Supervision & Procedures: Koestner, Harrison "Tyler" (MD)

 

The Residency Supervision Area is designed to assist hospitals and clinics with the protocols outlined for specific duties residents and fellows can perform. These guidelines are determined by the faculty of the University of Tennessee Health Science Center. Any questions about certain procedures not listed should be addressed to the faculty and not decided by the resident or fellow.

 

A credentialed and privileged attending physician ultimately provides supervision or oversight of each Resident's patient care activities. Direct supervision by a qualified attending physician (or a more senior Resident with Indirect Supervision immediately available) is required in the OR/Delivery Room or for non-routine invasive procedures like Cardiac Cath, Endoscopy, and Interventional Radiology. 

 

Click here to view the UT GME Policy 400 Resident Supervision 2018.

 

Click here to view the UT GME Policy 405 Patient Care Settings - Resident Supervision Standards 2018.

                                                   

Harrison "Tyler" Koestner, MD

Harrison "Tyler" Koestner, MD  

PGY-4

Fellow, Surgical Critical Care  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                

Resident Supervision will consist of four categories/levels:

  • Direct Supervision - the supervising physician is physically present with the resident and patient.
  • Indirect Supervision with Direct Supervision IMMEDIATELY available - the supervising physician is physically within the hospital or other sites of patient care, and is IMMEDIATELY available to provide Direct Supervision.
  • Indirect Supervision with Direct Supervision available - the supervising physician is not physically present within the hospital or other sites of patient care, but is IMMEDIATELY available by means of telephone or other electronic means, and can be available if required for Direct Supervision
  • Oversight - Supervising Physician is available to provide a review of procedures or the encounter with feedback after the care is provided but the procedure or care does not warrant the physical presence of the attending.
  • In particular, PGY-1 residents should be supervised either directly or indirectly with direct supervision immediately available as described in the levels of supervision, unless denoted as Oversight in the list that follows.
  • In an emergency, defined as a situation where immediate care is necessary to preserve life or prevent serious impairment, residents are permitted to initiate whatever care is necessary and reasonable to save a patient from serious harm even if an attending physician is not immediately available to supervise.  The appropriate Medical Staff member should be notified as soon as possible.  
  • Supervising physicians may be more advanced residents or fellows. 

               

Certifications current when the resident/fellow entered training at the UTCOMC.                
Basic Life Support (BLS)
Advanced Cardiac Life Support (ACLS)
Advanced Trauma Life Support (ATLS)

                                            

As a  Fellow in the one-year Surgical Critical Care Fellowship (PGY-4, PGY-5, PGY-6. or PGY-7 level), the Fellow can perform any Surgery or Surgical Critical Care physician skill or procedure deemed appropriate by his/her attending physician.  Residents and Fellows are expected to progressively assume more responsibility throughout each level of training and demonstrate competence in skills/procedures requiring less Direct Supervision.  The supervising physician may make adjustments in the level of supervision required for that specific procedure.

 

Patient Care Skills or Procedures that do not require Direct or Indirect Supervision presence of a supervising physician (i.e., Oversight/General Supervision) are listed below.  Anything not specifically listed requires either Direct Supervision, Indirect Supervision with Direct Supervision Immediately Available, or Indirect Supervision with Direct Supervision available by phone or other electronic media, at the discretion of the supervising physician. 

                                                

Surgical Critical Care Fellows (at the PGY-4, PGY-5, PGY-6, or PGY-7 level can perform the procedures under Indirect Supervision or Oversight highlighted in grey.

         

 

 Patient Care Skills and Procedures           SCC Fellow
PGY-4, 5, 6, or 7
 
    Perform all minor surgery related procedures as the Fellow is at an advanced level of training.  X
    Surgery, Trauma, and Surgical Critical Care consults in the Emergency Department  X
    Clinical and Social History  X
    Communicate with patients and family members  X
    EKG - perform and interpret  X
    Formulate diagnostic and treatment plans  X
    Formulate pre-and post-operative treatment plans  X
    Incision and Drainage Superficial Abscesses & Hematomas  X
    Interpret basic x-rays and imaging studies, including but not limited to skull, spine, chest, abdomen, and extremities   X
    Interpret laboratory and diagnostic studies and tests  X
    Mark diagnostic and surgical procedures on patients  X
    Obtain consent for endoscopic procedures X
    Order radiologic, laboratory, or other diagnostic tests  X
    Participate in and run a code (adults)  X
    Request specialty and subspecialty consults  X
    See patients and write patient orders  X
    Supervise Medical Students, Residents, and more junior Surgical Critical Care 
 Fellows
 X
    Physical Examination  X
    Write admission, treatment orders, and notes in the Electronic Health
 Record
X
   
 Cardiopulmonary Resuscitation and Airway Maintenance   SCC Fellow
PGY-4, 5, 6, or 7

   Perform Basic CPR and related procedures (airway management,

emergency drug therapy, rhythm strip interpretation, intravenous

catheterization, closed chest massage, adult resuscitation,

electrocardioversion & defibrillation, and venous cut-down) 

 X
 Adult Resuscitation  X
Pediatric Resuscitation X
Insertion of Oral Pharyngeal Airway X
Endotracheal Intubation X
   
 Additional Specific Patient Skills and Procedures  SCC Fellow
PGY-4, 5, 6, or 7
   Amputation of extremity or digit   X
   Appendectomy   X
   Arterial Puncture   X
   Breast Biopsy  X
   Bronchoscopy  X
   Central Venous Pressure Lines  X
   Diverting Loop Colostomy  X
   Drainage of Extremity   X
   Epigastric, Umbilical, or Inguinal Hernia   X
   Excision of subcutaneous or dermal lesion  X
   Intravenous Line  X
   Knot Tying X
   Nasotracheal Intubation  X
   Orotracheal Intubation   X
   Participate in and supervise patients in the Surgical ICU  X
   Perform procedures in the OR and assist junior residents with procedures in the OR   X
   Perforated Duodenal Ulcer  X
   Peritoneal Lavage  X
   Portacath, venous access   X
   Roll with the patient to surgery when staff is notified the attending is "on the way to the OR"   X
   Skin Graft  X
   Small bowel obstruction  X
   Suture Simple Wound/Laceration  X
   Swan Ganz Catheterization   X
   Thoracentesis   X
   Triage adult and pediatric trauma patients   X
   Tube Thoracostomy   X
   Venipuncture   X
   Wound Debridement   X
   

                                  

All other procedures are performed under direct supervision of a faculty member or more
senior fellow.  

 

Updated 4/1/2018

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