ABSENCE

If, for any reason, residents or students are not able to assume their responsibilities, they MUST notify:

• The attending of the service on which they are rotating.
• MeritCare Medical & Academic Education Services (234-5933).
• Their residency office or the Fargo campus office.

ACCESS

All residents and medical students on rotation at MeritCare Health System must obtain a photo identification card in security. This card will provide access to the employee parking ramp and hospital. In addition, it allows residents and students after-hours access to selected restricted areas.

BEEPERS/PAGERS

Residents and medical students will be assessed $25 if a beeper is lost, stolen or damaged due to misuse. Medical students must return their pagers to Medical and Academic Education upon completion of the rotation. They are not to be handed off to another medical student.

Procedure to Activate MeritCare Pagers . All telephone extensions within MeritCare facilities in the Fargo/Moorhead area can access the pager system.

• Dial 2222
• Listen for ring; computer will say, "Enter Pager Number."
• Enter the pager number you wish to access.
• At the prompt, dial in the 4-digit extension number if it is within the MeritCare system.
• When calling a pager with a 7-digit number, dial 9, then the pager number. At the prompt or tone, dial the number you are using. Terminate the call by touching #.

If a call is being held for you at the switchboard, dial 0 and the operator will connect you. Please answer as promptly as possible. If you have not responded within 5 minutes, your call will be transferred to your department so the caller may leave a message.

The pager system may also be accessed from outside the MeritCare system by dialing 234-2222 and following the prompts.

CALL POLICIES

Medicine Call
Weekday call responsibilities are from 1:00pm - 7:30am for interns on Medicine Teams A, B, C and D. Weekend (Saturday and Sunday) and holiday call responsibilities are from 7:30am-7:30am for interns. (24 hours)

Seniors on medicine teams have call responsibilities from 1:00pm - 9:00pm Monday through Friday. Saturday, Sunday and holidays the Senior is on call 7:30am - 7:30pm. (Some exceptions may arise.)

Senior Float has call responsibilities from 9:00pm - 7:30am Monday through Thursday. They are off on Friday. Saturday, Sunday and holidays the Senior Float works 7:30pm-7:30am. Some exceptions may arise.

Residents requesting vacation/meeting time during all medicine and medicine subspecialty rotations at MeritCare must comply with guidelines for UND residency programs.

Psychiatry Call
Experience in providing on-call coverage to emergency rooms and inpatient psychiatry units is an important part of psychiatry residents' training in emergency psychiatry that leads to the development of knowledge and skills in the emergency evaluation, crisis management, and triage of patients. Accordingly, this experience should include the assessment and management of patients who are a danger to themselves or others, the evaluation and reduction of risk to caregivers, and knowledge of relevant issues in forensic psychiatry. Such activities can occur during regular daytime work hours, but they must also occur after hours when available resources and the quality of the distress of patients, and those who accompany them, may be different and call for different responses. For effective learning, such on-call activities must be properly supervised, with the intensity of that supervision varying according to the level of training or preparation of the residents involved. Whether that supervision is better accomplished by telephone or by the attending psychiatrist's physical presence is subject to situationally-specific judgments arrived at by residents and supervising psychiatrists together.

Overall, these on-call activities should represent a dynamic balance between obtaining an education and providing service - with patient safety and educational value being the highest priorities - while incorporating the needs of trainees to maintain adequate physical and mental well-being in order to effectively deliver service and derive educational benefit, in regards to both on-call and regular daytime training activities. Accordingly, the program should not allow on-call schedules and activities outside the residency to interfere with education, performance, or clinical responsibility. The program should ensure: a) one day out of seven free of program duties, averaged over four weeks; b) on average, on-call duty no more than every fourth night, while on psychiatry services; and c) adequate backup if patient care needs create resident fatigue sufficient to jeopardize patient care or resident welfare during or following on-call periods.

