MANUAL OF GENERAL INFORMATION

MANUAL OF GENERAL INFORMATION

TABLE OF CONTENTS

The Addiction Psychiatry Fellowship Program .............................................................................................. 1 1. Mission Statement ............................................................................................................................ 1 2. Curriculum ........................................................................................................................................ 1 3, Goals and Objectives of Training ................................................................................................ 1-17 4. Residency Requirements ............................................................................................................... 17

a. Completion of a Psychiatry Residency Program ..................................................................... 17 b. BCLS Certification ................................................................................................................... 17 c. Duty Hours ........................................................................................................................ 17-19 d. E-mail Policy ............................................................................................................................ 19 e. Examinations ........................................................................................................................... 19 f. Medicare Time Reporting ........................................................................................................ 19 g. Program and Supervisor Evaluations ...................................................................................... 20 h. Supervision ............................................................................................................................. 20

5. General Information ....................................................................................................................... 20

a. Clothing Allowance .................................................................................................................. 20 b. Credit Union ............................................................................................................................. 20 c. Computer Services .................................................................................................................. 20 d. Dress Code and Decorum .................................................................................................. 20-21 e. Health and Disability Insurance ............................................................................................... 21 f. Housestaff Policies and Procedures Manual ........................................................................... 21 g. Keys ............................................................................................................................. 21 h. Library Services ....................................................................................................................... 21 i. Mail Room ............................................................................................................................. 21 j. Moonlighting and Locum Tenens Privileges ....................................................................... 21-22 k. Pagers ............................................................................................................................. 22 l. Parking Permit ......................................................................................................................... 22 m. Paychecks ............................................................................................................................. 22 n. Personal/Sick/Unpaid Leave .............................................................................................. 22-23 o. Photocopying/FAX ................................................................................................................... 23 p. Professional Development Fund ............................................................................................. 23 q. Resident Lounge ...................................................................................................................... 23 r. Vacation Leave .................................................................................................................. 23-24

6. Resident Standing, Progress and Promotion ................................................................................. 24 7. Remediation, Probation, Corrective Action, .............................................................................. 24-25 and Due Process 8. Hospital Communication Systems ............................................................................................ 25-26 9. The Dictation System ................................................................................................................ 27-29

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THE RESIDENCY PROGRAM 1. MISSION STATEMENT The Addiction Psychiatry Residency Program has been established to provide training for psychiatrists interested in the practice of addiction psychiatry, and to enhance resources for addiction treatment in the State of Kansas and metropolitan Kansas City. The residency program includes clinical and didactic experiences that meet the requirements for addiction psychiatry training developed by the Accreditation Council for Graduate Medical Education. 2. CURRICULUM

2 months

KCVAMC

Adult Residential/Partial Hospitalization Treatment

10%

Johnson County Mental Health

Adolescent Addiction Residential

Program/Adolescent Center for Treatment

50%

KU Medical Center Methadone Clinic Suboxone Clinic

40%

9 months

KCVAMC

Adult Residential/Partial Hospitalization Treatment

30% Dual Diagnosis Clinic

40% Consultation/Liaison

20%


10%

1 month

KCVAMC

Dual Diagnosis Clinic 30%

KU Medical Center Chronic Pain Management

60%


10%

3. GOALS AND OBJECTIVES The addiction fellowship program has its primary site at the Kansas City VA Hospital in Kansas City, Missouri. There are additional rotations at the University of Kansas Medical Center (KUMC) in the Opioid Replacement Treatment Program and the Chronic Pain Clinic program. The fellow will have training in adolescent psychiatry at the Adolescent Treatment Program, which is a component of the affiliated training site at Johnson County Mental Health Center. The curriculum is developed in accordance with the six competencies. The addiction resident will have completed psychiatric residency training and is expected to have met

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the competencies defined for general psychiatry. The following curriculum elaborates expected competencies more specifically for addiction psychiatry. The curriculum and evaluation methods are expected to evolve as the program gains additional resources for training. PATIENT CARE ACTIVITY EVALUATION METHODS AR Attending Rounds AE Attending Evaluation DPC Direct Patient Care PDR Program Director Evaluation FS Faculty Supervision DIDACTIC RESOURCES CAP Clinical Addiction Practice seminar BF Biological Foundations of Addiction CP Reading Seminar in Clinical Practice PSY Psychopharmacology Seminar BEH Behavioral Theory and Practice RD Research Design General Addiction Psychiatry Patient Care Principle Educational Goals Learning

