Menu UF Health Home Menu
 

Communication Policy

Communication between Residents and Faculty on the Clinical Ward Service

Effective communication is essential to safe and effective patient care.

The faculty and resident should clarify the communication plan prior to any shared clinical service experience. This clarification of expectations should include:

  1. Times of planned communication
  2. Ready availability and contact information (beeper, cell phone, e-mail, home phone and preferred method of communication)
  3. Expectations concerning when to initiate communication re: patient care and safety
  4. A discussion of how to effectively balance supervision, providing assistance and resident autonomy
  5. Review of “direct supervision” and “indirect supervision”

Planned Communication

  • Plan for specific times each day for communication between the attending physician and the resident.
  • Examples of times during the day when communication may occur include:
    • 7:30 AM – Identify new admission to be seen, prioritize patients with urgent issues to be evaluated
    • 08:30-11:30 AM – Rounds
    • 1:30 PM – Follow-up of specific patients
    • 4:30 PM – Sign-out pending issues, new admissions or planned admissions
    • 7:00 PM – After resident night shift sign-out for new information or clarification
    • 10:00 PM – After Tuck-in Rounds for new information
  • Attendings should clarify with the senior resident how they want to be contacted (e.g., cell phone, home phone, or beeper) if the method of contact is going to be different than what is listed in the online Shands UF On-Call System (aka CHRIS).

The “Tuck-in Rounds” Rule

  • Each night during Tuck-in Rounds the night shift senior resident should decide if any information discovered on Tuck-in Rounds (e.g., new or “impending admissions” and recent changes in patient status) should be conveyed to the appropriate attending for the specific specialty or general service.
  • Attendings should clarify with the senior resident how they want to be contacted (e.g., cell phone, home phone, or beeper) if the method of contact is going to be different than what is listed in the online Shands UF On-Call System (aka CHRIS).

Expectations concerning when to initiate communication

  • Deterioration in clinical status
    Examples include but are not limited to:

    • Unstable vital signs despite appropriate interventions
    • Acute deterioration in respiratory status / impending respiratory failure
    • Acute change in mental status
    • PEW Score: a value of “3” in one category or a total score of 4 or higher
  • Change in level of care
    Examples include but are not limited to:

    • Transfer to PICU or IMC
    • Cancellation of a planned discharge for medical or social reasons
    • Patient death
    • New admission or transfer from OR with significant medical issues
  • Issues related to medical decision making (present the case in SBAR format) and plan
    Examples include but are not limited to:

    • New critical labs
    • Before calling another service for a consult (including before calling the PICU)
    • New decisions or recommendations by consultants emergent/occurring before the next planned discussion – endoscopy, biopsy, bronchoscopy, surgery Change in DNR status
    • Any time you wish to discuss your planned medical decision making
  • Seeking assistance with systems issues or hierarchy
    Examples include but are not limited to:

    • To ask for assistance in obtaining urgently needed services for a patient
    • To facilitate attending to attending discussion between services
  • Miscellaneous
    Examples include but are not limited to:

    • To discuss patient or family dissatisfaction that has not been adequately resolved
    • Medical error(s) which has/have impacted patient care or safety
    • Any concern, question or issue relevant to patient care or safety

Discussion to balance attending supervision and resident autonomy

  • Supervision must be readily and easily available
  • Expectations of the attending and the resident are explicit
  • Communication is bidirectional
  • Autonomy can be preserved

Review direct and indirect supervision

  • Direct supervision: The supervising physician is physically present with the resident and the patient.
  • Indirect supervision: 1) 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.
  • Indirect supervision: 2) 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 provide direct supervision.