UCLA Tri-Campus Pediatric Residency Policies and Guidelines

1. UCLA DUTY Hours Policy
2. Moonlighting Policy
3. Post-call Notes Policy
4. UCLA Ward Structure
5. Ward Round Policy
6. Hospital Role
7. Schedule Changes
8. Dictations Policy
9. Continuity Clinic Policy
10. Jeopardy Call Policy
11. Jeopardy: Queue & Point System
12. Float Book Policy
13. UCLA Department of Pediatrics Overnight Cross-Cover Note Policy
14. For more information regarding general housestaff policies and guidelines, please visit the UCLA Graduate Medical Education website: http://www.medsch.ucla.edu/public/residencies/
15. Day ER Float Description
16. Night ER Float Description

Moonlighting Policy

Greetings everyone,

The UCLA Graduate Medical Education Committee recently approved a policy on moonlighting by residents.  The policy is provided below.  A key component of the policy is that all residents who moonlight must complete the attached form and return it to me.  Also, please note that moonlighting hours count toward the 80 hour maximum per week.  If you are currently moonlighting, please complete the form and return to me.  If you begin moonlighting in the future, you need to complete and return the form when you begin this activity.  

Thanks, Shahram

DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA
GME Policy on Moonlighting

The special nature of the residency programs requires extensive clinical activity and availability to patients at times other than the regular working day. In addition, residency programs have a continuing academic component that requires continual personal effort. The general policy of the School of Medicine is not to encourage any type of outside clinical employment.

Each program director has the authority to develop and adopt a definitive policy applicable to the residency program with respect to outside clinical employment. Such policy may allow or prohibit moonlighting of house officers. Residents must not be required to engage in moonlighting.

Because residency education is a full time endeavor, the resident must ensure that moonlighting does not interfere with their ability to achieve the goals and objectives of the educational program. All moonlighting hours must be counted toward the 80-hour weekly limit on duty hours. Residents are responsible for ensuring that the addition of moonlighting hours does not result in a work week in excess of the 80-hour maximum, or result in fatigue which might affect patient care or learning.

It is the responsibility of the residents to notify the program director if they are moonlighting. The program director may require detailed information on the timing and level or activity to assure it does not cause fatigue or interfere with patient care and the goals and objectives of the program. This information will be kept by the program director. The program director should acknowledge in writing that s/he is aware that the resident is moonlighting, and this information should become part of the resident’s folder.

Approved by the GMEC: 1/27/03

Download the Moonlighting Form

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UCLA Department of Pediatrics Post-call Notes Policy

Dated 4/6/2005 

Goal: To improve resident work hours and maintain patient continuity of care

Objectives:

1) Patient Care/Work Hours

a. Intern and resident writing of notes (with the 2 exceptions noted below) will maintain patient continuity of care

b. Compliance with ACGME Work Hours will result in improved patient care and safety for both residents and fellows

c. Fellow/attending writing of notes on days specified will result in continued Post-call Work Hour Compliance for residents

Policy:

Interns and residents will be expected to write Admission Histories and Physicials and daily Progress Notes on their patients with the exception of 2 scenarios:

1) Intern is post call and their senior resident is off

2) Senior resident is post call and the intern is off

The ward fellow or attending will need to write notes under the above scenarios which will result in an average of one day a week.  All discharge summaries will continue to be written by the interns and residents.    

This Policy has been reviewed by the Residency Council and submitted to Dr. Yazdani, residency program director, and Dr. McCabe, executive chair of the department.   

This Policy is effective 4/18/05. 

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UCLA Pediatric Ward Structure

Revised 8/17/06

1. The following teams will each have 2 interns and 1 senior:

• GI
• HO
• Card
• Gold = Renal + A&I + Endo + ID + Genetics
• Blue = Gen Peds + Neurosurgery + Ophthalmology + other surgical consults

2. Neuro functions as its own team with the fellow, Adult Neuro resident, and Peds R2.

3. Admissions during day (8am – 6pm): Chief Resident is the gatekeeper and will direct calls for admissions to the appropriate team’s senior.