• All call is taken from home and is not in-house call. On-call responsibilities include MeritCare Emergency Room, Inpatient Unit, and emergency hospital consultations and is scheduled as follows:
• Friday nights from 5:00 p.m. until 8:00 a.m. Friday residents attend clinical and teaching rounds with the staff psychiatrist at 9:00 a.m. Saturday, but no new patients are assigned after 8:00 a.m. Resident responsibilities end Saturday morning upon completion of morning report and teaching rounds. Should a scheduled Friday fall on a holiday observed by all training sites in the program, the on-call responsibilities will begin at 8:00 a.m. that day rather than 5:00 p.m., with clinical and teaching rounds at MeritCare at 9:00 a.m.
• Saturdays from 8:00 a.m. to 8:00 p.m. and from 8:00 p.m. to Sunday 8:00 a.m. Saturday daytime call residents attend clinical and teaching rounds with the staff psychiatrists at 9:00 a.m., along with the Friday resident; they go off beeper at 8:00 p.m. and no new patients are assigned afterward, although they may remain to complete work begun during on-call time. Saturday night call residents attend clinical and teaching rounds with the staff psychiatrist at 9:00 a.m. Sunday, but no new patients are assigned after 8:00 a.m. Resident responsibilities end Sunday morning upon completion of morning report and teaching rounds. At times when all residents' call obligations for the year can be satisfied with fewer than four on-call opportunities per weekend, Saturday on-call is scheduled from 8:00 a.m. Saturday to 8:00 a.m. Sunday, with residents attending both mornings clinical and teaching rounds.
• Sundays from 8:00 a.m. to 11:00 p.m. Residents attend clinical and teaching rounds with the staff psychiatrists at 9:00 a.m. Sunday. Residents turn off their beepers at 11:00 p.m. and then complete any work in progress (e.g., admissions, ER evaluations, order writing, and the like) before leaving. When a Sunday on-call is followed by a Monday holiday observed by all training sites, Sunday call will extend until 8:00 a.m. Monday, with clinical and teaching rounds Monday at 9:00 a.m., but no new patients are assigned after 8:00 a.m.
• Weekday holidays (Memorial Day, Labor Day, Thanksgiving, and Christmas, July 4th, and New Year's Day when they or their official observances fall on weekdays) from 5 p.m. the evening before to 8:00 a.m. (except for Monday holidays for which Sunday call is extended, as above) and from 8:00 a.m. to 11:00 p.m., with clinical and teaching rounds for both residents at 9:00 a.m. Weekday holidays are to be scheduled for resident call, even when Saturday call is increased to 24 hours as under c.
• Unscheduled daytime emergency room calls may be covered by first year residents as described below.

2. PGY-I residents may provide unscheduled daytime emergency room call as follows:

a. While assigned to the inpatient service at MeritCare, PGY-I residents may provide emergency assessments in the ER on days that their teaching service attending has day call.

b. At the VA, daytime emergency assessments are performed by Mental Health Clinic staff, but PGY-I residents may occasionally be called to provide that initial assessment under the supervision of a staff psychiatrist.

3. Residents will be on-call for a minimum of 52 times and a maximum of 55 times (54 if holidays scheduled as 30 hours) over their PGY-II and -III years.

4. PGY- IV residents rotate on-call in tandem new PGY-II residents at the beginning of the training year in order to orient new residents to the emergency room, the inpatient unit, and on-call responsibilities. PGY- IV residents serve an amount of call sufficient to provide each PGY-II resident with three nights of orientation during which the PGY- IV residents go to the emergency room or ward anytime the PGY-II resident does.

5. Supervision of on-call:

a. MeritCare staff should orient all residents to the responsibilities and procedures associated with resident call prior to any resident's first experience on-call at MeritCare. Ideally, this should include a written description of those responsibilities and procedures to which residents and staff alike can refer to for clarity as the year goes on.

b. For each PGY-II resident at the beginning of the training year, a minimum of the first three nights on-call are to be accompanied by a PGY- IV resident as described above.

c. MeritCare staff psychiatrists on call should be available immediately by phone and should be ready to get to the emergency room within 20 minutes. These attending psychiatrists should encourage residents to call them freely with any questions.

d. On Saturday and Sunday mornings, and on holiday Mondays where the resident was on-call through the previous night, residents and staff psychiatrists shall review all contacts from the night before during morning rounds and should see all overnight admits together and review all other patients currently on the teaching service. The focus should be on enhancing the educational value of the experience as well as providing necessary services.

