Radiology House Officer Manual 10.13.16

While there may be specific criteria for each year, a satisfactory performance in all the areas listed below is required for promotion: Satisfactory semi-annual and annual evaluations 

LSU School of Medicine

Department of Radiology

House Officer Manual

2016-2017

TABLE OF CONTENTS

Preliminary Intervention for Resident Non-Compliance

Preliminary Resident Grievance Procedure

American Board of Radiology (ABR)

RSNA Online Physics Modules

9

American Institute for Radiologic Pathology (AIRP)

37

PRELIMARY INTERVENTION FOR RESIDENT NON-COMPLIANCE

Substandard disciplinary and/or academic performance is determined by each Department Corrective action for minor academic deficiencies or disciplinary offenses which do not warrant remediation as defined in the LSU GME House Officer Manual, shall be determined and administered by each Department Corrective action may include oral or written counseling or any other action deemed appropriate by the Department under the circumstances Corrective action for such minor deficiencies and/or offenses are not subject to appeal.Residents are expected to comply with the policies stated in this Radiology Residency Handbook, the LSU GME House Office Manual, as well as policies of the affiliated institutions If a resident is found to be in non-compliance with any ofthese policies, the Chief Resident will meet with the resident to verbally discuss the non-compliance If the problem is not immediately resolved, the Program Director or Associate Program Director will meet with the residents and will verbally counsel the residents and will keep written documentation of the event and remediation plan

If the non-compliance persists, probation will be considered as per the LSU GMEHouse Officer Manual

PRELIMARY RESIDENT GRIEVANCE PROCEDURE

If a resident has a grievance, they should first discuss it with the Chief Resident,

if appropriate The Chief Resident should report the grievance to the Program Director or Associate Program Director The Program Director or Associate Program Director will then meet with the resident to discuss, and if possible, resolve the issue

Resident complaints and grievances related to the work environment or issues related to the program or faculty that are not addressed satisfactorily at the program or departmental level should be directed to the Associate Dean for Academic Affairs For those cases that the resident feels can’t be addressed directly to the program or institution s/he should contact the LSU Ombudsman (GMEC October 2007)

AMERICAN BOARD OF RADIOLOGY (ABR)

All residents are required to register with the ABR within their first month of residency Residents will pay all associated fees, which are available on the ABRwebsite at http://theabr.org/ All resident will register and take the ABR

examinations at the earliest time available for their level If you do not pass one

of these examinations, you are required to retake the examination at the earliest possible date

RADIOLOGY MEMBERSHIPS

Residents are required to register with the RSNA, ARRS, and the ACR by July

31st of their first year These memberships are either free or are at a discounted membership for residents Residents will pay any associated fees

RSNA ONLINE PHYSICS MODULES

Residents are required to complete the RSNA physics module at its assigned time in conjunction with the radiology physics course The modules that are assigned for that week are listed in the course schedule A minimum score of 70% is required Residents must email the residency coordinator a “print screen”

of their post-test

COLLABORATIVE INSTITUTIONAL TRAINING INITIATIVE (CITI)

The CITI program is a subscription service providing research ethics education toall members of the research community Residents are required to complete the CITI training and give the certificate of completion to the Program Coordinator within their first month of residency Instructions are located at

http://www.lsuhsc.edu/administration/academic/ors/training.aspx and training is located at https://www.citiprogram.org/

USMLE STEP 3 POLICY

The Louisiana State Board of Medical Examiners will confer unlimited licensure only after the candidate successfully completes the post - graduate year I level and passes the USMLE Step examinations 1 through 3 Residents are expected

to take USMLE Step 3 during their Internship year If you have not passed

USMLE Step 3 upon entering the LSU Radiology Residency program, it must be taken at the earliest available date If you do not pass Step 3 in your first year as

a Radiology Resident, you will not be promoted, and therefore must exit the program Please note that the Louisiana State Board of Medical Examiners will only allow three attempts to pass Step 3