4. Admissions during night (after 6pm): ERFL team will contact On Call senior, who will assign the patient to the appropriate team.

5. Consults:

• General Rules: All surgical patients under 2 years of age will automatically require a General Pediatric consult, and surgical teams may request consult on older patients. Recommendations may be given and consult notes written, however the surgical teams are responsible for their patients’ H&P’s, admission orders, and discharge summary. If the surgical resident is not easily accessible, the pediatric resident may write orders after notifying the appropriate surgical service with a text page.
• Blue Team will be the consulting team for the following services: Pediatric Surgery, Orthopedics, Head and Neck, Plastic Surgery, Ophthalmology, and General Neurosurgery cases (i.e. VP shunt placement).
• Neuro will be the consulting team on the Neurosurgery cases involving resection of seizure foci or hemispherectomies.
• Heme Onc Team will be the only pediatric consulting service for all cases involving resection of tumors, either malignant or benign.
• But ALL neurosurgery cases will receive a pediatric consult REGARDLESS of age.
• Ophthalmology is an independent surgical team, but due to their unfamiliarity with CHS, all of their patients will require a General Pediatric consult.
• Gold Team will consult/co-follow on Urology cases with renal compromise, and on Pediatric Surgery cases for dialysis catheter placement or AV fistula creation.

7. Patient Caps: Please see the hospitalist policy for each team’s patient cap.

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UCLA Department of Pediatrics Ward Round Policy

Revised 8/17/2006

Goal: To improve the efficiency of ward rounds, to continue to provide excellent patient care, to comply with work hours, and to enable residents and fellows to participate in educational obligations (including attendance at educational conferences).

Objectives:

1) Patient Care

a. Patient management decisions will be made in an expeditious manner to facilitate timely care.

b. The disposition of the patient will be known earlier in the day resulting in improved patient disposition.

c. Patient safety is a priority: Emergent and urgent patient care issues will take priority over all other resident endeavors.

2) Educational

a. Resident and fellow understanding of their patients will facilitate efficacy of ward rounds

b. Attendance at resident or fellow educational conferences will improve resulting in:

i. Improved resident and fellow funds of knowledge

ii. Greater dissemination of knowledge

3) Work Hours: Improved efficiency of rounds will result in improved resident and fellow work hours and patient care

Policy: Ward Rounds for all services will start promptly at 9:00 am. Rounds must be attended by an attending or fellow, though it is understood that some subspecialties may need to round by phone due to outpatient clinical duties. All service rounds must conclude no later than 11:30 am. Residents will have 11:30-12:00 to write orders, call consults, or perform other immediate duties. Noon conference will begin promptly at 12:00 with the expectation that all residents will be present with the exception of any post-call resident or a resident who is attending to a medically unstable patient.

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UCLA Pediatric Hospitalist Role 7/2006-6/2008

· Relieve the pediatric ER float team of their duties at 8am Monday-Friday (excluding holidays). Attend to the patients in the emergency room that require continuing care until respective primary teams have completed morning rounds. Any of these patients that require admission by any of the teams on the floor need to be admitted by the respective teams, unless the team is capped.

· Admit, manage, and attend to those patients 8am-4pm Monday through Sunday that exceed the proposed caps in each of the five services:

§ GI Team: 12 patients

§ HO Team: 16 patients

§ Card Team: 12 patients

§ Gold Team: 12 patients

§ Blue Team: 14 patients

· The cap is 6 patients per hospitalist. The hospitalist may exceed this cap upon their own discretion.

· The weekend hospitalist will admit additional patients to the hospitalist service when the combined census is less than 6.

