The RRC permits no more than four call-free rotations during the three years of pediatric residency training. Call-free rotations may not occur on inpatient services. All other rotations may have call either in-house (required for inpatient and intensive care rotations) or by pager/phone.
The RRC also requires a resident back-up schedule or alternate plan to provide coverage in the event that a resident is unable to fulfill the assigned responsibilities.

Night Call:

In-House Call (HC) -- in-house call is required for services with acutely ill inpatients (ward and intensive care rotations). Generally, on-call duty will occur with a monthly average of every third to fourth night for PL1 residents and every fourth to fifth night for upper level residents. Call may be less frequent for outpatient or elective rotations and may be in-house or by pager/phone.
At least one member of the patient care team (Inpatient Teams, PICU, Neonatal Intensive Care and Newborn Nursery) is on call for his/her area at night and on weekends.
The senior resident (PGY-3) on call (admitting resident) is the "Pediatrician in Charge" with the responsibility to assist and supervise all other house staff on call and to answer consults from other services.
House staff members must remain in the hospital complex while on call. Residents must not leave the hospital complex unless such absence has been explicitly approved by the Chief Resident and the replacement housestaff is physically present within the hospital complex. Sleep rooms are provided for the on-call resident, as is a residents' lounge with refrigerator and lockers.
The call schedule is prepared in advance. ALL changes and trades must be approved by the chief resident and the attending faculty prior to the effective date of the proposed changes.

Back-up Call (BC):

To facilitate a systematic and consistent process, and as mandated by the RRC, an on-call back-up system has been instituted to provide coverage in the event that a resident is unable to perform the assigned work duties and responsibilities. (See table)
Residents on back-up call must remain within 50 miles of UTMB Children's Hospital with pager on and ready to cover the hospital or clinic rotation responsibilities of the unavailable resident.

• PGY-1: If a PGY-1 must miss call or assigned work duties, the PGY-1 rotating on the Tox-Pharm Selective will serve as 1st backup, the PGY-1 rotating through the Surgery Selective will serve as 2nd backup and the PGY-1 on Adolescence will serve as 3rd back-up.
   
• PGY-2: If a PGY-2 must miss call or assigned work duties, the PGY-2 rotating on Elective with Nursery Weekend coverage will serve as 1st backup, the PGY-2 rotating through a no-call elective will serve as 2nd backup and the PGY-2 rotating through the Behavioral/Development portion of the year 2 Outpatient block will serve as 3rd back-up.
   
• PGY-3: If a PGY-3 must miss call or assigned work duties, the PGY-3 assigned to the HealthCare Hotline will serve as 1st backup, the PGY-3 rotating through a no-call elective will serve as 2nd backup and the PGY-3 rotating through an elective with AR call will serve as 3rd back-up.
   

Back-Up Resident Schedule

As evident from the table above, in situations of extreme personnel shortage, upper level residents will be asked to cover for lower level residents unable to fulfill their assigned call or work duties.
Residents on 2nd and 3rd back-up call, and not on an approved vacation, will be responsible for ensuring replacement coverage if intending to be unavailable to fulfill their back-up call responsibilities. If you are scheduled as the back-up call person, you must remain available on pager at all times. If the Chief Resident is unable to contact you while you are scheduled as back-up, you will be required to take two additional calls within one month.
To maintain the required on-call back-up system, a PGY-3 resident will be assigned to HCH and BC at the same time. Combining BC and HCH may sometimes require a resident to jointly cover both HCH and BC thereby increasing his workload and patient responsibilities. However, by combining the two on-call systems the number of days a resident will be required to be on BC call will be substantially decreased.

Call Responsibility:

Residents who must miss work or call due to illness or personal emergencies are responsible for notifying the residency coordinator, chief resident, and faculty and actively assisting in getting their replacement. If their continuity clinic schedule will be affected by their absence, they must inform the clinic coordinator and their Continuity Clinic faculty.

Missed Calls Policy: Unless exempted, all calls missed for whatever reason must be made up. This includes sick leave, leave of absence, maternity leave, and administrative leave of absence. This also includes missed calls when no additional person was required to come to the hospital to fill in.

1. Missed calls
All missed calls must be made up. If one or two calls are missed, they must be made up within one month after the missed call. If more than two calls are missed, two must be made up within a month after missed call. The remainder must be made up at a rate no less frequent than two calls per month. The resident must meet with the Chief Resident to discuss a schedule for making up the missed calls.

2. Multiple missed calls
The resident must meet with the residency Program Director to discuss the anticipated length of the illness leading to the missed calls, the resident's work status at anticipated time of return, the need for personal physician documentation of illness, rotations that will be missed, required rescheduling of core rotations and the possibility that residency training will be extended.

3. Call coverage policy.
All missed calls must be made up. However, although every effort will be made to have missed calls made up, it cannot be guaranteed that these calls will be made up to the individual on back-up call.

Days Off:

Residents will be off without assigned duties one day out of seven averaged over 4 weeks. Weekend coverage including cross coverage on weekends will be scheduled by the Chief Resident so as to provide, whenever possible, each resident one weekend day off per month.