PROGRAM EDUCATIONAL GOALS

The overall objective of the Diagnostic Radiology Residency Program at LSU is

to produce well-educated radiologists who have balanced experience in all

radiologic subspecialties in the PGY 2 through PGY 5 Years, who in the spirit of the American Board of Radiology’s October 26, 2007 Announcement, have the bulk of their Senior PGY 5 year to focus on 1 to 3 areas of interest This

education includes monthly rotations in each sub-specialty according to a

curriculum that is driven by educational needs and not by departmental service needs The curriculum includes daily intradepartmental teaching conferences, multiple weekly interdepartmental subspecialty conferences, and a core

curriculum of radiation physics and biology During his or her training, each resident will learn all radiographic modalities, including interpretation of digital radiographs, performance and interpretation of fluoroscopic and angiographic

examinations, interpretation of diagnostic ultrasound, MRI, and CT, and various interventional procedures This occurs in an adequately supervised setting with gradually increasing clinical responsibility over time

LSU seeks to:

Provide patient care that is compassionate, appropriate, and effective Residents will counsel patients in an effective and informed manner They will safely

perform various examinations, keeping in mind radiation exposure and contrast issues at all times

Incorporate a broad range of medical knowledge into the evaluation of patients and demonstrate an understanding of appropriate imaging studies based upon the clinical setting and evidence-based data

Be a consultant for referring physicians and demonstrate appropriate

communication skills

Become proficient in the use of picture archiving computer systems (PACS), voice recognition dictation system, online clinical document system, and other computer based imaging modalities

Provide clear, concise, and informative reports that are clinically relevant

Residents will notify referring clinicians of urgent and emergent findings in a timely fashion and document appropriately

Demonstrate professional behavior at all times, adhering to ethical principles anddemonstrating sensitivity Residents will be cognizant and respectful of patient confidentiality

Critically evaluate the scientific literature and apply it to daily practice and

develop good habits of continuing medical education

Play an active role in teaching of students, peers, and other members of the health care team

Demonstrate an understanding of the overall healthcare system, including

hospital administration, payer reimbursement, and medical-legal issues

SUPERVISION OF RESIDENTS

Faculty members are available at all sites of training There is direct faculty supervision of all percutaneous invasive procedures (excluding intravenous injection of contrast) The level of responsibility and independence given to each resident depends upon their individual level of knowledge, manual skills, and experience There is no in-house call Should independent in-house call be instituted, the resident will have a minimum of 12 months training in diagnostic radiology prior to in-house on-call responsibility Should in-house call be

instituted, all residents will participate in taking call during the first six months of the final year of their diagnostic radiology residency.

Residents always have faculty back-up when taking night, weekend or holiday call All images are reviewed by faculty and all reports are signed by faculty This faculty review always occurs within 24 hours There is continuous coveragefor Interventional and Neuroradiology by faculty at home When a resident is on that rotation residents are in a separate call pool and assist the attending Every rotation has at least 1 faculty supervising the rotation, and all studies must be signed out by the attending, and all procedures must be performed with an

attending

RESIDENT RESPONSIBILITY FOR PATIENT CARE

The expected components of supervision include:

1 Defining educational objectives

2 The faculty assessing the skill level of the resident by direct

observation

3 The faculty defines the course of progressive responsibility allowed starting with close supervision and progressing to independence as theskill is mastered

4 In addition to close observation, faculty are encouraged to give

frequent formative feedback and required to give formal summative written feedback that is competency based and includes evaluation of both professionalism and effectiveness of transitions

On each rotation residents are responsible for patient care For example, the resident is responsible for calling critical results, working-up Interventional

patients, obtaining informed consent, and communicating with the patient and family regarding results of examination and appropriate after care

