Call & Coverage

Call & Coverage

PM&R Residency Program Manual
PM&R Residency Program Hospital Rotations/Call/Coverage/Pager Policies

PM&R Guidelines for Inpatient Rehabilitation Hospital Rotations for PGY2
UVa-HealthSouth Medical Director: Alan P. Alfano, MD
Attending, Spinal Cord Injury Service -  Alan P. Alfano, MD;
Attending, Orthopedic Joint Replacement Service - Laura W. Lee, MD
Attending, Neurologic Rehabilitation Service- Paul T. Diamond, MD
Attending, General Rehabilitation Service- D. Casey Kerrigan, MD

During the PM&R Residency Program PGY2 inpatient rehabilitation rotations residents work full-time in the UVa-HealthSouth Rehabilitation Hospital. Each resident is assigned to a single attending physician and will function as primary physician for patients involved in the rehabilitation process. This is the primary inpatient experience of the residency program. 

Objectives:

  • Residents learn how to perform a comprehensive rehabilitation history and physical examination. As part of this process residents learn how to perform important components of this evaluation that are unique to rehabilitation medicine, i.e. the functional components of history and physical.
  • Residents learn how to formulate an appropriate rehabilitation plan, which addresses the specific needs of an individual patient.
  • Residents learn appropriate documentation of rehabilitation orders, assessments, and discharge paperwork. Daily progress notes and review of labwork will also be required. 
  • Residents learn the specific components of diagnosis-based specialty examination.  These components will be mentored by the attending physician.
  • Residents learn how to effectively function as a rehabilitation team leader.  Specifically, they will have the opportunity to lead multidisciplinary team meetings, family education sessions, and participate in staff education. 
  • Residents learn fundamental principles of Rehabilitation Hospital physician practice; including appropriate use of therapies, labs, diagnostics, consultations, and developing relationships with referring physicians and hospitals.
  • Residents may have the opportunity to participate in the Rehabilitation Hospital administrative structure. This participation will be in the form of regular communication with hospital administrators, and through participation in hospital committees.

Resident Responsibilities:

  • Inpatient rotation start times, daily rounds, and resident documentation will be communicated by the service attending.
  • Residents are to rotate on-call according to a schedule determined by the Chief Residents and approved by the residency program director.
  • Residents must maintain current BLS/Lifesaver AED certification.
  • Residents are responsible for reviewing relevant medical records and should obtain an appropriate history and physical exam on every new admission. 
  • Residents are responsible for dictating a comprehensive discharge summary for each patient under their care and it is important that the resident physician who knows the current medical picture best, dictates the summary.  The discharge summary must to be completed within 48 hours of the discharge date, however, it is preferred that the discharge summary be dictated before the patient leaves the hospital.
  • It is the resident’s responsibility to find out the attending’s preferences regarding time for rounds, paperwork, and the degree of resident involvement in family meetings and communication. 
  • Residents will participate in hospital-wide quality assurance exercises such as mock codes and disaster drills.
  • Residents will be evaluated based upon the above responsibilities as well as progress toward accomplishing the objectives as outlined. 
  • The individual attending physician working as supervisory physician for each individual rotation will supply relevant journal articles and suggested readings.

PM&R Resident Clinical Coverage Guidelines

PM&R Resident On-Call and Coverage Protocols     
The purpose of this policy is to ensure continuous call coverage by Physical Medicine and Rehabilitation residents.

PGY 1:

  • Residents’ call schedules will be determined by the service they are rotating on, and will be the same as other residents rotating on that service.
  • Call frequency may vary from specific rotation, but on average is not to exceed every fourth night.
  • Coverage responsibilities will be consistent with policies established by the specific service in question.