Activity Evaluation Methods

Components of addiction treatment FS, ACR, CAP, CP

AE, PDR

Setting, duration, intensity FS, ACR AE, PDR

Placement criteria FS, DPC AE, PDR

Harm reduction in treatment settings FS, ACR, CAP

AE, PDR

Brief interventions FS, FSP, CP

AE, PDR,RN

Assessment instruments FS, CP AE, PDR

Role and use of community & regulatory agencies in treatment efforts

FS, CAP, CP

AE, PDR, SW

Family problems, enabling, codependency, counseling

CAP, CP AE, PDR

Pathophysiology & management of alcohol intoxication, withdrawal

BF, PSY, CP, DPC

AE

Pathophysiology & management of opioid intoxication, withdrawal

BF, PSY, CP, DPC

AE

3

Pathophysiology & management of stimulant intoxication, withdrawal

BF, PSY, CP, DPC

AE

Motivational to change theory and motivational interviewing

DPC, FS, CAP

AE, PDR

Group therapies CAP, CP, DPC

AE, PDR

Individual therapies DPC, CAP, CP

AE, PDR

Contingency management CAP, CP, BEH

AE, PDR

Network therapy CAP, CP, BEH

AE

Aversion therapies CAP, CP, DPC, PSY

AE

Therapeutic communities CAP, CP AE

Twelve-Step Programs in practice CAP, DPC, CP

AE, PDR, SW, RN

Twelve-Step Programs theory and research CP, RS AE

Other community support recovery groups CP. BEH AE

Medical disorders and complications of alcohol dependence

DPC, CP, PSY

AE

Medical disorders and complications of opioid dependence

DPC, CP, PSY

AE

Medical disorders and complications of stimulant abuse

DPC, CP, PSY

AE

Body fluid sampling for drug/alcohol use DPC, CP AE

Diagnosis of comorbid psychiatric disorders DPC, AR, FS, ACR, CAP

AE, PDR

Psychopharmacology of comorbid psychiatric disorders

FS, DPC, CAP, CP, PSY, RS

AE, PDR, RN

Group therapies of comorbid disorders FS, DPC AE, PDR

Individual therapies with cormorbid disorders FS, DPC AE, PDR, RN

Pain management for addicted persons FS, DPC, PSY, BEH

AE

4

Substance abuse in the workplace FS, CP, BEH

AE

Substance abuse in criminal justice settings CP, CAP AE

Addicted professionals and physician health programs

CP AE

Pharmacokinetic and pharmacodynamic principles in addiction

PSY, BF AE

Pharmacology of alcohol and sedative-hypnotics

CP, PSY AE

Pharmacology of opiate addiction PSY, CP, DPC, FS

AE, PDR

Pharmacology of club drugs PSY, CP, DPC, FS

AE, PDR

Pharmacology of stimulants PSY, CP, DPC, FS

AE

Pharmacology of hallucinogens PSY, CP, DPC, FS

AE

Pharmacology of marijuana PSY, CP, DPC, FS

AE

Pharmacology of inhalants PSY, CP, DPC, FS

AE

Basic science foundations of addiction treatment

BF, BEH, RD

AE, PDR

Brain reward circuitry and behavioral manipulations in addiction

BF, BEH AE

Stress, comorbidity and gene-based advances in addiction neuroscience

BF, BDH AE

B. Medical Knowledge Principle Educational Goals Learning

Activities Evaluation Methods

Understand the diagnostic process and criteria for substance-abuse disorders

CP, FS, DPC, CAP

AE

Perform brief interventions and individual psychotherapies for substance abuse

CP, FS, DPC

AE, PDR

Diagnose psychiatric disorders in presence of substance abuse

DPC, FS, CP

AE

Understand use of psychotropic agents for substance-abusing patients

FS, CP, PSY

AE

Understand stages of change and motivational interviewing

CP, FS, DPC

AE, PDR

5

Adapt treatment practices to various stages of recovery

DPC, FS AE, PDR

Assess and treat or refer medical and neurological disorders frequently associated with drug & alcohol abuse

DPC, FS, CP

AE

C. Interpersonal and Communication Skills Principle Educational Goals Learning


Elicit comprehensive history, MSE and diagnostic information with

Communicate effectively with patients and families in conflict

FS, DPC AE, PDR

Acknowledge stigma and demonstrate respect for patients

DPC, FS AE, PDR, RN, SW

Collaborate with patients to develop an acceptable and realistic treatment plan

CAP, FS, DPC

AE, PDR, RA, SW

Develop an effective rapport with patients and family members

DPC, FS AE, PDR, RN, SW

Communicate effectively with physician colleagues and health care professionals to assure comprehensive care

FS, DPC AE, PDR, RN, SW

Recognize impact of cultural and ethnic differences in communication and expectations

FS, DPC, CAP, CP

AE, PDR, RN, SW

Communicate effectively with treatment team members

DPC, CAP, FS

AE, PDR, RN, SW

D. Professionalism Principle Educational Goals Learning


Understand and implement concept of boundaries with patients and staff

FS, DPC, CAP

AE, PDR

Appreciate the social context of addiction treatment

FS, DPC, CAP

AE, PDR

Maintain timely and effective medical records documentation

FS, DPC AE

Assure availability of continuous care as needed for accepted patients

FS, DPC, CAP

AE

E. Practice-Based Learning and Improvement Principle Educational Goals Learning


6

Identify gaps in personal knowledge and skill in patient management

FS, DPC, CP

AE, PDR

Develop methods for systematic critical review of professional literature

CP, PSY, RD

AE, PDR

Commitment to practice of evidence-based medicine

CP, RD AE, PDR

F. Systems-Based Practice Maintain awareness of cost-effective

diagnostic and treatment practices CP, RD, CAP

AE

Effectively use community and business services to support patient care

CP, CAP, FSP, SA, RT

AE, PDR, SW

Collaborative approach to law enforcement and criminal justice system

CAP, DPC AE, PDR, SW

Adolescent Center for Treatment This residential treatment program is a component of Johnson County Mental Health Center, and is located in Olathe, Kansas. The Center provides substance abuse treatment services for individuals age 12 through 18. Approximately three-fourths of the adolescents are involved in the juvenile justice system. Over half of this population also has comorbid psychiatric diagnoses, primarily affective and conduct disorders. Treatment modalities include individual, group and family counseling using various approaches such as motivation enhancement and cognitive-behavioral therapy. Treatment is provided by a multidisciplinary staff including addiction counselors, social workers, a psychologist, nurse, and a child and adolescent psychiatrist. This is a two-month, part-time (50%) rotation. The addiction resident is expected to attend and participate in program activities for the initial two weeks of the rotation. Subsequently the resident will become involved with initial evaluations and development of individualized treatment plans, conducting mental status examinations and developing differential diagnosis of potential psychiatric disorders. The resident will meet with family members of the adolescent patients and will be expected to attend selected family therapy and treatment activities. The resident will receive supervision from the program director for psychosocial treatments, and from the child psychiatrist in regard to comorbidity diagnosis and medication management. A. Patient Care Principle Educational Goals Learning


Understanding of risk factors for addiction including genetic, family, peer and social factors

CP, CAP, BEH, FS

AE, PDR

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Understand concept of resilience, and protective factors for adolescents

CP, CAP, BEH, FS

AE, PDR

Familiarity with various screening instruments and techniques for adolescent substance abuse

CP, CAP, BEH, FS

AE, PDR

Knowledgeable of epidemiology of substance abuse in adolescents

CP, CAP, BEH, FS

AE, PDR

Understand the role of denial and role-playing in context of substance abuse

CP, CAP, BEH, FS

AE, PDR

Know relevant state and federal law and regulations regarding right to privacy of the adolescent and involuntary treatment

CP, CAP, BEH, FS

AE, PDR

Know components of a complete mental status exam and developmental stages

CP, BEH, FS

AE, PDR

Knowledge of impact of biopsychosocial stage of development on substance abuse patterns

CP, CAP, BEH, FS

AE, PDR

Knowledge of treatment modalities including CBT, TC, 12-step, family therapy, relapse prevention, CRA

CP, BEH, CAP, FS

AE, PDR

Understand role of juvenile justice system in adolescent treatment

CP, CAP, FS

AE, PDR

Knowledge of placement criteria for adolescents

CP, CAP, FS

AE

Understand assessment dimensions for appropriate level of care

FS, CP, CAP

AE

Knowledge of epidemiology of comorbid substance abuse and psychiatric disorders in adolescent population