Residents and faculty must inform patients of their respective role in patient care.Before all procedures residents will inform patients of their role as well as the faculty’s role in their care On all services prior to performing a procedure

especially when consent is being obtained, the resident informs the patient of who they are, who the attending is, and who will be involved on all invasive procedures The Interventional and Neuroradiology staff will introduce

themselves during the time they are obtaining consent for invasive procedures.Resident responsibility for patient care increases progressively as the resident is promoted from year to year Where applicable, progressive resident responsibility

is based on specific milestones Before residents are able to perform Image Guided Lumbar Puncture with indirect supervision, they must complete a

specified number of LPs successfully and have the faculty fill out an electrnoic Entrustable Professional Activity (EPA) forms The supervising section will then

look at the EPA performance and determine if that resident is able to perform that

procedure with indirect supervision

The chart below outlines the guidelines for supervision of residents It is broken

down by year of training and level of supervision The level of supervision is

broken down as follows: direct supervision by faculty, direct supervision by

senior residents, indirect immediately available supervision by faculty, indirect

immediately available supervision by senior level residents, indirect available and

Oversight

PGY Direct by Faculty

Direct bySeniorResidents

Indirect butImmediatelyavailable -faculty

Indirect butimmediatelyavailableresidents

Indirectavailable OversightI

PerformingFluoroscopy

Pediatricovernight athome call

Pediatric athome call

Pediatric

at homecall

Pediatricovernight athome call Pediatric athome call

Pediatric

at homecall

Pediatricovernight at

Junior residents are expected to teach and supervise medical students Senior residents are expected to teach and supervise junior residents and medical students

SIX GENERAL COMPETENCIES

Moving towards a competency based education; the ACGME has implemented the requirement of six general competencies into the curriculum of all accredited programs These competencies will be used as an evaluation tool for faculty evaluating residents on each rotation, the definition of each is outlined below:

1 Patient Care – Compassionate, appropriate and effective treatment for and prevention of disease

2 Medical Knowledge – About established and evolving sciences and their application to patient care

3 Interpersonal and Communication Skills – Effective information exchange and cooperative “learning.”

4 Professionalism – Commitment to professional responsibilities, ethical

principles and sensitivity to diverse patient populations

5 Practice-Based Learning and Improvement – Investigate and evaluate

practice patterns and improve patient care

6 System-Based Practice – Demonstrate an awareness of and responsiveness

to the larger context and system of health care

RESIDENT SELECTION AND PROMOTION

The Radiology Residency Program follows the Residency Eligibility and Selectioncriteria of the LSU School of Medicine, as stated in the most recent version of theLSU GME House Officers Manual

Radiology residents are required to complete an intern year in a clinical based specialty (Surgery or Internal Medicine is preferred) A research year alone is notsufficient

CRITERIA FOR RESIDENT PROMOTION/ADVANCEMENT

In accordance with the policies for Medical Education at LSU Health Sciences Center and the Accreditation Council for Graduate Medical Education, the

following general criteria must be fulfilled for promotion to the next level of

residency training and/or graduation Ultimately, the Clinical Competency

Committee will make the final decision about promotion, graduation, remediation,

probation or dismissal from the program While there may be specific criteria for each year, a satisfactory performance in all the areas listed below is required for promotion:

 Satisfactory semi-annual and annual evaluations

 Satisfactory conference attendance (at least 70%)

 Timely and accurate completion of ACGME case logs and procedure logs

 Timely and accurate completion of dictated reports

 Satisfactory completion of intra- and extramural rotations

 Demonstrate appropriate expertise in teaching of junior colleagues

including medical students

 Demonstrate professional behavior

 In the judgment of the Program Director, Associate and/or Assistant

Director(s), the resident has sufficient clinical management skills to

warrant promotion and/or graduation

CLINICAL COMPETENCY COMMITTEE

The Clinical Competency Committee (CCC) of the Department of Radiology is tasked by the Accreditation Council of College for Graduate Medical Education (ACGME), as well as the Louisiana State University Health Sciences Center in New Orleans, with evaluating each Radiology Resident within the department and determining if they are progressing successfully throughout their training Assuch, the Radiology CCC determines if Residents are progressing through the ACGME defined Radiology milestones, as well as determining if they are capable

of fulfilling their responsibilities as a Resident

The Radiology CCC will make decisions about promotion, probation, remediation, dismissal and graduation These decisions will be submitted to the Radiology Program Director, who will make the ultimate decision as to what action to take regarding the resident If an action is made contrary to the decision

of the CCC, sufficient justification of a contrary action must be provided 5

members from the active teaching faculty will be chosen by the Chairman of the department and the Program Director based upon their standing amongst the residents as determined by evaluations and direct feedback and will serve a term

of at least 3 years These 5 members will be chosen to reflect varied opinions in

a relatively small department The CCC will meet at least quarterly and can be called to meet if an immediate problem arises

