Pulmonary Disease & Critical Care
Medicine Fellowship
Fellow Responsibilities 2014-2015
MICU – LIJ
There will be 2 fellows that rotate in the LIJ MICU at any given time, with specific responsibilities assigned
to each fellow.
MICU 1 Fellow:
1. Primary fellow responsible for all the patients in the MICU.
2. Fellow will receive sign-out at 7 am each morning and sign out to the night intensivist at 5 pm each day.
3. Supervise the residents with their responsibilities and procedures (central lines, arterial lines, etc).
4. Procedures such as intubation, percutaneous tracheostomies, and bronchoscopies are performed by
the fellow and supervised by the attending physician. All procedures must be logged into the procedure
book.
5. Certain procedures often require the bronchoscopy lab nurses to be present such as percutaneous
tracheostomies, FEESST, and bronchoscopies. The fellow is responsible for coordinating this with the
bronchoscopy lab, ext 7069, pager 06835.
6. Attend interdisciplinary rounds that occur daily at approximately 11:45 AM.
7. Daily care plans/goals: Assess the need for central lines, arterial lines, Foley catheters, PUD and DVT
prophylaxis on a daily basis
8. The fellow is responsible for a majority of the "non-rounding" teaching time. Formal lectures should
be given to the residents and interns by the fellow on critical care topics.
9. MICU to MICU inter-institutional transfers are coordinated by the transfer center. Requests for
transfer are to be directed to the MICU attending who will decide whether the patient is accepted.
10. It is the responsibility of the MICU 1 fellow to orient the interns & residents every Monday to the
MICU (preferably about 15 minutes before rounds). A housestaff orientation manual is located on the
Pulmonary fellows website (pulmfellows.homestead.com) to be printed and distributed.
MICU 2 Fellow:
1. Evaluate all new consults during ICU rounds. Consults after rounds will first be seen by the ICU
residents and then presented to the MICU 2 fellow and attending. Patients rejected from the ICU or
transferred will need at least 1x follow up within 12 hours.
2. Rapid responses and medical codes are run by the residents (MAR) but the fellow is expected to assist if
needed.
3. Assist the MICU 1 fellow with procedures and emergencies.
4. Round on and be responsible throughout the day for MICU boarders located in other critical care units.
5. Check and restock the ICU Bronchoscopy cart on Monday mornings and Friday afternoons.
6. Daily ensure that the ultrasounds are present and functioning, the glidescope is present with the stylet,
and the TEE probe is available and ready for use.
MICU – NS
1. The fellow will receive sign out at 7 am from the night intensivist on all the patients. Sign out to the
overnight fellow/NP each night at 6 PM.
2. There are 2 teams in the MICU – the yellow team (consisting of fellow, attending and internal medicine
interns) and green team (attending, NP or PA and emergency medicine housestaff). The fellow will round
on the yellow team patients every morning with the team, but is expected to assist with all emergencies
and procedures in the ICU as needed.
2. The interns are responsible for completing daily progress notes on all the patients. The fellow is
responsible for prerounding with the interns, overseeing care of the patients, reviewing their daily notes
and supervising all procedures.
3. The fellow is responsible for triaging all new ICU consults throughout the day, with assistance from the
Acute Critical Care Team (ACCT) as needed.
4. Bronchoscopies, intubations and percutaneous tracheostomies are all to be done by the fellow and
supervised by an attending. The MICU fellow is responsible for coordinating schedules with
the pulmonary attending and the bronchoscopy lab nurses (x4592). All procedures should be logged into
the ICU procedure book.
5. The fellow is responsible for a majority of the "non-rounding" teaching time and formal lectures should
be given to the interns and NPs/PAs.
8. Weekends- MICU fellow is responsible for all the patients in the ICU and see consults throughout the
day until 6 pm when the ACCT attending arrives.
9. MICU to MICU inter-institutional transfers are coordinated by the transfer center. Requests for
transfer are to be directed to the MICU attending who will decide whether the patient is accepted.
10. Daily care plans/goals: Assess the need for central lines, arterial lines, Foley catheters, PUD and DVT
prophylaxis on a daily basis.