CP AE

Know risk factors for psychiatric disorders among adolescent population

CP AE

Understand diagnostic criteria for adolescent psychiatric disorders when associated with substance abuse

CP, CAP, FS, BEH

AE, PDR

Familiarity with potential psychopharmacological treatments for substance abuse in adolescents

PSY, CP, FS

AE

Understand psychopharmacology for comorbid psychiatric disorders

PSY, CP, FS

AE

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Conduct a comprehensive mental status exam for adolescents in treatment

FS, CAP AE

Use addiction screening instruments for adolescent populations

CP, CAP AE, PDR

Evaluate risk factors for addiction in adolescent populations

CP, CAP AE, PDR

Use motivational interviewing technique in treating adolescents

CAP, FS AE, PDR

Use specialized interviewing techniques to gather information with adolescents

CAP, CP, FS

AE, PDR

Use developmental stage to inform evaluation and treatment

CP, CAP, BEH, FS

AE, PDR

Gather and interpret information from multiple sources to reach diagnosis

CAP, FS AE, PDR

Use family therapy principles in treating adolescent patients

BEH, CP, FS

AE, PDR

Use cognitive-behavioral techniques and relapse prevention

BEH, CP, CAP, FS

AE, PDR

Adapt 12-step processes for adolescent use FS, CAP AE, PDR

Understand Community Reinforcement Approach

CP, FS AE

Apply placement criteria for level of care matching

CP, FS AE

Develop psychiatric diagnosis in presence of substance abuse in adolescents

CP, FS AE

Use psychopharmacologic agents for psychiatric disorders in presence of substance abuse

PSY, FS AE

C. Interpersonal Skills and Communication

Principle Educational Goals Learning


Ability to modify interviewing techniques to obtain history of substance abuse

CP, FS, DPC

AE, PDR

Establish understanding of confidentiality with family members and adolescent

CP, FS AE, PDR

9

Maintain non-judgmental attitude with adolescent

FS, BEH, DPC

AE, PDR

Modify interviewing strategy for patient developmental stage

CP, BEH, FS

AE, PDR

Ability to gather sensitive information such as history of abuse, trauma

FS, CP. DPC

AE

Use screening instruments to assess adolescents in general medical practice

CP, CAP AE

Assure communication among treatment team members and adolescent family

FS, DPC AE, PDR

Assure thorough understanding of use of psychopharmacologic medications

PSY, FS AE

D. Practice-Based Learning and Improvement



Commitment to evidence-based practice CP, FS AE

Critical analysis of scientific studies of adolescent addiction treatment

RD, CP, FS AE

Use on-line resources to monitor emerging clinical literature

CP, FS AE, PDR

Develop patient database to monitor behavior changes over time

RD, FS AE

E. Professionalism



Demonstrate reliable and ethical behavior DPC, FS, CP

AE, PDR

Assure continuity of care across medical specialties

DPC, RS AE

Demonstrate knowledge and compliance with laws and regulations regarding treatment of minor patients

CP, FS, DPC

AE, PDR

Understand impact of developmental stage on boundaries and roles

FS, DPC AE

10

F. Systems-Based Practice

Principle Educational Goals Learning Activity

Evaluation Methods

Knowledge of community agencies including law enforcement involved in adolescent behavior management

DPC, FS, CP

AE, PDR

Maintain awareness of trends in drug abuse among adolescents in community

DPC, FS AE, PDR

Monitor treatment availability within juvenile justice purview

DPC, FS AE, PDR

Monitor placement criteria and protocols in use by third-party payers in community and impact on treatment availability

DPC, CP, FS

AE

METHADONE AND SUBOXONE CLINIC FOR OPIATE ADDICTION, THE UNIVERSITY OF KANSAS MEDICAL CENTER The KUMC Methadone and Suboxone Treatment clinic is a required rotation, beginning with a two-month period of 50% time. During this period, the resident will become familiar with the treatment program, and will learn assessment and motivational strategies. This rotation provides experience in diagnosis and management of opiate dependence throughout the first year of recovery. The resident will work closely with the director and multidisciplinary team during the initial presentation and evaluation of the opioid-abusing person, and during initiation of medication assisted recovery. Emphasis will be on stabilization of addictive behaviors using substitution methods, and re-integration into the family and community milieu. The resident will have experience in diagnosis and management of patients with co-occurring psychiatric conditions, especially affective and anxiety disorders that are widely represented in this population. An important component of training is gaining understanding about the evolution of recovery stages throughout the first year of treatment. As the resident undertakes direct patient care, s/he will identify five patients to be followed in continuity clinic throughout the fellowship year. The resident is expected to understand all aspects of opiate replacement treatment, including clinical and administrative/legal requirements. In addition to methadone, treatment modalities include individual and group psychosocial and educational therapies, motivational enhancement, cognitive-behavioral, and 12-Step experience, and pharmacotherapy for addiction and comorbid psychiatric disorders. A fulltime psychiatrist with extensive experience treating substance dependence is Director of the Clinic, and will be readily available for supervision. The Clinic is staffed with a master's level counselor, addiction counselors, and nurses who are members of the multidisciplinary team to develop and implement treatment plans for patients entering treatment.

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A. Patient Care Principle Educational Goals Learning


Neurobiology of acute opiate use and opiate dependence

BF, PSY, DPC

AE

History of opiate use and abuse; political and diplomatic issues

CP, CAP AE

Assessment and diagnosis of opiate dependence by DSM-IV criteria and ICD-9 criteria

CP, CAP, DPC, AR

AE

Psychosocial treatment methods for opiate dependence, including role of NA

CP, DPC, CAP, ACR

AE, PDR

Pharmacologic treatments for opioid dependence other than replacement

DPC, PSY AE, PDR

History and practice of methadone replacement treatment

DPC, PSY, CAP, FS

AE, PDR

Buprenorphine, development of office-based treatment and implementation

PSY, DPC, FS

AE

Diagnosis and treatment of psychiatric comorbid disorders

AE, PDR

Pharmacologic management of comorbid psychiatric disorders

PSY AE

Medical disorders and complications of opioid dependence

DPC, FS, CP

AE

Physical exam and characteristic findings for drug-abusing patients

CP, AR, DPC

AE

Management of prescription opioid abuse and dependence

DPC, FS, CAP

AE, PDR

Treating pain in addicted populations, relapse liability, diversion

CP, CAP, PSY, AR

AE

Law enforcement and forensic involvements common for drug-abusing patients

CAP, CP, BEH

AE



Perform focused physical exam accounting for common disease stigmata

FS, DPC, CP

AE

Perform appropriate laboratory and imaging to fully evaluate medical status

FS, DPC AE

12

Perform thorough mental status exam and develop differential diagnoses

CP, FS, CAP

AE

Manage acute opiate withdrawal, prevention and treatment to resolution

CP, FS, PSY, DPC,

AE, PDR

Management of opioid overdose including multiple-drug complications

FS, DPC, PSY

AE

Knowledge of criteria for admission to methadone maintenance and understanding of Federal regulations for use of methadone