The current members of the Radiology CCC are Dr Leonard Bok,

Chairman Department of Radiology, Dr Michael Maristany, Vice Chair in charge

of Clinical Operations, Dr Aran Toshav, Program Director, Dr Michael Morin, Academic Director of Ultrasound and Program Director of the Women’s Imaging Fellowship, Dr Robert Karl, Academic Director of Thoracic Radiology and

Chairmen of the Clinical Competency Committee and Dr Mignonne Morrell, Clinical Director of Breast Imaging The Chairmanship of the committee was decided by vote of the committee The Chair of the CCC is responsible for

calling the committee to order, holding votes on all decisions and reporting

decisions to the Program Director Ultimately, if adverse actions are required, the Chair of the CCC will assist the Program Director in conveying the decision of

the CCC and help to explain the decision process to the Resident The Program Director will be a member of the CCC and may, if called upon, act as a Chair These guidelines and revisions will be voted upon and approved by the CCC

be knowledgeable of the milestones and understand that they will be evaluated based on their ability to reach their milestone for their appropriate level A copy

of the Radiology Milestones can be found on the LSU Radiology website or the ACGME website

Diagnostic Radiology Milestones

PROGRAM EVALUATION COMMITTEE/ANNUAL PROGRAM EVALUTION

The Department of Radiology Program Evaluation Committee (PEC), formerly known as the Curriculum Committee, meets at least 5 times a year to review the Radiology Residency and its academic mission The committee is made up of all

of the academic directors within the department, as well as invited guests such

as the Director of Faculty Development, the Director of Medical Student

Education and the Chief Resident The committee is responsible for performing the Annual Program Evaluation (APE) of the entire residency, as well as meet on

a routine basis to make sure that the department is following through on its goals,objectives and action plans The PEC also approves significant changes to the program including new rotations, changes to evaluations or goals and objectives,

as well as changes to the curriculum or lecture series

DUTY HOUR POLICIES

The institution through IGMEC supports the spirit and letter of the ACGME Duty Hours Requirements as set forth in the common Program Requirements

Though learning occurs in part through clinical service, the training programs are primarily educational As such, work requirements including patient care,

educational activities, administrative duties, and moonlighting should not prevent adequate rest The institution supports the physical and emotional well being of the resident as a necessity for professional and personal development and to guarantee patient safety

Resident Duty Hours (per ACGME, effective July 1, 2011)

Maximum Hours of Work per Week

Duty hours must be limited to 80 hours per week, averaged over a four weekperiod, inclusive of all in-house call activities and all moonlighting

Duty Hour Exceptions

A Review Committee may grant exceptions for up to 10% or a maximum of 88 hours to individual programs based on a sound educational rationale

1) In preparing a request for an exception the Program Director must follow the duty hour exception policy from the ACGME Manual on Policies and Procedures

2) Prior to submitting the request to the Review Committee, the Program Director must obtain approval

Moonlighting

Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program

1) Time spent by residents in Internal and External Moonlighting (as defined

in the ACGME Glossary of Terms) must be counted towards the 80-hour Maximum Weekly Hour Limit

2) PGY-1 residents are not permitted to moonlight

Mandatory Time Free of Duty

Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks) At-home call cannot be assigned on these free days

Maximum Duty Period Length

Duty periods of PGY-2 residents and above may be scheduled to a maximum of

24 hours of continuous duty in the hospital Programs must encourage residents

to use alertness management strategies in the context of patient care

responsibilities Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m and 8:00a.m is strongly suggested

It is essential for patient safety and resident education that effective transitions incare occur Residents may be allowed to remain on-site in order to accomplishthese tasks; however, this period of time must be no longer than an additionalfour hours