11. It is the responsibility of the MICU fellow to orient the interns & residents every Monday to the MICU
(preferably about 15 minutes before rounds). A housestaff orientation manual is located on the
Pulmonary fellows website (pulmfellows.homestead.com) to be printed and distributed.
12. Daily ensure that the ultrasounds are present and functioning, the glidescope is present with the stylet
PULMONARY CONSULTATION SERVICE – LIJ
1. Responsible for receiving all new pulmonary consults for service patients (no prior pulmonologist, has a
pulmonologist that does not come to LIJ, patients seen in the faculty practice or fellows clinic) between
7am and 5pm. Any consults that are deemed non-urgent from the previous night by the on call fellow will
be relayed to the consult fellow by 7 am the next morning.
2. Cystic fibrosis patients - admitted to the pulmonary consult service and are covered by housestaff. The
housestaff will evaluate the patient and present to the pulmonary consult or on-call fellow. The
housestaff is responsible for writing the H&P, orders and for discussing the daily plan of care with the
pulmonary fellow as well as any acute changes. The fellow must round on these patients daily.
4. Communicate recommendations to the primary attending and residents/NPs/PAs.
5. Written sign-out to the weekend on-call fellow. Included on the sign-out should be a list of which
patients to see on which days, acute issues and plan of care. Also, there must be a clear indication of
which patients are on our service (CF patients).
6. Provide the next consult fellow (at the end of the rotation) with a detailed sign out.
7. Ultimately the consult attending is responsible for all decisions related to patient care and the fellow
should inform the attending immediately of any urgent issues which arise.
8. The consult fellow is primarily responsible for all conferences that involve case presentations (Monday
Radiology Conference and Wednesday Management Conference). See the conference section for further
detail.
9. The procedure fellow will perform all procedures on consult patients.
PULMONARY CONSULTATION SERVICE – NS
1. The fellow is responsible for receiving all new pulmonary consults (including RCU consults) between
7am and 5pm. These patients should be unattached (no prior pulmonologist), have a pulmonologist that
does not come to NS, or are patients seen in the faculty practice or fellows clinic. Any consults that are
deemed non-urgent by the overnight on-call fellow will be relayed to the consult fellow by 7am the next
morning.
2. The fellow is responsible for rounding with the consult attending. Every patient admitted to the
pulmonary service/RCU must be seen daily.
3. Communicate recommendations to the primary attending and residents/NPs/PAs.
4. The procedure fellow should be available to perform all procedures on consult patients, especially
when the service is busy.
5. The consult fellow is primarily responsible for all conferences that involve case presentations
(radiology conference and the Wednesday management conference). See the conference section for
further detail.
6. The fellow is responsible for providing the weekend on-call attending with written sign-out every
Friday afternoon.
7. Provide the next consult fellow (at the end of the rotation) with detailed written sign out of all the
patients on the consult service.
8. Ultimately the consult attending is responsible for all decisions related to patient care and the fellow
should inform the attending immediately of any urgent issues which arise.
9. The RCU at NS is covered by the consult fellow. The fellow is responsible to round with the RCU staff at
10 am Mon-Fri on the service patients. Private patients will not be covered by the fellow. The
Bronch/procedure fellow is expected to help out with any emergencies.
10. Regarding all potential transfers to the RCU, the consult fellow must discuss each patient with the
consult attending to determine if the transfer is appropriate.
11. The procedure fellow will perform all procedures on consult patients.
PULMONARY/RESPIRATORY CARE UNIT - LIJ
1. This is a 16-bed unit composed of 6 RCU beds & 10 Pulmonary beds
2. Fellows will round with an attending and NP/PA’s, as well as attend interdisciplinary rounds.
3. The fellow is directly involved in the coordination of care for all patients on the ward and is expected to
oversee the decisions made by the NP/PA’s.
4. The attending is ultimately responsible for all decisions related to patient care and the fellow should
inform the attending immediately of any urgent issues which arise.
5. There will be 2 dedicated NP/PA's during the week. The RCU NP will take care of the 6 RCU patients,
including H&P's, daily notes, orders, discharge note, etc. The second NP will take care of the remaining 10
pulmonary patients, including daily notes, orders, discharge notes, etc.