CP, FS AE, PDR

Perform methadone induction and subsequent dose regulation

FS, DPC, PSY

AE

Indications for use of psychopharmacologic medications in presence of opioid dependence

CP, PSY, FS, DPC

AE

Interactions and contraindications of pharmacological agents with methadone and buprenorphine

PSY, DPC, FS

AE

Manage post-acute withdrawal, craving and relapse

FS, DPC, CP, PSY

AE, PDR

C. Interpersonal Skills and Communication

Principle Educational Goals Learning Activities

Evaluation Methods

Develop understanding of idiosyncratic language frequently used by substance abusing patients

DPC, FS AE, PDR

Demonstrate respect in communication style and presentation with patients

DPC, FS AE, PDR

Provide education for patient and family members in culturally sensitive language

DPC, FS AE, PDR

Ability to communicate effectively with various law enforcement agencies and representatives

DPC, FS, CP

AE

Assist patients in communicating with social service agencies and State offices

FS, DPC AE

Maintain medical records and medication administration as required by Federal regulations

CP, FS, DPC

AE, PDR

Explain methadone treatment plan requirements and coordinate communications with treatment team

FS, DPC AE, PDR

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D. Practice-based Learning and Improvement Principle Educational Goals Learning


Maintain knowledge of current treatment guidelines for addictions

CP, FS, PSY

AE

Ability to critically evaluate scientific literature in addiction treatment

CP, RD, BEH

AE, PDR

Demonstrate ability to use professional and non-professional information technology for patient care and education

CAP, FS AE

Learn systems of practice monitoring to identify errors and institute corrections

CAP, FS AE

E. Professionalism

Principle Educational Goals

Learning Activities

Evaluation Methods

Demonstrate responsibility for patients across various treatment settings

FS, DPC AE

Respond to communications from patients and other treatment providers in a timely manner

FS, DPC AE

Provide continuity of care including coverage when unavailable

FS, DPC AE

Maintain effective coordination of care with members of treatment team

FS, DPC, CP

AE, PDR

Participate in peer review activities for opiate replacement treatment providers

FS, CP AE

F. Systems-based Practice Principle Educational Goals Learning


Develop a systematic method to monitor changes in regulatory requirements

CP, FS AE, PDR

Develop collaboration with other agencies using opioid replacement treatment to monitor duplication of services or diversion activity

FS, DPC AE

Facilitate patients’ use of various community social services to improve patient care

DPC, FS AE, PDR

14

Understand the role of law enforcement in regulatory requirements and support of opioid replacement treatments

CP, CAP, FS

AE, PDR

CHRONIC PAIN CLINIC UNIVERSITY OF KANSAS MEDICAL CENTER

The Chronic Pain Clinic is located in the Psychiatry Department offices, directed by Teresa Long, M.D., who is board-certified if Psychiatry, Internal Medicine, and Pain Management. This clinic specifically cares for patients who have disorders involving chronic pain that are not associated with cancer (cancer pain is managed in another KUMC setting). Many of these patients require opioids for adequate pain control, and are expected to continue opioids for lengthy periods of time. The clinic has a multidisciplinary staff providing medical, psychosocial, and psychological treatments of pain. Because of the use of opioids, this clinic frequently must manage patients who are referred with characteristics suggestive of addiction and comorbid psychiatric disorders. Patients may be referred from KUMC acute medical/surgical inpatient services, outpatient clinics, and from practitioners in the metropolitan area. The chronic pain clinic has an active consultation service at KUMC, and typically sees an average if three consults daily.

This rotation provides experience in diagnosis and management of various pain disorders, including pseudoaddiction and opioid dependence. The resident works closely with the pain clinic director and the multidisciplinary team in both clinic and consultation roles. Emphasis is on differential diagnosis and management of individuals requiring longterm opioids, including the use of adejunctive medications, behavioral methods, contracts, body fluid monitoring, compliance, and pharmacologic management of comorbid disorders. Longterm use of opioids remains controversial, with quite limited sources of evidence-based practice; this rotation will prepare the addiction resident to assist general medical practitioners with issues of addiction in pain management. A. Patient Care Principle Educational Goals Learning


Neurophysiology of pain FS, CP AE

Interface of pain and addiction neurophysiology

CP, BF AE

Approaches to chronic pain management FS, CP AE

Psychological techniques for chronic pain management

FS, CP, CAP, BH

AE

Assessment of pain in presence of addiction FS, CAP AE

15

Non-opioid medications in management of pain disorders

PSY, CAP AE

Physical therapy and rehabilitative therapies CP, CAP, FS AE

Opioid medications for chronic pain management

PSY, CP, CAP, FS

AE

Controlled Substance Act and regulatory guidelines for opioid medications

PSY, CP, CAP AE

Buprenorphine and office-based treatment of addiction

PSY, CP, CAP AE

Addiction treatment programs, NA, and community support for pain patients

FS, CP, CAP AE

Relapse prevention in chronic pain disorders FS, CAP AE



Understand diagnostic process and criteria for pain disorders

FS, CP, DPC AE

Perform appropriate physical examination, laboratory and testing to fully evaluate medical status

CP, CAP, FS, DPC

AE

Perform mental status exam and collect appropriate corollary information

FS, CP, CAP, DPC

AE

Develop differential diagnosis for chronic pain disorder and addiction disorder

FS, CP, CAP AE

Understand the use of the WHO ladder in pain disorders

CP, FS, DPC AE

Competent use of opioid medications including dose equivalents, tolerance, and withdrawal strategies

FS CP, CAP, DPC

AE

Develop addiction treatment program for patients taking opioids for analgesia

FS, DPC AE, PDR

Know regulatory and legal requirements for use of opioids

CP, PSY, CAP, DPC

AE

Provide consultation on addiction and pain management to other physicians

FS, DPC AE

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Perform and supervise opioid withdrawal protocols