PGY 2- 4:

  • Any/all call schedule changes, including changes to rotations, coverage for vacations, sports event coverage, and so on, need to be run by the chief residents prior to the resident making final arrangements.
  • Monday through Friday first call begins at 5:00 pm and ends at 8:00 am the following day.  Saturday, Sunday, and holiday call begins at 8:00 am and ends at 8:00 am the following morning. However, duty hours may begin earlier if the attending on call wishes to start earlier. Duty hours will not end until rounds and progress notes are complete.
  • If emergencies or questions on patient management arise, a second call (back-up) resident is scheduled to be available by pager and may be required to report to the hospital (see the call schedule for the back-up call list).  If situations should arise that require further assistance, the on-call attending is available at all times.
  • The pager of the resident on-call may not be forwarded or covered by any other pager or phone. It is also unacceptable for the on-call resident to leave his/her pager unattended for any reason for any period of time while on call.
  • If, for any reason, an on-call resident cannot fulfill his/her assigned on-call duties, he/she must call one of the chief residents to ensure that alternative arrangements are made.
  • If a resident wishes to switch a call one of the chief residents must be notified, plus the residency coordinator, and the page operator.

PGY 2:

  • Residents are scheduled for first call (home call) approximately once a week.
  • Back-up call is taken for seven days approximately every third week by PGY2 residents

PGY 3:

  • Residents are scheduled for first call (home call) approximately every 16 days.

PGY 4:

  • Residents are scheduled for first call (home call) approximately every 35 days.
  • Back-up call is taken for seven days approximately every 12 weeks by PGY4 residents.

PM&R Resident Weekend Call Responsibilities

Primary Call Resident:

  • The on-call and post-call residents will each round with the attending physician on one floor (approximately half of the patients) at the UVA Rehabilitation Hospital.
  • Every patient will be evaluated as to pain or other discomforts and will be given a physical examination.
  • Latest lab values and therapeutic plans will be reviewed; if needed, changes will be discussed with the attending.
  • Residents will write a progress note for each patient on whom they rounded.
  • The resident will be available throughout their on-call period for questions concerning patient care and will respond immediately to emergencies.
  • The resident will inform the attending on call about any complications.

Secondary Call Resident (backup resident):

  • The backup call period begins at 8:00 am on Sunday and ends at 8:00 am the following Sunday.
  • The resident will be available in case of an emergency and must be available by pager throughout the backup call week.
  • The resident will serve as a consultant to the primary resident on call, will substitute for the primary call resident in case of emergency or illness, and will come in to the hospital if additional assistance is needed.
  • The backup resident may be required to fill in for any PGY1 on another service at UVA who is unable to fulfill his or her duty requirements. This will be determined on a case-by-case basis by the chief residents and the residency director or assistant director.

Attending On-Call Responsibilities:

  • The attending will round with residents at his or her preferred time on all patients.
  • The attending will personally examine the patient and evaluate the possible need for acute intervention and/or a change of treatment plan. 
  • The attending will write notes on each patient and will be available for consultation to the primary and/or secondary resident until 8:00 am Monday morning. 

Home Call: The resident on call may leave the treatment facility at 6:00 PM and will be available for emergencies throughout the rest of the coverage period. He or she will be responsible for being accessible by pager at all times during this period. Residents will be expected to report to the facility if this request is made, or it is necessary for patient care; otherwise, residents will be allowed to handle phone orders and resident questions from home. 

PM&R Resident On-Call Schedule Changes
This policy is to ensure continuous on-call coverage on the Department of Physical Medicine and Rehabilitation Inpatient Bed Services.The following procedures must be implemented when making a change to the initial Physical Medicine and Rehabilitation Call Schedule published at the beginning of the academic year.

  • All Physical Medicine and Rehabilitation medical staff affected by the changes on the call schedule must agree to the proposed changes.
  • All proposed call changes must be approved by the chief residents before becoming official.
  • Individuals initiating the call change are responsible for contacting the following Individuals and divisions to notify them of the change(s):
    • Rehab Hospital Nursing Units (you need to make sure the written changes are made to the schedules on both the 2nd and 3rd floors)
    • Hospital Call Sheet Operator (make a note of with whom you spoke, and email that information to the chief residents and the residency coordinator)
    • Residency Program Coordinator
    • For weekends, also notify the attending on call

PM&R Resident Vacation Coverage Policy
The purpose of this policy is to ensure adequate coverage when residents take vacations.

