations, including private physicians’ offices
        ​​​​​​​Supervision of off-site resident care must be defined in writing by each program. When residents are assigned to physicians' offices, they are under the supervision of that attending physician.

Approved by GMEC: November 2010
Approved by The Medical Board: April 2011