PSY, FS, DPC AE, PDR

Knowledgable RE regulations and implementation of office-based opioid treatment

CP, FS, PSY AE

Able to access current research findings for pain disorders and addiction management

PSY, FS AE

C. Interpersonal Skills and Communication Principle Educational Goals Learning


Communicate effectively to convey openness and respect for patient needs

DPC, FS, AR, CP

AE, PDR

Recognize impact of cultural and ethnic differences in communication styles

DPC, FS AE, PDR

Maintain communication with treatment team members to facilitate patient care

DPC, FS AE, PDR

Maintain accurate and timely records of prescribed medications

PSY, DPC, FS AE

Clearly document all aspects of medication compliance

DPC, FS AE

Organize information received from treatment team to develop treatment plan

DPC, FS AE

D. Practice-Based Learning and Improvement Principle Educational Goals Learning


Use on-line resources to monitor clinical literature in pain management

PSY, CP, CAP, FS

AE, PDR

Critical analysis of pain professional literature and practice guidelines

CP, RD, FS AE, PDR

Commitment to evidence-based practice CP, PSY, RD AE, PDR

E. Professionalism Principle Educational Goals Learning


17

Assure availability of continuous care and access to pain medications

FS, DPC AE, PDR

Demonstrate reliable and ethical behavior DPC, FS AE, PDR

Demonstrate compliance with state and federal regulations of opioid medications

DPC, PSY AE

Understand and implement concept of boundaries with patients

FS, DPC AE

F. Systems-Based Practice Principle Educational Goals Learning


Collaborate with pain management physicians to enhance treatment continuum

CP, FS AE

Maintain awareness of trends in drug diversion and abuse in own community

PSY, DPC, FS AE, PDR

Knowledge of community support groups appropriate for recovering people prescribed opioid medication for pain

DPC, FS AE, PDR

Facilitate use of office-based buprenorphine for patients with pain and addiction

DPC, FS AE, PDR

4. RESIDENCY REQUIREMENTS a. Completion of Psychiatry Residency Program. The Addiction Psychiatry

Fellowship program requires completion of an accredited four-year psychiatry residency program. A letter from the Residency Director at the training institution confirming completion of all requirements is necessary prior to acceptance in the Addiction Psychiatry residency.

b. BCLS/ACLS Certification. Residents are required to be certified in BCLS prior to the entry of the psychiatry residency program. Certification in BCLS is valid for two years. Please contact the training office at ext. 83214 for more information.

c. Duty Hours. Residency programs in the United States must comply with the

Accreditation Council for Graduate Medical Education's duty hours standards, which limit resident duty hours to a maximum of 80 hours a week and set other restrictions on duty hours. The standards, which the ACGME Board of Directors approved in February 2003, are the culmination of two years of work to develop common duty hours standards for residents in all specialties that balance the needs of patient care, resident well-being and academic and clinical education. Residency

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Programs that fail to comply with the new standards will face adverse accreditation action, including loss of accreditation. While the Addiction Psychiatry program does not require on-call assignments, the program follows the guidelines of the ACGME standards, as follows: Resident Duty Hours and the Working Environment Providing residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. Each program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of residents' time and energies. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients.

Duty Hours

Residency programs in the United States must comply with the Accreditation Council for Graduate Medical Education's duty hours standards, which limit resident duty hours to a maximum of 80 hours a week and set other restrictions on duty hours. The standards, which the ACGME Board of Directors approved in February 2003, are the culmination of two years of work to develop common duty hours standards for residents in all specialties that balance the needs of patient care, resident well-being and academic and clinical education. Residency Programs that fail to comply with the new standards will face adverse accreditation action, including loss of accreditation. Following is an outline of the ACGME duty hours standards:

“Duty Hours (the terms in this section are defined in the ACGME Glossary and apply to all programs) Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site. 1. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. 2. Residents must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call. 3. Adequate time for rest and personal activities must be provided. This should 10-hour time period provided between all daily duty periods and after in-house call.

On-call Activities

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1. In-house call must occur no more frequently than every third night, averaged over a four-week period. a) On psychiatry rotations, in-house call must occur no more frequently than every fourth night, averaged over a four week period. 2. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care. 3. No new patients may be accepted after 24 hours of continuous duty. a) a new patient is defined as any patient for whom the resident has not previously provided care.

4. At-home call (or pager call) a) The frequency of at-home call is not subject to the every-third-night, or 24+6 limitation. However at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. b) Residents taking at-home call must be provided with one day in seven completely free from all educational and clinical responsibilities, averaged over a four-week period. c) When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit”

d. E-mail Policy. Residents are expected to check their KUMC e-mail daily. It is

essential that residents stay in touch with the KUMC e-mail system, which is the most commonly used form of communication at KUMC.

The Kansas City VAMC e-mail policy is provided during orientation at that Hospital. The resident is able to access KUMC functions including library search engines and references, on-line journals, and KUMC e-mail.

e. Examinations. Mock oral board examinations are scheduled once a year for

residents in their last year of training and others preparing to take the oral portion (Part II) of the American Board of Psychiatry and Neurology specialty certification exam. The location rotates between UMKC, KUMC-Wichita and KUMC-Kansas City. All three of the residency programs participate. Additional Mock Board experience is a part of the scheduled educational activities during the Adult Outpatient Clinic rotation and is also available post-graduation on an individual basis with various faculty members.

f. Medicare Time Reporting. Residents are required to keep track of their hours

worked by entering the information into the E*Value online management system. Time entry for the previous week (Monday-Sunday) is required to be entered into the system by 9:00 a.m. every Monday morning. Residents who are consistently

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late in entering their time will be reported to the Program Director. Instructions and training for time entry are available in the Residency Office.

g. Program and Supervisor Evaluations. Residents are required to complete online

evaluations of their faculty attending and the service to which they rotated at the end of a rotation or quarterly, whichever is earlier. Resident evaluations of attending faculty members and of rotations are completely anonymous and are not released until three online evaluations have been completed. Neither the faculty member nor the Residency Director (or anyone else) will be able to link specific faculty or rotation evaluations with specific residents.

h. Supervision. Clinical training includes regularly scheduled individual addiction

psychiatry supervision. Each resident receives two hours of individual supervision in addition to teaching conferences and rounds; one of these two hours is devoted to psychotherapy supervision.