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UCLA Pediatric Chief Residents

POLICIES GOVERNING SCHEDULE CHANGES, JEOPARDY CALL, CONTINUITY CLINIC, & DICTATIONS

Revised 7/14/06

OVERVIEW

1. As previously noted, we would like to give residents a reasonable amount of freedom and responsibility to shape their own schedules and educational goals.  By adhering to these protocols, residents will enjoy a fair degree of autonomy, provided, again, that they play by the rules of common courtesy.  Residents are encouraged to suggest modifications and enhancements to the prescribed protocols at future Residency Council Meetings.

2. The Chief Residents shall honor reasonable Sick Call requests for personal or family emergencies, and acute illnesses.  Sick Call requests for post-residency job interviews and presentations at conferences will be honored if reasonable attempts at schedule changes do not succeed.

3. Individual residents are responsible for all other desired schedule changes.  Furthermore, all non-clinic schedule changes must be submitted in writing to the Chief Residents at least 72 hours before the dates in question.  All parties affected by the proposed schedule change must confirm their agreement by email to the chief residents, and then abide by the approved or denied schedule change.  The requesting resident shall be expected to inform all relevant parties of the approved schedule change. Chief residents will notify the page operator.

4. Continuity Clinic schedules are completed 2-3 months in advance.  Therefore, residents are instructed to submit formal requests for changes at least 8 weeks prior to the clinic date in question, such that continuity patient appointments can be coordinated appropriately.  Unauthorized Continuity Clinic changes are unacceptable, as delineated by the current RRC Guidelines. It is the responsibility of each individual resident to check their clinic schedule against the following: their call schedule, their team’s schedule, and any other responsibilities. Residents must notify the chiefs of any conflicts within one week of the initial email. Failure to attend clinic may result in negative jeopardy points.

5. Relevant documents regarding policies and procedures, including the RRC Guidelines and UCLA Housestaff Manual, shall be accessible to the Housestaff for review at all times.

SCHEDULE CHANGES

1. Arranging coverage for a proposed schedule change is the responsibility of the resident desiring the change.  Common courtesy dictates that the resident in question notify and obtain approval from all residents affected by the proposed schedule change.  An email denoting the relevant dates, clinical duty, and affected residents will be submitted to chief residents, and cc’d to all affected parties.  Inclusion of any resident’s name on the email implies that he or she was notified of the proposed change and gave approval.

2. Upon ratification by the Chief Residents, an E-mail will be transmitted to all relevant parties giving approval for the change, and the official schedule shall be amended to reflect the change.  Presuming adherence to all procedural rules, the Chief Residents shall ratify any change request unless it is felt that resident education or the quality of patient care will be unduly compromised.  A resident’s approval implies full acceptance of any potential consequences.

3. If a legitimately affected resident asserts that approval for a schedule change was not given, or a proposed schedule change not asked for, the Chief Residents shall promptly investigate the complaint.  If the complaint is deemed valid, the Chief Residents will bring all relevant parties together to negotiate a fair settlement.

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DICTATIONS

1. In an effort to reduce delinquency and medical errors, it is highly recommended that all death, discharge, or transfer summaries be completed on the day of discharge.  It is understood that this may be difficult at times due to patient care obligations, extended work hours, and/or fatigue.  In such situations, a reasonable grace period will be allowed for the completion of outstanding dictations.
2. Dictations are the ultimate responsibility of the intern assigned to the care of a given patient.
3. As a courtesy to interns, and at their own discretion, Senior Residents may complete any outstanding death, discharge, or transfer summaries.
4. If a delinquent dictation is erroneously assigned to any resident, it is the responsibility of that resident to personally clear the matter with the Medical Records Department staff.
5. The Chief Residents will issue “courtesy” reminders each week.  If a resident fails to complete the dictation despite several reminders, this will be addressed with the resident by program administrators as an issue of professionalism.
6. The UCLA Medical Center Quality Improvement Division reviews, at random intervals, delinquent dictations.  They will suspend the clinical privileges of the Attending Physician of record for the patient in question.
7. If an Attending Physician is contacted regarding impending suspension of clinical privileges, the point system delineated above does not apply.  In such cases, the resident responsible for the outstanding dictation will be notified by the Chief Residents, and will have until the following Monday to complete the dictations.  Failure to complete the delinquent dictation will result in an automatic assigning of “– 2 Points” and the matter will be referred to the Chairman of the Department of Pediatrics.
8. The ultimate goal of this system is to improve the timeliness of completing outstanding dictations.  This will facilitate:

