STONY BROOK PEDIATRICS
CONTINUITY CARE CLINIC
RESPONSIBILITIES AND SUPERVISION
This Document is designed to:
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Delineate the responsibilities of residents in their Continuity Care Clinic.
Enumerate the number of patients that residents must see during each session.
Describe the attending preceptor responsibilities for Continuity Care Clinic.
Apply to all resident Continuity Care Clinic sites
Goals of Continuity Care Clinic Experience:
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Residents will demonstrate an understanding of outpatient health care system,
including cost control, billing, and reimbursement and coding.
Residents will provide quality health care to a variety of patients.
Residents will advocate for patients within the context of the health care system.
Residents will understand systems-based practice in an outpatient setting
1) Residents will:
a) Arrive on time at their weekly clinic site, having reviewed their schedule of patients prior
to arrival.
b) Evaluate their patients in a timely manner.
c) Present all patients – new and return visits – to the attending.
d) Review and sign-off on all laboratory or radiologic study results for their patients.
e) Review and sign-off on all consult letters or Emergency Department notes received for
their patients.
f) Review and sign-off on any telephone messages handled by others for their patients.
g) Review any notes documenting clinic visits performed by others for their patients.
h) Write a clinic note appropriate for the level of care delivered before leaving clinic.
i) Bill all encounters through the Patientkeeper Billing System.
j) Notify the Chief Resident in the event of illness or other emergent absence as soon as
possible.
2) Schedules:
a) The Chief Residents, along with the Program Director, will assign new residents to a
Continuity Care Clinic site for the duration of their training.
b) The Chief Residents will ensure that each resident’s clinic schedule meets RRC
requirements, including:
i. Residents will attend a minimum of 36 weeks of clinic each year. This is a
minimum, and it is expected that residents will attend their weekly clinic
whenever possible.
ii. Residents will not attend their clinic when on Night Intern, NICU and Newborn
Nights. Residents will attend clinic during all other rotations.
iii. The Chief Residents will cancel clinic for vacations and maternity/paternity
leave.
iv. Residents will not attend their clinic when they are post-call after being on duty
for 24 hours.
v. Rarely, due to schedule constraints, residents may be scheduled for clinic after a
night shift call if they are not working the next night, and will not surpass 24
hours of patient care duties.
vi. Clinics will be rescheduled when residents are out sick or for a personal
emergency.
c) The Site Preceptors will ensure that residents are assigned a sufficient number of patients
each session as follows:
i) PL-1 residents must see a minimum of 3 patients/session. (6 booked)
ii) PL-2 residents see a minimum of 4 patients/session. (8 booked)
iii) PL-3 / PGY-4 residents must see a minimum of 5 patients/session. (10 booked)
d) It is imperative that the residents have a variety of patients of various ages for well child
checks, as well as a variety of subspecialty patients that they will follow as a primary care
physician.
3) Supervision:
a) The attending must be present on-site at all times.
b) The attending must see all patients with the PL-1 residents for the first 6 months of
training, and then as needed.
c) All residents must present all patients to the supervising attending.
d) The attending must review all notes in a timely fashion and inform the residents of any
changes, additions or suggestions.
e) The attending is responsible to ensure that residents follow up on all pending
labs/studies/consults, etc.
f) Each resident will be evaluated semi-annually by their faculty preceptor(s) for their
performance in the Continuity Care Clinic via a formal evaluation in New Innovations.
g) Routine informal feedback from faculty preceptors is encouraged to be done on a weekly
basis.
4) Making continuity a priority:
a) With supervision of the attending physician, each resident will provide all ongoing care
to patients seen by him/her in the Continuity Care Clinic, including all follow up of acute
or chronic medical problems, preventive and maintenance health care, appropriate
counseling of patients and families, and patient education.
b) Residents will work with the Site Preceptors, registration staff, nurses and other
personnel to maximize the continuity of care, including ensuring patients receive
appropriately timed return visits and informing their fellow residents when patients are
admitted to the hospital.
c) Residents will develop a positive therapeutic relationship with their patients. Among
other things, residents are should inform patients in a timely fashion of test results and
should give patients their business card during continuity visits with a patient new to
them.
d) Residents are expected to provide the highest quality of care to patients at all times. This
includes appropriately responding to patient’s needs between clinic visits. Residents must
be responsive to pages and needs communicated by their clinic, and ensure patients under
their care are able to contact them easily between visits. Residents will also follow up as
appropriate on any patient lab work or testing between clinic visits.
e) Residents will work with their “site team residents” to ensure follow-up for patients
during weeks when the primary resident is not in clinic.
5. Residents Duties:
a) It is the responsibility of the resident to inform the attending physician of any change in
the arrival time.
b) Residents should present to the clinic in a professional manner.
c) Residents should write legibly and should use their official stamp for identification
along with their signatures.
d) Residents must time and date all clinic notes and orders.
e) Presentation to the attending physicians should be done in an organized manner with
clear assessments and plans.
f) Residents who do not a have full schedule in a continuity clinic will see overflow
patients at the attending’s discretion.
g) If a resident sees another resident’s continuity patient that patient should be referred
back to their continuity physician for the next visit.
h) Residents should routinely, and in a timely manner appropriate to the situation,
follow‐up on laboratory results and ancillary results and inform the patients of those
results. A note must be placed in the chart to document review of the results and the
communication between the resident and patient.
6. Chart Review:
a) Each clinic day the resident team members present, or the attending physician on a nonresident day, will deem which information needs to be dealt with urgently or can be
placed in each resident’s inbox.
b) Each clinic day each resident will review the materials left in his/her inbox. If a resident
is not in clinic that week, a member of the team will review the absent member’s inbox
and deal with any lab or prescription issues. Residents must sign off on results reviewed,
and note any actions taken. After completion the charts will be filed.
c) Residents should refer patients to their own clinics.
6. Appointment Schedule:
a) Every resident has reserved time in their schedule to add additional new patients to their
continuity schedule. (For example if a resident is on the wards and the resident
discharged a patient to follow up with them they will call the clinic and schedule the
patient a clinic appointment).
b) The clinic has a an appointment line to call for scheduling of appointments.444-KIDS
c) All residents will be expected to have their business cards with them when they are
working. All continuity patients are to be given by the resident their professional business
card in order for the patients to be able to identify “their” doctor.
7. Continuity Clinic Leave Protocol:
a) If residents are unable to attend their continuity clinic the following people should be
informed in a timely manner:
i.
ii.
iii.
Pediatric Chief Residents
Clinic Preceptor
Program Coordinator
b) Medical Leave:
When medical leave is taken it will be taken from your sick leave allowance.
c) Non-Medical Leave:
If a resident must reschedule a clinic due to reasons other than sick leave he or she must :
i.
Contact the above mentioned parties at least one week in advance.
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All non-medical leaves must be approved by the chief residents and program director
A Clinic Leave Form must be completed for all non-medical leaves (see below)
Residents must make up the clinic day, which will be schedule by the chief residents.
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d) Resident Vacation Schedule:
The clinics will be given a schedule of each residents’ vacation dates at the beginning
of the academic year.
Created April 2009
Revised August 2010
Revised July 2011