SUPERVISION AND ACCOUNTABILITY POLICY - Addiction Medicine Fellowship
Harborview Medical Center, Public Health – Seattle & King County, VA Puget Sound Healthcare System
Responsibilities and Accountability
Each patient must have an identifiable and appropriately-credentialed and privileged attending physician (or licensed independent practitioner as specified by the applicable Review Committee) who is responsible and accountable for the patient’s care. This information will be available through personal introduction and photo ID badge to fellows, faculty members, other members of the health care team, and patients.
The Addiction Medicine fellows, and faculty members must inform each patient of their respective roles in that patient’s care when providing direct patient care.
The program will provide the appropriate level of supervision for each fellow based on each fellow’s level of training and ability, as well as patient complexity and acuity. Supervision may be exercised through a variety of methods, as appropriate to the situation.
As part of their education program, fellows are given graded progressive responsibility according to the individual’s clinical experience, judgment, knowledge, and technical skill. Each fellow must know the limits of their scope of authority, and the circumstances under which the fellow is permitted to act with conditional independence.
Supervision Definitions
To promote oversight of fellow supervision while providing for graded authority and responsibility, the following levels of supervision are recognized:
Direct Supervision:
The supervising physician is physically present with the fellow and patient during the key portions of the patient interaction.
Indirect Supervision:
With direct supervision immediately available – the supervising physician is physically within the hospital or other site of patient care and is immediately available to provide Direct Supervision within 15 – 30 minutes.
With direct supervision available – 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 come to the site of care in order to provide Direct Supervision.
Oversight:
The supervising physician is available to provide a review of procedures/encounters with feedback provided aftercare is delivered.
Fellows Competence & Delegated Authority
The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each fellow must be assigned by the program director and faculty members.
The program director must evaluate each fellow’s abilities based on specific criteria, guided by the Milestones.
Faculty members functioning as supervising physicians must delegate portions of care to fellows based on the needs of the patient and the skills of each fellow.
Clinical Responsibilities by PGY-Level
Fellows
Fellows may be directly or indirectly supervised. They may provide direct patient care, supervisory care or consultative services, with progressive graded responsibilities as merited. Fellows should serve in a supervisory role to medical students, junior and intermediate residents in recognition of their progress towards independence, as appropriate to the needs of each patient and the skills of the fellow; however, the attending physician is responsible for the care of the patient.
Levels of Supervision for Common Specialty Clinical Activities and Invasive Procedures
|
Clinical Activity/Procedure |
Resident level (PGY)
|
Location
|
Supervision Level
|
|
Fellows in Addiction Medicine do not perform invasive procedures |
NA |
NA |
NA |
Circumstances and Events in which Supervising Faculty Member (s) MUST be Contacted
Fellows must contact their attending with any potential life-threatening deterioration related to a patient’s substance use disorder (for example, severe alcohol or benzodiazepine withdrawal necessitating ICU admission). If fellows want immediate consultation with an attending physician for any reason, it is always available. If the attending physician does not respond in a timely fashion, the fellow is encouraged to contact (1) the program director or (2) any other available faculty member within the Addiction Medicine program.
Supervision of Consults
The attending of record is ultimately responsible for the care of the patient and thus must be available to provide direct supervision when appropriate for optimal care and/or as indicated by individual program policy. The availability of the attending should be appropriate to the level of training, experience and competence of the fellow and is expected to be greater with increasing acuity of the patient’s illness. Information regarding the availability of attendings and fellows should be available to residents, faculty members, and patients. Fellows performing consultations on patients are expected to communicate verbally with their supervising attending at regular time intervals (no later than 24 hours after the consult is performed).
Emergency Procedures
It is recognized that in the provision of medical care, unanticipated and life-threatening events may occur. The fellow may attempt any of the procedures normally requiring supervision in a case where death or irreversible loss of function in a patient is imminent, and an appropriate supervisory physician is not immediately available, and to wait for the availability of an appropriate supervisory physician would likely result in death or significant harm. The assistance of more qualified individuals should be requested as soon as practically possible. The appropriate supervising practitioner must be contacted and apprised of the situation as soon as possible.
Faculty Supervision Assignment
Faculty supervision assignments are of one week or longer duration and therefore are of sufficient length to assess the knowledge and skills of each fellow and to delegate to the fellow the appropriate level of patient care authority and responsibility.
Supervision of Handoffs
Addiction Medicine fellows have no night or weekend call and only work during regular hours 8 a.m. through 5 p.m. If they need coverage for patients, they work the coverage out in advance with other fellows or attending physicians.
Fellows conducting hand-offs are expected to use structured verbal and electronic processes for patient transfers between services and locations.