a. Achieve optimal patient care

b. Facilitate continuity of care (i.e., availability of a discharge summary for the next caretaker)

c. Avoid suspension of Clinical Faculty

d. Facilitate Medical Billing

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CONTINUITY CLINIC

1. As described in the current RRC Guidelines, this residency program “will provide adequate continuity experience for all residents, to allow them the opportunity to develop an understanding of and appreciation for the longitudinal nature of general pediatric care, including aspects of physical and emotional growth & development, health promotion and disease prevention, management of acute and chronic medical conditions, family and environmental impacts, and practice management.”

2. Residents “must assume responsibility for continuing care of a group of patients throughout their training.”

3. As described in the RRC Guidelines, “inherent in the principle of continuity of care is that patients are seen on a regular and continuing basis, rather than on a single occasion.  Isolated block experiences will not satisfy this requirement.”  Continuity coverage provided for you by other residents will not be credited.

4. Residents must devote at least one-half day per week to their continuity experience throughout the three years of residency.  This experience must receive priority over other responsibilities, and may be interrupted only for vacations and outside rotations “located at too great a distance to allow residents to return.”

5. The periods of interruption may not exceed 2 months in any single academic year, or 3 consecutive months at any time.  Vacation time equals 4 weeks of interruption, and Holiday Schedule another 2 weeks.  This leaves only 2 free weeks for “interruption,” easily consumed during ICU rotations or ER Float.  Please be aware of this!

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JEOPARDY CALL

1. Residents on Jeopardy Call must be available on pager 24 hours a day, should call back in response to the page within 30 minutes at most, and should arrive at the designated site within 1 hour of the page.  If a resident is found to be unavailable for Jeopardy Call, the Chief Residents will deduct jeopardy points and may refer the matter to program administrators as a violation of the professional code of conduct.

2. It is expected that residents will submit, via email, a plan for direct payback within two weeks of utilizing the jeopardy call system. The plan may simply be a notification to the chiefs to defer to the following year when schedules may be more flexible for payback. When this plan is formulated, jeopardy points assigned/deducted will be removed/restored. If a resident is out for an extended period of time, requiring extended use of the jeopardy call system, full direct payback may not be possible. This will be evaluated on a case-by-case basis.

3. A resident on Jeopardy Call may travel or be otherwise unavailable if he or she obtains approval from the Chief Residents and finds another resident (of his / her level of training or higher) who is not scheduled to work during that period and who is not already on Jeopardy during that period to take his / her Jeopardy call. Again, such approval must be obtained per the aforementioned Schedule Change Request protocol, and all aforementioned rules will apply.

4. To maintain continuity of patient care, coverage of a single resident’s absence will be covered by a single Jeopardy Call Resident, whenever possible.  If coverage extends beyond 7 days (or 4 consecutive days for ICU rotations), a single Back-up Jeopardy Call Resident will be activated for the remaining 7 days of the rotation (or 4 consecutive days for ICU rotations.)