5. GENERAL INFORMATION

a. Clothing Allowance. Three white coats are provided at the beginning of

residency.

b. Credit Union. Residents and their immediate families are eligible for membership in the Credit Union. They offer several savings programs, including a passbook account, Certificate of Deposit, and a money market fund, all at competitive rates. They make loans to qualified persons for any good reason. Other services include a notary service, traveler’s checks, and a VISA card. The Credit Union is located on the first floor of Delp Pavilion, Room 1037. (588-5375). Hours: Lobby - 8-4 M-F and Walk-up window - 7-8 am and 4-5 PM M-F.

c. Computer Services. Each resident is assigned a KUMC Network login and password for access to email, clinical data and the Internet. KUMC email can be accessed from outside KUMC via the Internet. Residents have access to computers throughout the department and in designated resident areas. Residents are expected to check their KUMC email once daily and required to check their KUMC email once weekly regardless of rotation. When assigned to the VAMC, residents will have access to KUMC functions and e-mail.

d. Dress Code and Decorum. White coats may be worn in all patient care areas and are required on certain rotations as determined by hospital policy and/or their staff supervisor. Scrubs are prohibited in all cafeterias. Residents are expected to present a clean, neat and professional appearance at all times. Beards and mustaches are allowed as long as they are properly maintained. Residents must

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wear the Medical Center identification badge and nametag when involved in clinical or administration activities. Conduct consistent with the dignity and integrity of the medical profession is required in all contacts with patients, families, and other health professionals. Patient confidentiality is clearly a paramount issue, and discussions of any patient-related matters must not be conducted in public areas.

The use of alcoholic beverages or drugs that impair judgment while on duty is prohibited, as is the consumption anywhere on the VAMC or KU Medical Center premises. Refer to the Housestaff Policies and Procedures Manual for more detail.

e. Health and Disability Insurance. Health insurance is provided for all residents

and dependants for a minimal charge and is payroll deducted. Disability insurance is supplied for all residents by KUMC. The premium paid by KU provides coverage for $1,000 per month on a long-term basis, if a resident should become disabled. Additional coverage may be purchased by the individual. The disability insurance may be converted to a private plan following residency.

f. Housestaff Policies and Procedures Manual. This manual presents the institutional guidelines, policies, and procedures governing a wide range of resident issues at the University of Kansas School of Medicine and Medical Center. It can be accessed only through the Internet under the Office of Graduate Medical Education Home Page at http://gme.kumc.edu/documents/gmepolicyandproceduremanual.pdf.

g. Keys. The Residency Coordinator distributes the keys to the Olathe Resident Offices, Olathe Elevators, Common Areas and master keys to the Outpatient Clinic. Office and elevator keys must be returned to the Residency Office at the end of a KUMC rotation. Common Area keys should be returned at the end of residency training. At the Kansas City VAMC, keys will be distributed through the Mental Health Administrative Offices, and must be returned at the end of the training period.

h. Library Services. The Resident Library is located in the Residency Office. All

library materials must be signed out. The main library requires an ID number to check items out. Extensive on-line resources are available through Dykes Library, and may be accessed through the KUMC home page.

i. Mail Room. Every resident is assigned her/his own box in 1012-Olathe Pavilion. Department and hospital communications will be delivered there. It should be checked and emptied frequently. The addiction resident will have a mailbox assigned at the Kansas City VAMC.

j. Moonlighting and Locum Tenens Privileges. Residents are allowed to moonlight in accordance with the policies outlined in Section 16 of the GME

http://gme.kumc.edu/documents/gmepolicyandproceduremanual.pdf

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Housestaff Policies and Procedures Manual. Residents doing training on a J1 visa are not eligible to moonlight outside KUMC. Moonlighting residents are not allowed to work more than 96 hours per two months. A resident wishing to moonlight must have a permanent license in the applicable state. Individual malpractice coverage must be provided by the resident or his moonlighting employer at the maximum level of at least $1,000,000/3,000,000. Evidence of the coverage must be submitted along with the Department’s request forms. The extrainstitutional practice must be outside normal business hours of 8:00 a.m. to 5:00 p.m. and must not interfere with call duties or performance in the residency program. Any violation of these regulations will result in immediate termination of these privileges. Requests must be submitted well in advance and must be approved by the Residency Review Committee, the Department Chairman and the Executive Dean. The forms may be obtained from the Residency Office. Moonlighting residents must adhere to the policies set forth by the ACGME regarding duty hours as follows described in Section E, 8 above.

k. Pagers. All residents are assigned an alphanumeric pager to carry during residency. When assigned to a VAMC rotation, residents should carry both their VAMC and KUMC pagers. Residents are expected to return pages in a timely manner. Residents will be responsible for the replacement cost of a lost or stolen pager.

l. Parking Permit. The Department pays for one parking permit in the red zone for each resident. The Residency Coordinator has information regarding parking. Cars will be ticketed if parked in an improper location/zone. If for any reason a different car must be driven that does not have a displayed permit, Parking Services must be notified between 8:00 a.m. and 5:00 p.m. that day (they will need the license # of the car). If a ticket is received, it should be forwarded back to Parking Services with “courtesy” written on it. The fine will be waived.

m. Paychecks. The first paycheck will not be received until approximately one month after training has begun. Thereafter, residents are paid every two weeks, on Fridays.

n. Personal/Sick/Unpaid Leave. Residents may request up to three months per

year of leave for reasons of personal or family illness, serious health condition, disability, or the birth or adoption of a child. In most cases, residents elect to use allotted vacation and sick leave before taking unpaid leave. If time is taken as unpaid leave, stipend payments are suspended for that period, but all other benefits continue. Any unpaid leave that exceeds 4 weeks must be made up at the end of the residency program. For a brief illness or for other medical reasons, residents are allowed up to 10 days sick leave per year. These days do not carry over from one contract year to the

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other and are clearly not to be abused. Please refer to the Housestaff Policies and Procedures Manual for further details. For women who are breast-feeding after returning to work, there is a private place designated to express milk in Room 2044 Wescoe Pavilion at KUMC. Residents who are aware of a medical leave in advance of the leave should complete a blue leave request form to ensure proper approval and coverage is obtained. RESIDENTS ARE REQUIRED TO NOTIFY THE RESIDENCY COORDINATOR AS WELL AS THE APPROPRIATE PERSONNEL AT THEIR ASSIGNED ROTATION BEFORE THEIR SHIFT BEGINS IF NOT REPORTING TO WORK DUE TO SICK OR MEDICAL LEAVE.