Residents must not be assigned additional clinical responsibilities after 24 hours

of continuous in-house duty

In unusual circumstances, residents, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient Justifications for such extensions of duty are limited to reasons of required

continuity for a severely ill or unstable patient, academic importance of the

events transpiring, or humanistic attention to the needs of a patient or family.Under those circumstances, the resident must:

 Appropriately hand over the care of all other patients to the team

responsible for their continuing care; and document the reasons for

remaining to care for the patient in question and submit that

documentation in every circumstance to the Program Director

 The Program Director must review each submission of additional service, and track both individual resident and program-wide episodes of additionalduty

At present the department does not have a 24 hour call but, If the department was ever to adopt a 24 hour call then we would follow the protocol below

Policy on residents staying longer than 24+4

Policy and Process

PGY 1 residents’ duty periods may be no longer than 16 hours and there are no exceptions allowed Upper level residents are not allowed to stay longer than 24 hours with 4 hours for transitions In those rare and

extenuating cases where a resident absolutely must remain after 24+4 theresident must contact the Program Director for a specific exemption If that

is permitted verbally then the resident must communicate by email with the Program Director telling:

1 the patient identifying information for which they are remaining,

2 the specific reason they must remain longer than 24+4 ,

3 assurance that all other patient care matters have been

assigned to other members of the team,

2 assurance that the resident will not be involved in any other matter than that for which the exemption is allowed and

3 assurance that the resident will notify the program director when they are complete and leaving

In the event that the Program Director does not hear from the resident in areasonable time 1 hour, the Program Director or designee will locate the resident in person and assess the need for any further attendance by the

resident Residents caught in violation of this policy or who abuse this rareprivilege will be subject to disciplinary action for unprofessional behavior.

How Monitored:

The program director will directly monitor each of these cases It is

anticipated these requests will be infrequent at most The Program

Director will collect and review the written requests on a regular basis on each case and all cases in aggregate The institution will monitor numbersand types of exceptions of this during annual reviews of programs and Internal Reviews

Minimum Time Off between Scheduled Duty Periods

R1-R3 should have 10 hours free of duty, and must have eight hours between scheduled duty periods They must have at least 14 hours free of duty after 24 hours of in-house duty

Residents in the final years of education (R4) must be prepared to enter the unsupervised practice of medicine and care for patients over irregular or

extended periods

This preparation must occur within the context of the 80-hour, maximum duty period length, and one-day-off-in seven standards While it is desirable that residents in their final years of education have eight hours free of duty between scheduled duty periods, there may be circumstances when these residents must stay on duty to care for their patients or return to the hospital with fewer than eight hours free of duty Circumstances of return-to-hospital activities with fewer than eight hours away from the hospital by residents in their final years of

education must be monitored by the Program Director

Maximum Frequency of In-House Night Float

Residents must not be scheduled for more than six consecutive nights of night float

one-day-in-1) At-home call must not be so frequent or taxing as to preclude rest or

reasonable personal time for each resident

2) Residents are permitted to return to the hospital while on at-home call to care for new or established patients Each episode of this type of care, while it must

be included in the 80-hour weekly maximum, will not initiate a new “off-duty period.”

Neuro and VIR call:

We allow the residents to choose their own call schedule during the Neuro and VIR rotations The resident chooses 9 call days (including 1 of each day of the week) for the block First year residents should weight the call towards the second half of the rotation

Night Float Rotation:

We allow the residents to make their own schedule during the night float block The intention is for residents to get exposure to every night of the week, but givesthem flexibility to choose their own schedule Residents should follow the

guidelines below:

Residents will need 20 shifts total per block including at least 1 of each day of theweek, plus one more Friday, Saturday or Sunday of your choice ( at least 4 shifts total on a Friday, Saturday or Sunday.)

