Attending Responsibilities 

• Attending rounds should set the tone for the intellectual rigor and quality assurance that are important for our teaching programs.
  
• At the start of each rotation, the attending should discuss the goals (available at this link Educational Goals for Residents ) for the rotation with the housestaff and students.
  
• Attending rounds should be made sometime between 10:00 AM and Noon on weekdays and between 8:00 AM and 10:00 AM on weekend days and holidays.
  
• Attending rounds should not extend beyond noon so that the housestaff can attend Noon Conference.
  
• The attending should see and discuss all new admissions to the attending's service and provide documentation that this has taken place. Patients of private attendings are to be considered as teaching patients.
  
• The attending should provide surveillance for all patients and, if necessary, serve as a mediator between the housestaff and the private physician or with a member of the full time faculty should there be questions or problems.
  
• Attending rounds should not be a repetition of or a substitute for work rounds but rather an opportunity for new case discussion, exploration of pathophysiology, dissection of complex problems, review of topics by students and housestaff, discussion of differential diagnosis as well as an opportunity to demonstrate physical findings.
  
• Attendings should encourage their teams to initiate and complete their work rounds prior to Intake Conference. Interns should carry out their patient care responsibilities early in the morning and should be strongly encouraged to attend Intake Rounds.
  
• The attending should not travel during the months they are on service. Additionally, unless there is an emergency, there should never be more than two individuals who function as attendings during a rotation.
  
• At the end of each rotation, the attending should meet individually with each house officer and student and discuss their evaluations. The evaluations should be turned into Dr. Siegel (housestaff) and to Dr. Steinberg (students) within 48 hours after the completion of their rotation.
  
• If the attending identifies a problem with a student or house officer during the rotation, he/she should meet with and counsel the individual. If the problem appears to be serious or rate-limiting for the student or house officer, the attending should make certain that he/she formally meets with the individual no later than two weeks into the rotation. If the problem has the potential to result in an adverse evaluation for the student or houseofficer, the attending should notify the Director of the Medical Student Education Program (Dr. Steinberg) or the Chief Residents and/or Chairman, respectively.
  
• The attending should strongly encourage the students and housestaff to attend all scheduled teaching conferences including Intake and Noon Conferences. Every effort should be made to encourage the housestaff to be on time for their continuity of care clinics (RPP).
  
• The attending should be aware of and strongly supportive of our commitment to provide each intern with at least one full day off during each seven-day period. 

Policy for Resident Supervision

Purpose: The purpose of this policy is to assure that quality patient care is coupled with progressive resident educational training and that there is always appropriate supervision for pediatric residents.
This policy is linked to the policy on Attending Responsibilities

Responsibility: Pediatric residents, UTSW faculty and Pediatric Chief Residents.

Policy: When admission to an inpatient service is determined to be necessary for a patient who will enter our system via the emergency room or by transfer from an outside institution or office, the admitting team will be notified by bed control or by the PL-2 caring for the patient in the emergency room. The admitting team consists of a PL-1 and PL-3 and, sometimes, a PL-2.

After a history and physical (including assessment and plan) is completed and is documented in the patients medical record, the attending of record for the patient shall be contacted; if the patient's condition is judged to be serious or life-threatening, the attending is to be notified immediately. In the more usual and routine circumstances, the plan will be discussed and confirmed between the residents and plan, including provisions for notification of the attending should there be a deterioration of the patients condition, will be discussed with the attending.

PL-1's have primary responsibility for the direct care of patients assigned to their service, and any services they cross cover. If the PL-1 has questions, the senior resident on the service (or on call) will be their immediate resource. In instances of emergency, the PL-1 may directly contact the attending however in most instances he/she should first discuss the patient or the problem with the PL-3.

PL-3's are responsible for oversight and supervision of all patients on their service. They are responsible for including attending physicians in the construction of all care plans. Thus, the attending physician of record is the immediate resource for the senior resident.

PL-2's must sign patients out to the attending ER physician when working in the emergency room. When a patient is admitted through the emergency room, it is the responsibility of the PL-2 to inform the admitting team of the involvement of any private community physician, or consulting physician used in the workup of the patient.

When a patient is admitted to a specialty floor of the hospital, it is always acceptable to contact the fellow for a service in place of the attending. It is then the responsibility of the fellow to include the attending physician's wishes in the plan.

The attending physicians and fellows on call shall be kept on record by the PBX operators of the hospital, who keep the most current telephone numbers and beeper numbers of all faculty.