Principles for H1N1 Emergency Coverage UW Internal Medicine Residency Program

Transcription

1 1. The Residency Program Guidelines for Resident Backup Coverage policy should be used for guidance when pulling residents from Risk. 2. In the event of an epidemic, patient safety and patient care will be the most important priority. Residents with an influenza-like illness should not come to work per medical center policy; Hospital services should minimize, as much as possible, elective or non-urgent admissions. Emergency resident coverage should conform to the ACGME and UW policies regarding duty hours. Pregnant residents are strongly urged to follow all recommended infection control procedures when taking care of all patients, including those with influenza, independent of subtype. Pregnant women are not prohibited from taking care of patients with influenza; however, those who have not received influenza vaccine (including H1N1) or have unknown immune status, are encouraged to express any concerns they may have to their chief resident and/or program director and discuss their patient care responsibilities. Exposure management should conform to hospital policy for management of asymptomatic healthcare workers potentially exposed to a person with influenza. In principle, asymptomatic residents exposed to a person with influenza: o Do not need to stay home o Should self-monitor for development of symptoms and stay home if symptoms develop (symptoms include fever, cough, sore throat, runny or stuffed nose, myalgias, arthralgias, headache, chills, diarrhea, and fatigue) o Should consider prophylaxis if their exposure occurred within the previous 48 hours o Should be offered prophylaxis through the appropriate Employee Health Service if the exposure occurred at work or via a family member or close contact with probable or confirmed influenza

2 Illness management should conform to hospital policy for symptomatic healthcare workers with an influenza-like illness or a respiratory illness. In principle, symptomatic residents with an influenza-like illness should: o Put on a mask, notify their chief resident and/or attending physician, and go home o Not come to work if already at home o Contact the appropriate Employee Health Service for recommendations regarding possible treatment. o Contact their primary care provider if there is not a known work-related exposure o Go to the ER or their PCP if they are at risk for influenza-related complications or have warning signs of more severe illness o Contact Employee Health if having continued or prolonged symptoms. o If possible, please have someone who is not ill pickup appropriate medications/prescriptions o Not return to work until 24 hours after resolution of fever and respiratory symptoms (or 7 days at the VA) o Refer to the resources below and the UW Medicine Internal Influenza website through at (AMC/OCRA login required) for additional guidance. 3. In addition to the Guidelines for Resident Backup Coverage policy, the following principles should be followed in the event of an overwhelming risk situation: All inpatient/call services and ER have equal priority for coverage; All residents are potentially at risk for having to provide coverage; Priority for non-coverage (i.e., the order of rotations from which to pull residents) once the risk pool is depleted: - Low-acuity consult rotations - High-acuity consult and dayfloat rotations

3 Should additional housestaff still be needed after the above pools have been depleted, priority will be given to provide staffing to the services listed in point # 5 to at least their minimum numbers by pulling the following residents: - Research rotations - Outpatient GIM and thematic ambulatory rotations - Holiday Time Off (HTO). Notification will occur no later than 24 hours prior to the start of an affected HTO period. - Residents scheduled to go to a WWAMI rotation or start vacation. Notification will occur no later than 24 hours prior to the start of that rotation/vacation. Chief residents, fellows, and faculty become at risk and will need to function with fewer residents and/or provide patient care without residents. 4. On-call frequency may need to be adjusted based on decreased numbers of available providers but must not occur more frequently than every third night. 5. All attempts should be made to provide coverage for the following minimum number of providers per service*: HARBORVIEW UWMC VAPSHCS Service Minimum Service Minimum Service Minimum H-Med 2 per team U-Med 1 per team V-Med 2 per team H-MICU 6 U-MICU 5 V-CCU 3 H-ED 3 U-Cards 3 V-Pulm 1 H-CCU 3 U-HO 4 V-Nightfloat 1 H-Neuro 2 U-ED 3 H-Nightfloat 1 U-Nightfloat 1 (* Services/minimum subject to change depending on conditions)

4 6. Ideally, the medical services will maintain a cap of 10 patients per provider or less. 7. The Residency Program (i.e., program director, associate program director, assistant program director, or chief resident) must prospectively approve any planned exceptions to duty hours. 8. Resources Harborview Medical Center: - ts+new.htm - Employee Health Service Tim Dellit, MD, pager , thdellit@uw.edu UW Medical Center: - /index.htm - Employee Health Service Estella Whimbey, MD, , ewhimbey@uw.edu VA Puget Sound Health Care System: - Employee Health Service - Rich Miller, MD,

5 A H-GI H-HO H-MedConsult H-OccMed H-Pain H-Palliative U-AdvCards U-Endo U-GI U-Heart U-MedConsult U-MedGenetics U-Palliative U-Rheum V-Derm V-Endo V-GI V-HO V-Neph V-Neuro V-Rheum S-Hospitalist B H-Hospitalist H-ID H-Neph H-Pulm U-Hep U-Hospitalist U-ID U-Pulm U-Med E U-Neuro U-NeuroRad V-Cards V-DayFloat V-ID C Research H-Geri D H-Addiction H-Clinic H-GIM H-Global H-HIV H-Homeless H-Metabolic U-Autoimmune U-Clinic U-GIM U-Hep U-Musc U-Neph U-Women s V-Clinic V-GIM V-Pulm P-Clinic P-CardioResp P-EndoDerm P-NMS S-HO E HTO F WWAMI International G Vacation