5. Herein, the Chief Residents shall defer to the UCLA Medical Center Sick Leave Policies outlined in the UCLA Housestaff Manual, if necessary.  Specifically, these are:

a. Sick Leave is credited to the year of appointment.  There is no carry over between training programs or years of training.

b. Sick Leave is accrued at the rate of 8 hours per month, (12 “working” days or 96 hours per year.)

c. Each House Officer shall immediately notify the Chief Resident or Program of any illness requiring use of Sick Leave.  If required by the department, the resident shall provide physician records to document illness lasting three or more consecutive days, or any unusual pattern of absence.

d. Additional Sick Leave may be granted at the discretion of the department chairperson; makeup time may, however, be required to meet all educational objectives.

e. Leave of Absence for jury duty shall be granted with no loss in pay or benefits.

f. Paid Maternity Leave is 2 weeks each year.  Time taken in addition to this, with the exception of Sick Leave or vacation time, will be leave without pay, and may require makeup time for specific Board Requirements.

g. Paid Paternity Leave is 1 week per year, provided the following conditions are met:

o The House Officer has given written notice to the Program Director of his intention to take Paternity Leave, at least 30 days prior to the projected birth or adoption date.

o Paternity Leave cannot be taken later than 30 days after the actual birth or adoption date, nor can it be commenced earlier than 30 days prior to the projected birth or adoption date.

h. If a House Officer has been issued advance vacation or Sick Leave and separates from the program prior to the beginning of the next academic year, all advance time shall be reimbursed to the University.

i. No more than 5 days of accrued Sick Leave may be used when a House Officer is required to be in attendance or provide care because of illness or death of a relative.

j. Family and Medical Leave is provided for an eligible House Officer’s serious health condition, the serious health condition of a House Officer’s child, spouse, or parent, or to bond with the House Officer’s newborn, adopted, or foster care child.  Medical Leave may be requested by a House Officer for a medical condition affecting his/her ability to continue in a training program or provide patient care.  These leaves must include the use of vacation, Sick Leave, or Education Leave at the onset.  The duration of leave must conform to one’s departmental and American Board requirements, together with applicable state and federal law, including AB1460, the Federal Family and Medical Leave Act.  Both Family and Medical Leave are unpaid leaves.

k. A female resident is entitled to a maximum of 4 months of unpaid leave for pregnancy-related disability, in addition to the 12 weeks of Family Leave Entitlement in any 12-month period.

6. A flexible, Point System of payback for Sick Call utilization and coverage was adopted in March 2002.  The details of this system are described below.

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JEOPARDY CALL:  QUEUE & POINT SYSTEM

LOGISTICS

1. Jeopardy Call service will be assigned and completed in 1 week blocks.

2. Schedule permitting, there will be 2 Interns, 2 Junior Residents, and 2 Senior Residents (to increase to 3 Junior Residents and 3 Senior Residents starting in July 2007) assigned to Jeopardy Call at any given time of the academic year.  The exact numbers may change.

3. Med/Peds residents are expected to cover half the number of jeopardy weeks as categorical Pediatrics and CHAT residents with similar point tallies. Of note, their points will be counted double, positive and negative. 4th year Med/Peds residents will be considered as 3rd year Pediatrics residents when distributing number of jeopardy weeks and in sharing of jeopardy coverage as a class.

4. With the exception of emergencies, each class will provide Jeopardy coverage for their own class only.

5. The Chief Residents may, at their discretion, elect to “jeopardize” any available resident on Jeopardy Call if the need arises, provided that the coverage any resident is asked to provide is appropriate to their level of training.

6. The System is based on the premise of “Program Payback.”  The ultimate goal of the Jeopardy Call Policy is to evenly distribute the responsibility of covering absent residents, and:

a. Although the system is not meant to be punitive, it discourages “inappropriate” Jeopardy Call use.

b. The System will “reward” those residents who contribute to Jeopardy Call coverage.

c. The System will normalize the amount of Jeopardy coverage provided by various residents.

7. The Chief Residents will maintain accurate records of coverage and utilization.  Residents are expected to comply with this system.  The system is a work-in-progress, and the Chief Residents reserve the right to enforce and modify this system as necessary. Point tallies will be audited at least on a yearly basis, to occur just before assignment of jeopardy weeks for the following year.

8. Failure to attend mandatory events (e.g. orientation) will result in deduction of jeopardy points and notification of program administrators as an issue of professionalism.

QUEUE SYSTEM