Residents should not schedule themselves on the last Sunday since they will be starting a new day-time rotation the following Monday

ACGME rules dictate that residents must not be scheduled for more than six consecutive nights of night float

If there are hospital holidays during the block, it is subtracted from the total shifts

Residents will:

Residents are required to log all duty hours in New Innovations or its

replacement Residents who fail to log duty hours or log erroneous duty hours are subject to disciplinary action by the program

Duty Hours will be monitored through New Innovations Residents are required tolog their duty hours daily Duty Hours will be monitored on a weekly basis by the Residency Coordinator and Program Director

Resident Duty Hours in the Learning and Working Environment (per

ACGME, effective July 1, 2011)

Professionalism, Personal Responsibility, and Patient Safety

Programs and sponsoring institutions must educate residents and faculty

members concerning the professional responsibilities of physicians to appear for duty appropriately rested and fit to provide the services required by their patients.The program is committed to and responsible for promoting patient

safety and resident well-being in a supportive educational environment

The program is committed to a culture of professionalism that supports patient safety and personal responsibility Residents and faculty members must

demonstrate an understanding and acceptance of their personal role in the following:

a) assurance of the safety and welfare of patients entrusted to their care;

b) provision of patient- and family-centered care;

c) assurance of their fitness for duty;

d) management of their time before, during, and after clinical assignments;

e) recognition of impairment, including illness and fatigue, in themselves and in their peers;

f) attention to lifelong learning;

g) the monitoring of their patient care performance improvement indicators; and,

h) honest and accurate reporting of duty hours, patient outcomes, and clinical experience data

All residents and faculty members must demonstrate responsiveness to patient needs that supersedes self-interest Physicians must recognize that under

certain circumstances, the best interests of the patient may be served by

transitioning that patient’s care to another qualified and rested provider

TRANSITIONS OF CARE

Assuring effective transitions (hand offs)

1 Policy for accepting of a patient for Interventional Radiology to conduct

procedure This process ultimately leads up to the performing of the Time Out after the patient is brought into the procedure room The Time Out is a documented check of an affective transition of patient care

2 Policy for transitioning of care and monitoring patients that

Interventional radiologists have consulted on

When a resident is present on the Interventional Radiology rotation, the faculty and residents will hold regular meetings The meeting discussions will include changes in the patients that they are monitoring, procedures they have performed, any follow-up for those patients as well as any change in thestatus of patients on which they have been consulted These services are completely covered by the faculty and often but not always a resident is assigned on a monthly basis to this rotation There is not continuous resident coverage on this rotation; it is primarily covered by faculty When a resident is

on Interventional Radiology they participate in the meetings If there is an important change in a patient’s status it must be directly communicated to faculty, and this is monitored continuously by the interventional radiology staff

as well as during daily rounds with faculty

At the end of the rotation if there is a resident on the current rotation and a resident coming in to the next rotation a resident to resident transition occurs during the evening sign off of the last day of rotation or the last day the

resident is on rotation Otherwise, if there is no resident coming on all patientinformation is conveyed to the faculty during the evening meeting Verbal face

to face handoffs as well as the daily meetings are conducted in an area whereinterruptions are less likely, in a radiology reading room or angiography suite There will be direct faculty monitoring of this handoff

3 How monitored:

Faculty are required to answer a question on effectiveness of witnessed transitions on each evaluation The following statement will be added to the New Innovations evaluation for Interventional Radiology “ I have witnessed effective transitions in person and attest the essential elements as defined in the Transitions Policy was transmitted to and understood by the receiving team.”

The process and effectiveness of each program’s system is monitored

through the Annual Program Review and the Internal Review process The institution and program will monitor this by periodic sampling of transitions, aspart of the Annual Review of Programs and as part of the Internal Review Process As above the Interventional Radiology staff will monitor the

transitions

MANDATORY NOTIFICATION OF FACULTY

In certain situations, faculty must be notified of a change in patient status orcondition The following require immediate notification of staff:

