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Policies and Procedures 2. Nephrology Fellow Protocol for Defining

Circumstances that Require Attending Notification or Involvement

During the first 3 months of fellowship training, fellows must notify their supervising attending for:

- Any admissions to the service - Any new consults - Any change in level of care for a patient

- to an intermediate bed or to an ICU bed - Anytime the fellow makes a decision to urgently or emergently dialyze or pherese a

patient - Any significant complication of hemodialysis (such as potentially lethal arrhythmia or

hemodynamic instability) - Death of a patient - Individual attendings have the authority to request notification from fellows above and

beyond what is listed above. During the remainder of fellowship training, fellows must notify their supervising attending for:

- Any admissions to the service where the fellow needs guidance from the supervising attending

- Any new consult where the fellow needs guidance from the supervising attending - Attending MUST be notified for all hyponatremia consults, ICU consults, consults requiring hemodialysis or CRRT at the time of consult, TTP patients or any other patient requiring apheresis, any patient called in for kidney transplant or unstable pregnancy consults.

- Any change in level of care for a patient - To an intermediate bed or to an ICU bed

- Anytime the fellow makes a decision to urgently or emergently dialyze a patient - Any significant complication of hemodialysis (such as potentially lethal arrhythmia or

hemodynamic instability) - Death of a patient - Individual attendings have the authority to request notification from fellows above and

beyond what is listed above. It is expected that the fellow will achieve progressive independence from the 1st 3 months of training to the end of training. We will never stipulate a situation where the fellow “should not” call, but it is expected that gradually over the 1st year of training, particularly from the 3rd to 12th month, the fellow will develop the ability to make an increasing number of decisions independently. Furthermore, as the fellow progresses through training, it is expected that the fellow will have an increasing ability to formulate a thorough differential diagnosis, diagnostic evaluation and treatment plan.

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Back-up systems for notification - If a fellow is unable to reach their supervising attending, they must page or telephone the

program director. Of note, the program director is available 24/7 for the 1st 3 months of each fellow’s training and most other times of the year as well. If the program director is out of town or cannot be reached, the fellow will page or telephone the division chief. If for any reason the fellow is not able to reach any of these 3 individuals, the fellow should then begin calling any of the remaining 4 faculty members until someone is reached. Phone lists are available at \\Piratedrive\ecukidney\SCHEDULESandPHONElists.

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