 

Pediatrics Health Care Hotline Call

Purpose:

1. To develop skills needed to interact in an appropriate manner with protocol-driven Nurse Telephone Advice and Triage System.

2. To develop skills in off-site, after hours telephone management of common pediatric concerns of parents.

3. To increase the number of months residents participate in an on-call arrangement during their third year of pediatric training.

Structure:

1. Third year Pediatric Residents assigned to Electives or Elective/Vacation will be on call for the Health Care Hotline (HCH) on a predetermined rotating schedule (only during the elective portion) established by the Pediatrics Chief Resident.

2. Health Care Hotline staff will function as per presently established protocols, with one change: If physician back-up is desired for any patients who usually seek services at the Texas City Regional Maternal Child Health Clinic or the Primary Care Pavilion Pediatric Care Group in Galveston, the Health Care Hotline staff will contact the resident on call for that day.

3. The Hotline resident on call will be expected to deal with the pending Hotline call issue, which may include authorizing prescriptions, speaking with parents, following up labs, etc. The resident on call will be notified by the HCH nursing staff of a call and given brief, summative information about the patient. The resident will then call the parent back from his/her own home or cell phone (dial *67 prior to dialing to block caller ID). If needed, the transfer center can connect the call on a recorded line. The number is 747-2500.

4. The Faculty member already assigned to the HCH call will be the faculty member supervising the PL-3 on HCH call. The PL-3 (or M/Peds-4) will be required to call the supervising faculty after each call to a parent and discuss the decision that has been made or the directions that were given. If the HCH personnel have difficulty reaching a resident or do not feel that the issue has been appropriately managed they should directly contact the faculty member on call.

5. Call hours will be the same hours that the Health Care Hotline is in service (5pm to 8am weekdays, 24hrs on weekends). The coverage will be for one week block(s) for residents (Wednesday to Wednesday). The resident on call will be issued a separate HCH call pager and should be available by beeper for the entire time assigned to call. Handing off of the pager should occur at 5pm on the day that the new PL-3 starts the HCH call. The schedule provided to the HCH will include the HCH pager number (645-5830), the resident's pager number and the resident's home number (just in case). Residents will also be given a long distance calling card and specific paperwork for call documentation in the patient's medical record.

6. Residents will document the essence of their Hotline phone calls on specific, pre-developed paperwork and will review their documentation with the Faculty on call for HCH for that particular patient or day as soon as reasonable. Once reviewed, the HCH call sticker will be affixed to an UTMB progress note and sent to Medical Records for placement in the patient's permanent file.

7. The Chief Resident will be responsible for creating and delivering the HCH call schedule to Lucia Mock at the Health Care Hotline office with the appropriate resident on call and the supervising General Pediatrics faculty.

 

Duty Hours

The Pediatrics Residency Training Program adheres to the Accreditation Council Graduate Medical Education (ACGME)'s duty hours requirements. The specifics of these requirements are outlined below.

Resident training is a full time responsibility. Clinical duties must not be so pressing or consuming that they preclude ample time for educational activities, other important phases of the training program or personal needs. It is equally important that the resident have a keen sense of personal responsibility for patient care. Residents' obligation to patients, however, is not automatically discharged at any given hour of the day or on any particular day of the week. Residents are not relieved of duty until the proper care and welfare of the patients have been ensured by the presence of a suitable replacement.

Policies:

• Residents's duty hours must not exceed more than 80 hours per week averaged over four weeks.
   
• Continuous on-site duty must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to maintain continuity of patient care, to transfer care of patients and to participate in didactic activities. Residents are not to evaluate/admit new patients after 24 hours of continuous duty.
   
• Shift work, in high intensity settings such as the ICUs and the Emergency Department, must not exceed more than 12 continuous hours.
   
• A duty-free interval of at least 10 hours must be provided between all in-house, daily program duty activities.
   
• On-call duty should occur no more frequently than every third night, averaged over a four-week period, for all rotations.
   
• Residents' duty schedule should provide a monthly average of at least one full (24 hours) day out of seven without assigned patient care responsibilities.
   
• Internal, in-house, moonlighting counts towards the 80 duty hours per week maximum. ALL moonlighting must be pre-approved in writing by the program director.

If, at any time, a resident feels that he/she is unable to satisfactorily perform his/her patient care duties because of excess fatigue or illness, he/she must report immediately to the appropriate supervisory resident to be temporarily relieved of all duties. As soon as patient safety has been ensured, the supervisory resident must contact the chief resident to determine back-up coverage.

Pagers:

Individual pagers (beepers) are provided to each resident. Pager malfunctions associated with usual wear and tear are covered by a service contract. However, loss and negligent or willful damage will require that the pager be replaced at the resident's expense. A list of all house staff and their pager numbers is available at all pediatric nursing stations, in the residency program coordinator's and the chief resident's offices and in the residents' lounge. All needed back-up pagers must be obtained from the residency coordinator.

Unless on vacation, all residents must keep their pagers on and answer in a timely fashion, even when at home as an emergency may occur that requires others to contact you.

Pagers: Code Pagers on Wards:
          Daytime by 1) AR 2) PGY-2 on Blue Team and 3) PICU resident on call
          Nighttime by 1) AR 2) intern on call and 3) PICU resident on call