1 Patient admission

2 Transfer of a patient on the IR inpatient service to the ICU

3 Transfer of a patient under the direct care of an IR physician (resident orfaculty) to the ICU

4 Code or rapid response called for a patient on the IR inpatient service orunder the direct care of an IR physician

5 Unexpected/unplanned admission overnight observation of a patient to thehospital following a procedure

6 Any change in a patient’s advanced directive

7 Any patient death

A change in a patient’s care needs that requires more than a typical IRadmission, such as consultation to other services or subspecialty (like cardiology,internal medicine, endocrinology, general surgery, vascular surgery, etc.) must

be discussed with staff as soon as circumstances allow, with a maximum of 6hours elapsed time This includes transfer of a complex patient on the IR service

to another service for more expert management

ALERTNESS MANAGEMENT/FATIGUE MITIGATION

Residents and faculty are educated about alertness management and fatigue mitigation strategies via on line modules and in departmental conferences

Alertness management and fatigue mitigation strategies are outlined on the pocket cards distributed to all residents and contain the following suggestions:

1 Warning Signs

a Falling asleep at Conference/Rounds

b Restless, Irritable w/ Staff, Colleagues, Family

c Rechecking your work constantly

d Difficulty Focusing on Care of the Patient

e Feeling Like you Just Don’t Care

f Never drive while drowsy

2 SLEEP STRATEGIES FOR HOUSESTAFF

a Pre-call Residents

1 Don’t start Call w/a SLEEP DEFICIT – GET 7-9 ° of sleep

2 Avoid Heavy Meals / exercise w/in 3° of sleep

3 Avoid Stimulants to keep you up

4 Avoid ETOH to help you sleep

b ON Call Residents

1 Tell Chief/PD/Faculty, if too sleepy to work!

2 Nap whenever you can á > 30 min or < 2°)

3 BEST Circadian Window 2PM-5PM & 2AM- 5AM

4 AVOID Heavy Meal

5 Strategic Consumption of Coffee (t ½ 3-7 hours)

6 Know your own alertness/Sleep Pattern!

c Post Call Residents

1 Lowest Alertness 6AM –11AM after being up all night

2 Full Recovery from Sleep Deficit takes 2 nights

3 Take 20 min nap or Cup Coffee 30 min before Driving

In addition programs will employ back up call schedules as needed in the

event a resident can’t complete an assigned duty period

How Monitored:

The institution and program monitor successful completion of the on line

modules Residents are encouraged to discuss any issues related to fatigue and alertness with supervisory residents, chief residents, and the program

administration Supervisory residents will monitor lower level residents during any

in house call periods for signs of fatigue Adequate facilities for sleep during day and night periods are available at all rotation sights and residents are required to notify Chief Residents and program administration if those facilities are not

available as needed or properly maintained At all transition periods supervisory residents and faculty will monitor lower level residents for signs of fatigue during the hand off The institution will monitor implementation of this indirectly via monitoring of duty hours violations in New Innovations, the Annual Resident Survey (administered by the institution to all residents and as part of the annual review of programs) and the Internal Review process

Use of Alertness Management Strategies

The program is committed to and is responsible for promoting patient safety and resident well being in a supportive environment If a faculty member is concernedthat a resident is not fit for duty due to fatigue or illness or any cause, they will immediately report this to the program director or associate program director or chief resident The department has distributed information on recognizing signs

of fatigue; this information is also located on the website

http://www.medschool.lsuhsc.edu/radiology/docs/Recognizing%20Signs%20of

%20Fatigue.pdf

If a faculty member is concerned that a resident is not fit for duty due to fatigue orillness or any other cause, they should immediately report this to the Program Director or Associate Program Director or chief resident Residents are also informed of the ACGME duty hour rules and receive similar education on the signs of sleep deprivation, alertness management and fatigue mitigation through

a variety of educational sources They include the LSUHSC core modules, semiannual discussions during monthly resident meetings and at semiannual reviews Residents are provided a call room with a bed in a quiet area away frompatient care to rest Napping is encouraged for the residents who are required to work overnight during the hours of 10pm to 8am to minimize the effects of sleep deprivation If a resident feels that fatigue is affecting patient care, they should tell the faculty that is in house at that time If a resident should feel that fatigue may affect patient care or their transportation home, they may access the call rooms at any time for rest In addition, if they feel that they are too fatigued to