6. Scheduling of resident on-call is done as follows:

a. Responsibility for establishing and maintaining the call schedule rests with the residency program staff in the UND Neuroscience Office under the direction of the Program Director. Whenever possible and to the extent possible the schedule will be laid out for the entire year, July through June, by the middle of the June preceding.

b. Once the schedule is set, residents are responsible for their assigned days. They may trade assignments with each other, subject to final approval of the Program Director. They must notify the responsible Residency Program staff person as soon as the trade has been arranged and complete an On-Call Change Form. If notice is received by the 10th of the month preceding the date of the on-call nights being traded, the program staff assumes responsibility for mailing out the revised schedule. If not, then when the trade has been approved by the Program Director, the resident who initiated the trade must then contact all parties who need to be notified of the resident call schedule. The responsible program staff person maintains a list of those names and telephone numbers whom the resident must contact.

7. This policy and procedure is a revision and continuation of one implemented July 1, 1998 and will remain in effect until and unless changed by a majority vote of the Residency Committee.

Revised and approved by Psychiatry Residency Committee, June 9, 2004

CHART REVIEW/RETRIEVAL PROTOCOL - MEDICAL STUDENTS

Hospital charts are pulled and on 3 West Medical Records for review. All requests for chart review will be handled by Medical Records staff, with the expectation of at least a 48 hour advanced notice. Hours for this review are typically from 8:00 am - 4:30 pm Monday - Friday. If students do need to review charts after hours or on weekends, Medical Records can make special arrangements, but must be informed in advance.

An IRB number must be obtained and that can be done by contacting Quality Management at 5143. A list of patients that are to be reviewed (name, medical record number, and date of service must also be obtained and this can be done by contacting Quality Management at extension 6155.

To make arrangements for charts to be reviewed anytime, please contact Health Information Management at 5871.

CODES

The on-call attending and the on-call senior carry the code beepers during the day and are expected to respond to all code blues. At night, the hospitalist and the float resident carry the code beepers and respond to all codes blues. In addition, the entire on-call team is expected to respond.

CONFERENCES

There are daily conferences that are considered an important part of the education program. All Internal Medicine and Transitional Year residents are required to attend all conferences noted on the Internal Medicine Morning Report and Noon Conference Calendar. Attendance is taken and will be reported to each Program who requests it.

Conference notices are posted in the resident lounge. Information is also available on CareNet (MeritCare's intranet) regarding upcoming events in Personal Registrar. This application also allows you to register for events on line.

ORDERING CONSULTATIONS

Consultations are available from the wide range of services available at MeritCare. You must discuss the care with your attending physician or senior resident before ordering a consult. Clarify consult with a specific reason for request and how soon the patient needs to be seen. Additionally, it is also a professional courtesy to discuss the care with the individual you are consulting.

DISASTERS

In the event that a Disaster is called, all residents are to report Disaster Headquarters for assignment. Disaster Headquarters is located in the basement of the hospital across from the library.

HIPAA

HIPAA stands for Health Insurance Portability and Accountability Act. It was designed to protect patient health information. To accomplish this, HIPAA uses extensive standards to maintain security, electronic signatures and the privacy of healthcare information. The HIPAA privacy standards went into effect on April 14, 2003 and it requires that all associates must be trained on the privacy regulations. All residents and medical students will be required to complete HIPPA education prior to working in patient care areas.

ILLNESS

Residents who are unable to report for duty because of illness must notify the attending physician on the service to which they are assigned, Medical & Academic Education (234-5933) and their residency offices (see Absence).

INCLEMENT WEATHER POLICY

The inclement weather policy of the University of North Dakota School of Medicine and Health Sciences Southeast Campus is designed to provide optimal patient care while insuring the safety of all assigned personnel.

The inclement weather policy applies to all personnel, staff, faculty, residents and medical students.

The determination of inclement weather is made by the Campus Dean and Department Chairs. Determination is based on a notification of early closing by North Dakota State University , or by an announcement by clinical training site notice of closures (i.e. hospitals and/or outpatient clinics).

During inclement weather, teaching rounds are to be suspended, and work rounds may be delayed until such time that the appropriate team members can arrive at the assigned clinical training site.

All residents and students assigned to patient care services will complete their patient care activities according to the specific policy of the program, department and/or hospital to which are assigned.

In the event that the resident or student is unable to make it to the hospital, he/she is obligated to:

• Check with the hospital to see if arrangements can be made to be picked up and brought to the hospital.
• Inform the attending the physician.
• Arrange for resident coverage of his/her patients by other residents who are at the hospital.
• During inclement weather, the residents in the hospital are required to cover for those colleagues who cannot get to the hospital.