6. The fellow is expected to triage admissions. Eligible patients include unattached patients (no private
pulmonologist) or faculty practice (seen as outpatient by our attending or in the NS/LIJ clinics).
7. Admission Criteria: primary pulmonary issue, including COPD exacerbations, Asthma exacerbations,
ILD, pneumonia, pulmonary HTN, and bronchiectasis exacerbations. Patients who require first time BiPAP
for a pulmonary issue can be admitted to the Pulmonary unit (not for heart failure, not for patients with a
private pulmonologist).
9. CF patients will not be admitted to the Pulm/RCU unit, but will continue to be admitted to 5 North and
will be followed by the consult fellow and attending.
10. Admission Process: The ED will contact the fellow for admission of a patient with a primary pulmonary
issue. If the patient is unattached, seen in faculty practice or the fellows’ clinic, then the fellow either
accepts or rejects the patient depending on bed availability and the case presented.
11. Fellows are responsible for completing the Admission note on weekdays from 7AM-5PM for all the
pulmonary patients and the NP will complete the admission orders. Evenings and overnight (5PM-7AM),
the admission will be done by hospitalist or housestaff. If a hospitalist does the H&P, then the case does
not have to be reviewed with the fellow. If housestaff perform the H&P, then the fellow will get called to
discuss the case and plan.
12. Signout: the fellow covering the Pulm/RCU Unit during the week will provide a written and brief
verbal signout to the on-call fellow. The most important information to include is any acute issues and
bed availability so that the on-call fellow can know how many patients to accept overnight.
13. For patients that remain on housestaff, the fellow is expected to round with the resident and intern
daily to discuss the plan and provide case-based learning.
14. It is the fellows’ responsibility to notify the consult fellow if a patient is transferred to another floor
15. Fellows are responsible for emergencies on all patients in the Pulmonary/RCU unit. During the night,
there will be an NP/PA available, but the on call fellow will be called for acute issues.
16. Fellows will be rounding in the Pulm/RCU Unit on Saturdays & holidays with the attending. The RCU
NP will see the 6 RCU patients. The fellow & attending will divide the remaining 10 Pulmonary patients
(except for the housestaff-covered patients). Usually, the fellow rounding on Saturday is the same fellow
rounding during the week with some exceptions. Rounds should be done by 12 PM, after which the fellow
may leave when all issues are taken care of. Admissions from Friday 5 pm through Monday 7 am will be
done by the hospitalist or housestaff.
OTHER ROTATIONS
1. Required:
Sleep: total of 2 blocks for the fellowship, supervised by Dr. Greenberg
Cardiothoracic ICU: 1 block (at North Shore)
Neurosurgical ICU: 1 block (at North Shore)
Surgical ICU: 1 block (at North Shore)
These will be scheduled in advance by the chief fellows.
2. Other:
PFT’s: 2-4 weeks throughout fellowship. PFT’s are reviewed throughout the week with Dr. Talwar.
Pulmonary rehab lectures are usually given during this rotation. It is expected that the fellow
attend any scheduled CPET’s during this rotation (usually on Fridays) as well as spend time
observing PFTs being performed. There will also be structured learning of PFTs for each class with
Dr. Talwar.
ELECTIVES
1. Fellows on elective will be required to select a rotation from a list of approved electives unless the
fellow will be engaged in structured research.
2. While on elective the fellow will still have on-call responsibilities and attend scheduled clinics as well as
be available to cover other services (MICU, consults, bronch, etc.) as needed. It is imperative that fellows
on elective carry their pagers and respond to pages between 8AM – 5 PM. They can be pulled at any
time to cover fellows from required rotations in the event of illness or unforeseen events.
3. Some elective choices include:
Cardiac Care Unit/EP lab
Radiology (with Dr. Shah/Bacchus/Chusid)
Research
ENT
Allergy/Immunology Clinic (865 Northern Blvd)
Palliative Care
Thoracic Surgery
Ultrasound
Echo
Burn unit (at NUMC)
4. You must inform Jiselle Macdonald at least one month in advance about which elective you are doing
and who you are working with. We need to account for your time for Medicare reimbursement and
payroll purposes. You will be evaluated by the appropriate attending at the end of each elective.
