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Policies and Procedures 6. Limitations on Patient Numbers

1. Introduction Fellows on nephrology services or on outpatient rotations are limited with regard to the total number of patients they are assigned. These limitations are outlined for each clinical setting. II. Consult rotation Nephrology fellows are limited to writing notes on 20 patients on the consult rotation. The consult team total number may exceed 20 given that all patients are not seen every day and it is important for nephrology fellows to be able to manage these volumes of patients in preparation for future practice. If the number of patients that the fellow sees and writes notes on exceeds 20 patients, the nephrology attending is responsible for designating patients as non-teaching cases to achieve a teaching team for that day of less than 21. The non-teaching cases become the sole responsibility of the consult attending. Though no specific limit is placed on the number of new consults a nephrology fellow sees in one day, attendings are expected to limit these consults to a reasonable manner. III. Service Nephrology fellows are limited to 20 patients on the service rotation. If this service exceeds 20 patients, the nephrology attending is responsible for designating patients as non-teaching cases to achieve a teaching service of less than 21. The non-teaching cases become the sole responsibility of the inpatient service attending. IV. Outpatient

At the ECU Physicians Nephrology and Hypertension dialysis facility, nephrology fellows are responsible for their cohort of ECU nephrology patients on the shift to which they are assigned. Fellows are not responsible for patients on other dialysis shifts or patients on their shift who are not ECU nephrology patients. The total number of dialysis patients followed by a fellow are 5 in the first year, transitioning up towards 10 at the end of the first year if requested by the fellow, and a maximum of 10 patients in the 2nd year of training. Nephrology fellows are limited to on average 8 patients per weekly continuity clinic (including monthly PD clinic, transplant clinic and their ½ day per week ambulatory clinic averaged out per week over a 2 month period). All patients seen after this limit of 8 are the sole responsibility of the assigned attending physician. V. Transplant Rotation Nephrology fellows are limited to 24 patients on the inpatient transplant service. The acute transplant continuity clinic typically includes 1-4 follow-up patients. Nephrology fellows will see these patients in conjunction with the attending but will be responsible for writing notes and full evaluation on no more than 8 patients per clinic (including monthly PD clinic, transplant clinic and their ½ days per week ambulatory clinic averaged out per week over a 2 month period). All patients past this limit of 8 are to be managed by the assigned attending physician. VI. Continuity Clinic Nephrology fellows will see on average 4 to 8 patients per half-day ambulatory continuity clinic. The supervising attending will see any patients in excess of this number.

Revised 7/18/06