INTRAVENOUS AND PHLEBOTOMY TEAMS

The Hospital maintains a 24-hour registered nurse IV service and the Medical Group maintains a 24-hour phlebotomy service. The residents are not responsible to start IV's, for the drawing of blood, or for direct administration of most drugs into the tubing.

Students may gain additional experience in phlebotomy by scheduling directly with the Phlebotomy Service of MeritCare Medical Group.

LIBRARY

The Medical Library is located in the basement of the Hospital's North wing. The Library is open from 8 a.m. to 5 p.m. Monday through Friday. The photo ID card issued to each resident can be used for after-hours access after attending an orientation session. UND Medical Students are given after-hours access upon completion of the library orientation process. After-hours access is by photo ID only. Others (i.e. residents and/or medical students, MeritCare associates, Security) are not authorized to permit access. Specific library services for residents and medical students are covered in the orientation sessions. All MeritCare computers provide access to Medline as well as several other databases and some full-text online journals through Ovid. For details on Library services and resources, please check with the Library staff or call 234-5571.

LOUNGES

Lounges for faculty, residents and medical students are located on 3 West. Locker rooms are located adjacent to the lounges. The lockers require that each individual provide his/her own lock. It is the responsibility of each person to keep the lounge and locker areas clean. A lounge is also located in the call room suite on 1 North. Both areas have computer access for residents and students. Residents and medical students must follow all MeritCare guidelines and policies related to computer use and internet access.

MAIL

Resident mailboxes are located in the locker rooms adjacent to the lounges on 3 West. You should check your mailbox daily for Hospital communications, announcements, mail, and notices of conferences, as well as outside mail. Residents of the Internal Medicine and Transitional Year residency programs also have mailboxes in the Resident Clinic, Desk 58. Please monitor your mail at this location for patient data and information related to your clinic practice.

MEALS

Residents

• Meal tickets will be distributed at the start of each rotation. Tickets will be a $1.50 value. Lost tickets will not be replaced and Food Service personnel are not authorized to permit charging of meals.

Medical Students

• Students may receive meal tickets if a written schedule is provided to Medical Education demonstrating that late night call is required during the rotation. All other meals are at the student's expense.

ON-CALL SLEEPING ROOMS

Sleeping rooms for residents on call will be assigned by Medical & Academic Education. Each resident is given a key as an intern and a senior to keep for the duration of their residency. It is your responsibility to keep your key. There will be a $5.00 replacement fee for lost keys.

No food is allowed in sleep rooms. Please have your personal items collected and vacate the sleeping rooms promptly so that Environmental Services can clean them. Your cooperation in using closets, keeping personal items together and general tidiness will be appreciated.

Scrub suits will be available in or adjacent to the sleeping rooms. Lab coats will be kept in the closet in the Lounge area on 3 West.

PARKING

Parking is a service provided free of charge at MeritCare Health System. Residents and students are required to park in the employee section of the parking ramp when rotating at MeritCare. Your ID card will provide access to this area.

A parking permit will be issued by Security for residents' and students' vehicle(s). The hand-tag style permit must be displayed from the rear view mirror. Improperly parked vehicles will be ticketed or impounded. Charges are the responsibility of the vehicle owner. Repeated violations of parking rules and regulations are subject to actions established by the parking supervisor.

Please lock vehicles when unattended.

PHOTOCOPYING

Residents

• There is a small photocopier available for use in the Medical & Academic Education office. The photocopiers in the Hospital require an access code. Please request assistance from Medical & Academic Education associates if you need to use a hospital photocopier.

Medical Students

• MeritCare Medical Library has a coin-operated photocopier for the convenience of students. Copies are 10 cents per page.

POLICIES

All MeritCare policies are available on CareNet. This is accessible through your individual MeritCare computer login. You are responsible to follow these policies as they apply to your rotation here. Please take note of the safety policies and also those on Patient Rights, Ethics and Confidentiality.

PUBLIC ADDRESS SYSTEM

Fire : Paged as "Code RED" with location

Bomb Threat: Paged as "Code RED BRAVO"

Cardiac Arrest: The operators will first triple page over the code pagers for the CPR Team. The overhead page will follow. Paged as "Code BLUE" with location.

Fire Protection System Failure: Paged as "Code YELLOW"

Missing Child/Infant: Paged as "Code PINK "

Trauma: "Trauma Team report to ER "STAT", or "Trauma Team report to ER in __minutes."