o. Photocopying/FAX. Residents have access to the department copier located 1012 Olathe. The code for the Residency Program is “1091”. The department FAX machine is also located in Room 1012 - Olathe Pavilion. The FAX number is 913-588-6414. (For professional use only).

p. Professional Development Fund. The Department provides $300.00 per year reimbursement for addiction psychiatry residents for such things as books, journal subscriptions, conferences and other educational expenses. Contact the Residency Coordinator to obtain a "Professional Development Reimbursement Request" form. Attach original documentation of expenses and turn in to the Residency Coordinator or the Department Administrator, Room 1005 – Olathe Pavilion.

q. Resident Lounge. The Shawn Storm M.D. Memorial Resident Lounge is located on the first floor of Sudler, just adjacent to the Child Psychiatry faculty offices. This is for use of the entire housestaff body. The door has restricted access through a keypad—the entry code is 157.

r. Vacation Leave. Residents are provided a maximum of 3 weeks (15 days) per year. The resident’s stipend is covered during this time. Vacation requests should be submitted in early July for the time period July-December and in early January for the time period January-June. Residents who request their vacation one year in advance will receive preference if a conflict arises with another resident’s vacation request. Vacation requests will not be approved for the last two weeks of June and the first two weeks of July. The Residency Review Committee will have the authority to approve vacation requests for these times only under extraordinary circumstances

All vacation requests must be initiated at KUMC. Always obtain a vacation request form from the Residency Coordinator so that she can verify the vacation balance.

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Requests must be approved and signed by the attending staff, the Chief Resident and the resident(s) covering clinical responsibilities before submitting it to the Residency Office for final approval. Once approved, the Residency Coordinator will block the requesting resident’s clinic schedule for the requested time and notify the clinic staff of the resident’s leave dates and who is providing coverage for that resident in their absence. While on a V.A. service, residents need to submit additional vacation paperwork which may be obtained from the psychiatry secretary at the V.A. Requests will be considered on a first-come-first-served basis. Requests for vacation or professional leave submitted less than 30 days in advance will not be considered.

6. RESIDENT STANDING, PROGRESS, AND PROMOTION Residents are evaluated by their attending staff and nursing staff quarterly or at the end of each rotation (whichever is earlier). Evaluations are available for review on line when they are completed. Residents being evaluated will receive an email notification when an evaluation has been completed. These evaluations are to insure that residents are progressing satisfactorily from rotation to rotation and that deficiencies, if present, can be addressed as soon as possible. Residents are reviewed as to performance by the Addiction Psychiatry Residency Director and, as appropriate, at Residency Review Committee Meetings at regular intervals, at least twice yearly. 7. REMEDIATION, PROBATION, CORRECTIVE ACTION, AND DUE PROCESS Concerns regarding any aspects of a resident’s performance are brought before The Departmental RRC. One or two low satisfactory grades will result in informal counseling. A poor grade or unsatisfactory rotation evaluation will result in formal counseling, which may include development of a remediation plan, repetition of the rotation or probation. Consistently poor performance may suggest a need for adverse action. Very specific guidelines from the School of Medicine govern remediation, probation, and due process/grievance procedures pertaining to any such actions. Please refer to the appropriate section in the Housestaff Policy and Procedure Manual for details.

Whenever the Addiction Psychiatry Residency Director is informed of significant concern regarding a resident’s performance, the resident involved will be contacted and given the opportunity to provide a response. The resident may provide this response by any or all of the following: in the form of a written document, through verbal communication with the residency director, or by personal appearance before the departmental Residency Review Committee. The RRC will subsequently review the facts and make a decision as to whether this information should be included in the resident's permanent file. If a decision is made to place the material in the resident's file, both criticism and response will be included. Supervising faculty may include, in correspondence regarding concerns about

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resident's performance, a proviso that same not be placed in the resident's file if difficulties are corrected within a given time frame.

8. HOSPITAL COMMUNICATION SYSTEMS The Paging System:

All the departments in the medical center use the Verizon pager system. The page numbers begin with 917 followed by four digits specific to the individual pager. You must dial 9 prior to dialing the pager number in order to gain access to an outside line. Leave your message, then press the # sign and hang up. Please refer to the Miscellaneous section of this manual for a list of the KU faculty and residents pager numbers. Each resident is assigned a personal pager that they will keep throughout their training. You may also call the page operator for specific pager information at extension 85155. The VA Hospital has a radio broadcast system. To page from inside the hospital, dial 86 and the page ID number. Enter the number where you want the call returned and hang up. Your pager is your responsibility. If you lose it or deface it you will be responsible for the cost of a new pager. Do not put tape on the pagers for any reason as it interferes with the inscribed numbers, voiding the warranty. Check your batteries frequently and replace them as necessary. Batteries are available in the mailroom at KU and from the department secretary at the VA. KANS-A-N Long Distance System This is a state long-distance network. It is for business calls only. The state of Kansas prohibits the use of long distance for personal use. To make a long distance call you must use only approved extensions. Dial 9, then 1, followed by the area code and the seven-digit number. To phone the KU-Wichita or KU-Lawrence campus, you simply need to dial the last four digits of the number (equivalent to the extension). Record all calls made on a Telephone Record form that is available from the mailroom, Room 1012 OP, and should be turned in to the department receptionist. KUMC Phone System: To make an outside call, dial 9 to get an outside line. To call another number in the hospital, dial the 5-digit extension number. All extensions within the hospital may be dialed directly from outside by adding the prefix 913-588-. Overhead Paging: The page operator (ext. 85155) can place a voice page for you on the overhead system. Overhead paging is not available in certain areas of Olathe Pavilion or in the library, so it will generally be more efficient to use the pager system.