  • When a floor resident takes vacation, the resident covering the General Rehabilitation service will then cover the absent resident’s service.
  • The resident on the Inpatient Orthopedic/Joint service will cover both the IP Ortho/Joint and General Rehab services.
  • In the event that the resident on the General Rehabilitation service takes leave, the resident on the IP Ortho/Joint service will cover both the IP Ortho/Joint service and the General Rehab service.
  • If the resident on the IP Ortho/Joint service takes leave, the resident on the General Rehab service will cover both the IP Ortho/Joint and General Rehab services.
  • If the patient load for the combined services of IP Ortho/Joint and General Rehab exceeds 16 patients, additional coverage will be provided by other floor residents. The residents on the Inpatient Neurorehabilitation and Spinal Cord Injury services will assist with coverage as follows: whichever resident has less patients will take on additional patients from the combined IP Ortho/Joint and General Rehab services to decrease the number of patients
    to 16. If the Neurorehab or SCI resident’s patient load exceeds 16, prior to getting the combined Ortho/General service load down to 16, an additional resident (from neuro or SCI) will take patients from the combined Ortho/General service until that service is down to 16.
    This means that in some cases, an attending physician will be rounding with more than one resident. However, it is felt that this is safer for patient care. One resident should not cover more than 16 patients at a time.
  • Although vacation dates have been prearranged with coverage already planned, a leave request form must still be filled out and signed by the covering resident, the service attending, and the residency coordinator. This way, the residents that are covering your service are reminded that they are going to be covering, and the attendings will be aware that you are off. All vacation leave requests for the entire academic year are due to the chief residents prior to the chief residents’ completion of the master schedule for the year. A specific due date will be determined yearly by the chief residents.
  • Specifically, for the PGY3 resident on the Pain Management rotation: any leave days must be covered by another PM&R resident. All leave requests must be approved by
    Dr. Hamill-Ruth at least 8 weeks in advance.
  • Residents may not take vacation during their KCRC Inpatient rotation.

PM&R Resident Pager Policy
Pager/beeper availability: all residents must be available for radio paging, option 10, during the work day.  This includes during the research, elective and cardiopulmonary rotations.  If there is an urgent situation or illness requiring coverage, you may be called to cover another service. 

If you are not available, do not return pages, and have not turned in a vacation form you will be charged for a vacation day.

Do not use your pager to screen calls and only return selected pages.  If your pager is on option 10, available for radio paging, you are expected to return all calls.  If you will not be returning calls, change your pager to option 19, not on call.

PM&R Resident Meals

  • Resident lunches are provided free of charge to all PM&R PGY2-4 residents in the UVa-HealthSouth cafeteria Monday through Friday.
  • Residents on call will be provided free breakfast on their post call day.
  • Residents on weekend call will be provided free lunch, but need to telephone the UVa-HealthSouth kitchen in advance to request their meal.
  • Residents in the hospital after normal meal hours may eat snacks from the UVa-HealthSouth refrigerators on the nursing units (sandwiches, crackers, peanut butter, fruit, ice cream) or buy snacks from the vending machines.
  • The UVa Hospital provides money for each call night. The money is applied to the meal card (ID) and can be used in the UVa Hospital cafeteria, or the KCRC cafeteria.

UVA House Staff Policy for Resident On-Call Meals:
On-call meals are provided to any housestaff member required to remain overnight in the hospital in an on-call capacity for 24 hours or more. One meal is issued for each qualifying night. Each meal is valued at $5, $8, or $11 depending upon the total number of hours in-house. Meal money is calculated monthly based on call schedules provided by the Chief Residents and is placed on the cafeteria on-line retrieval system. Funds are accessed by using your ID badge in the card readers located at each cash register.

From website: http://www.healthsystem.virginia.edu/internet/housestaff/policy-manual/oncall.cfm