RESIDENT SUPERVISION POLICY

The Program Director and faculty in a discipline sponsoring a residency program or participating in a program must ensure, direct and document that supervision is available to residents in the program at all times.

The individual residency program policies and procedures regarding supervision must be shared and periodically reviewed by the participating and primary sponsoring institution, the University of North Dakota School of Medicine and Health Sciences.

The teaching and supervising faculty in any program must have documentation of faculty appointments with the sponsoring institution, the University of North Dakota School of Medicine and Health Sciences.

The residency programs must provide written assurances and documentation that the attending physician and/or senior residents have the knowledge and experience appropriate to the severity and complexity of the patient's condition which is being treated, and available at the sites where the resident is participating in patient care activities.

• The responsibility for independence given to the individual residents by the supervising physician for care and management of patients should depend upon the resident's knowledge, manual skill, experience and complexity of the patient's illness and risk factors involved with procedures performed.
• The on-call schedules of faculty and senior and supervisory residents must be structured to ensure that the supervision is readily available to residents on duty. These call schedules must be available for review by the primary sponsoring institution, the University of North Dakota School of Medicine and Health Sciences.
• An appropriate, qualified member of the program's faculty must be in attendance on site when needed services or procedures exceed the capability of the most senior resident supervising the resident, or when qualified senior residents are unavailable for supervision of more junior residents.

TELEPHONES

The Hospital and Clinic share a telephone network. Simply dial the extension you wish to reach or #66 plus the extension to reach MeritCare South University . You need to dial "9" to access an outside line.

MERITCARE TELEPHONE NUMBERS

• CODE BLUE/FIRE 5666
• SECURITY 5719
• INFO DESK/PATIENT LOCATION 5523
• MEDICAL & ACADEMIC EDUCATION 5933
• SWITCHBOARD 0

VACATION/MEETING REQUESTS

All Vacation/Meeting requests must be approved by the 10 th day of the month prior to the start of the service.

It is the Resident's responsibility to bring the vacation/meeting request to Medical/Academic Education. This is in order to meet institutional and individual program requirements for granting vacation/meeting time requests.

Signature of Program Director will denote that the resident has discussed his/her plans and has received approval for time away.

For meetings, a copy of a brochure or outline must accompany all requests .

For interview appointments, a copy of the e-mail or invitation must accompany all requests.

All requests for vacation must meet the individual residency program, hospital and/or outpatient facility criteria for approval of requests.

Once the call schedule is published, it is the Resident's responsibility to arrange changes, if necessary, and notify the appropriate Medical Education offices.

Vacation days can NOT be carried over to a new academic year.

Please review the Guidelines for Vacation/Meeting Requests and the Department of Internal Medicine Resident Leave Policy in the UND Policies sections of this Handbook.

POLICY FOR ACADEMIC ASSISTANCE GRANTS

Definition:

Academic Assistance Grants are monies available to Internal Medicine and Transitional Year residents to participate in academic endeavors that transcends the capabilities that are available at the Fargo Campus to augment their own academic efforts. The purpose of this policy is to define academic assistance grants as well as to define how these assistance grants are to be distributed for each resident.

Guidelines:

• PGY-1 residents will receive up to $100 for books, professional dues, or other academic expenses. It will not carry over to the PGY-2 or PGY-3 year.
• PGY-2 residents beginning July 1, will have a $1,000 stipend. This stipend is to be utilized for both their PGY-2 and PGY-3 year. They will not receive any additional monies in their PGY-3 year. He/she may decide how to use this money to enhance their medical knowledge. They may use it for meetings, texts, tapes, CD-Roms, or dues for professional organizations.
• Chief Residents will receive a stipend of $500. He/she may decide how to use this money to enhance their medical knowledge. They may use it for meetings, texts, tapes, CD-ROMs, professional dues or fees.
• Reimbursement will only be by check.
• None of the monies can be used for payment of USMLE Step 3 or the Board Examination.
• None of these monies can be used for activity following completion of the Program.
• All distribution of these monies must be approved by the Program Director. The utilization must be in the academic area that is consistent with the program's goals. THERE MUST BE A PRIOR APPROVAL. Attendance at meetings or conferences will generally not be funded retrospectively.
• MeritCare will retain monies that are not utilized by the resident.