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The Paging System:

All the departments in the medical center use the Verizon pager system. The page numbers begin with 917 followed by four digits specific to the individual pager. You must dial 9 prior to dialing the pager number in order to gain access to an outside line. Leave your message, then press the # sign and hang up. Each resident is assigned a personal pager that they will keep throughout their training. You may also call the page operator for specific pager information at extension 85155. The VA Hospital has a radio broadcast system. To page from inside the hospital, dial 86 and the page ID number. Enter the number where you want the call returned and hang up. When you are outside the hospital, you may page someone by calling 816-922-3337 and following the directions given. Your pager is your responsibility. If you lose it or deface it you will be responsible for the cost of a new pager. Do not put tape on the pagers for any reason as it interferes with the inscribed numbers, voiding the warranty. Check your batteries frequently and replace them as necessary. Batteries are available in the mailroom at KU and from the department secretary at the VA. KANS-A-N Long Distance System This is a state long-distance network. It is for business calls only. The state of Kansas prohibits the use of long distance for personal use. To make a long distance call you must use only approved extensions. Dial 9, then 1, followed by the area code and the seven-digit number. To phone the KU-Wichita or KU-Lawrence campus, you simply need to dial the last four digits of the number (equivalent to the extension). Record all calls made on a Telephone Record form that is available from the mailroom, Room 1012 OP, and should be turned in to the department receptionist. KUMC Phone System: To make an outside call, dial 9 to get an outside line. To call another number in the hospital, dial the 5-digit extension number. All extensions within the hospital may be dialed directly from outside by adding the prefix 913-588-. Overhead Paging: The page operator (ext. 85155) can place a voice page for you on the overhead system. Overhead paging is not available in certain areas of Olathe Pavilion or in the library, so it will generally be more efficient to use the pager system.

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9. THE DICTATION SYSTEM DICTATING AND REPORT REVIEW INSTRUCTIONS A central dictation system is available for all dictation of history/physical reports, consultation reports, operative reports, and discharge summaries. Dictation instructions are as follows: TO DICTATE A REPORT:

1. Dial 1-877-544-4999. There will be a prompt, “Welcome to the KU Hospital Central Dictation System”

2. To dictate a report, enter your 6 digit dictating ID number. 3. Enter the 2 digit report type: Discharge Summary 01 Speech/Language Evaluation 07 Transfer Summary (Stat Report) 03 Speech Therapy Progress Note 17 Operative Report 02 Video Swallow 27 Intraoperative Neurophysiologic Electroencephalogram 08 Monitoring Report 12 Evoked Response 18 Delivery Note/Operative Report 22 Endoscopy 09 History and Physical 04 Pediatric GI 19 Consultation 06 4. Enter the 7 digit medical record number. 5. Press 1 to dictate and 4 to pause. (Intermittent beep indicates pause mode – press 1 to

resume dictation.) 6. Press 5 or 9 to end current report. Job confirmation number will be announced. TO DICTATE ANOTHER REPORT WITHOUT CALLING BACK INTO THE SYSTEM:

1. At end of dictation, Press 5 on telephone keypad. The system will announce a job confirmation number for the report you just completed. 2. Enter the 2-digit report type.

3. Enter the 7-digit medical record number. 4. Press 1 to dictate and 4 to pause. (Intermittent beep indicates pause mode – press 1

to resume dictation.) 5. Upon pressing 5 or 9 to end current report, job confirmation number will be announced. NUMBER FUNCTIONS 1 - Dictate 5 - End current job/Start new #1 - Report review/Post-dictation listen 7 - Fast forward 2 - Dictate/Pause toggle 9 - Disconnect 3 - Short rewind 4 - Pause IMPORTANT REMINDERS

• Always call the Medical Record Dept. ext. 8-2432 (M-F, 7-4:30), ext. 8-2454 (after hours) when dictating a transfer (report type 03) to provide pertinent information regarding the patient transfer.

• Always press 9 to disconnect after completing your entire dictation or to disconnect if the ID digits have been entered incorrectly and the ready tone is heard.

• Always press 5 between reports if you are dictating multiple reports. Then repeat from step 3 of the dictating instructions listed above.

REPORT REVIEW Dial 1-877-544-4999. To review a report press #1. Enter your 6-digit user ID. To review by medical record number, press 1. After pressing 1, enter the 7-digit medical record number to hear the most recent dictation. To review a previous dictation on the same patient, press 5. To review another patient’s report, press 5, and enter the patient’s medical record number. To dictate press 1, or press 9 to disconnect. “Report not found” will be heard if a report is not available.

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HISTORY & PHYSICAL REPORT REQUIREMENTS 1. Patient name - please spell out full name 2. Medical record number 3. Date of History & Physical 4. Expected Admission Date 5. Expected Surgery Date (if surgery is scheduled) 6. Chief complaint 7. Details of the present illness, including, when appropriate, assessment of the patient’s emotional, behavioral, and social status. 8. Relevant past, social, and family histories, appropriate to the age of the patient. 9. Significant past surgical history. 10. Any remarkable past medical history. 11. Inventory by body systems. 12. In services, as appropriate, for children and adolescents, the history must include: -- An evaluation of the patient’s growth and development -- The parent’s report or other documentation of the patient’s immunization status -- Consideration of emotional, cognitive, social and daily activities, as appropriate -- The family’s and/or guardian’s expectations for, and involvement in, the assessment, treatment and

continuous care of the patient. 13. Comprehensive current physical assessment. 14. A statement on the conclusions or impression drawn from the admission h&p examination. 15. A statement of the course of action planned for the patient while in the hospital. OPERATIVE REPORT REQUIREMENTS All operative reports must be dictated immediately following surgery. 1. Patient name - please spell out full name 2. Medical record number 3. Date of operation 4. Preoperative diagnosis 5. Postoperative diagnosis 6. Operation 7. Surgeon 8. Assistant surgeon 9. Description of the findings 10. Technical procedures used 11. Specimens including dispostion of the specimen 12. Referring Physician name, address, and fax number if available. CONSULTATION REPORT REQUIREMENTS 1. Patient name - please spell out full name 2. Medical record number 3. Admission Date 4. Consultation date 5. Consulting physician 6. Attending physician 7. History of present illness 8. Physical examination 9. Impression 10. Recommendation

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DISCHARGE SUMMARY REQUIREMENTS All discharge summaries must be dictated within 48 hours following discharge. 1. Patient name - please spell out full name 2. Medical record number 3. Dates of admission and discharge 4. Attending staff physician 5. Dismissing hospital service 6. Reason for hospitalization 7. Significant findings including Physical Examination and test results 8. Treatment rendered/Description of hospital course 9. Final Diagnoses 10. Procedures performed 11. Instructions to the patient and/or family, as pertinent, to include:

a) Physical activity b) Diet c) Follow-up care d) Medications 12. Referring Physician name, address, and fax number if available. It is imperative that all diagnoses and procedures performed be dictated in the discharge summary, as well as being recorded on the discharge orders. For assistance with any dictation issues, please call Ext. 8-2432 or 8-2446 (M-F, 7- 4:30 p.m.) or Ext. 8-2454 any other time. For assistance with Radiology Reports call 8-1827.

SPEAK CLEARLY AND DISTINCTLY!

Documents

MANUAL OF GENERAL INFORMATION