5. If you would like to design your own elective, please see the program director. All electives will be
chosen and preferably scheduled at the beginning of each academic year. Away electives take several
months to be approved and finalize paperwork.
PROCEDURE
1. Procedures performed by the fellow include:
i. Bronchoscopy
ii. EBUS
iii. FEESST
iv. Percutaneous tracheostomy
v. Endotracheal Intubation
vi. Central line placement*
vii. Arterial line placement*
viii. Temporary dialysis catheter placement*
ix.
Thoracentesis*
x.
Chest tube insertion
xi.
Indwelling pleural catheter placement (Pleurx)
xii. Closed pleural biopsy
xiii. Ultrasound guided lung biopsy
xiv.
Cardio-pulmonary exercise testing
2. Procedures marked with * may be performed by residents under supervision. All other procedures are
always performed by the fellow.
3. The procedure fellow will be responsible for all bronchoscopies scheduled for one of our
pulmonologists.
4. It is the responsibility of the fellow to perform all FEESST studies. At NS, they must coordinate these
tests with the speech and swallow therapist and the FEESST attending. They must also coordinate the
tests with the bronchoscopy nurses to assure sufficient scopes are available for all the studies planned for
the day (sheaths are also available if there are multiple FEESST’s scheduled).
5. The fellow will also be available to assist the consult and MICU fellows with all procedures.
6. The fellow is responsible for maintaining a log of all procedures on New Innovations that they perform.
This log must include initials and MR of patient, date, supervising attending, complications and indications
for procedure. Every procedure listed must be logged.
7. ALL procedures MUST be supervised by an attending.
8. The procedure fellows are responsible for logging potential pathology conference cases in the Pulm
Pathology folder on the shared L drive. Each month they will choose cases to be presented at pathology
conference.
CALL-LIJ
1. Call officially begins at 5pm and ends at 7am. Accordingly, weekend call is from 5PM Friday to 7AM
Monday.
2. LIJ Weekend call involves rounding in the MICU followed by rounding on the consult service patients
with the on-call attending, including evaluation of new consults. The patients that need to be seen will be
dictated by the consult team during the week. Patients that are admitted to our service that are not in the
Pulmonary/RCU unit need to be seen daily (e.g., CF patients). The answering service for the faculty
practice is also covered by the on-call fellow the entire weekend.
3. Pulmonary/RCU fellow will round on Saturdays & holidays with the attending, equivalent to a short call.
The RCU NP will see the 6 RCU patients. The fellow & attending will divide the remaining 10 Pulmonary
patients (unless some patients are housestaff-covered). Usually, the fellow rounding on Saturday is the
same fellow rounding during the week with some exceptions. Rounds should be done by 12 PM, after
which the fellow may leave after all issues are taken care of. Although there remains the possibility that
fellows may have to continue covering Saturdays/Holidays during the 2nd half of the year, the
department is working hard to add another NP so that this does not become necessary.
4. Pulmonary consults may be requested during nights and weekends. It is the responsibility of the on-call
fellow to determine if the patient needs to be seen that night or if the consult can wait until morning.
Detailed information needs to be requested in order to make a safe decision. When in doubt it is better
to go in and see new consults. One exception to this rule is consults requested on the obstetric service.
Even if these do not sound like an emergency, they must be seen as soon as possible. The fellow must
discuss all urgent and OB consults with the on-call attending. If a fellow decides that a patient can be seen
in the morning, he/she must discuss this with the on-call attending.
5. Starting July, the on-call fellow will also be responsible for accepting or rejecting patients to the
Pulmonary/RCU Unit. After the ED evaluates a patient with a primary pulmonary issue (e.g., COPD
exacerbation), the fellow will be called. If the patient is unattached or faculty practice, then the fellow
either accepts or rejects depending on bed availability and the case presented. As listed above, the
admission criteria to this unit include primary pulmonary issues, especially COPD exacerbation, but can
also include Asthma exacerbations, ILD, pneumonia, pulmonary HTN, bronchiectasis, etc. CF patients will
not be admitted to the Pulm/RCU unit, but will continue to be admitted to 5 North and will be followed by
the consult fellow and attending (on weekends, will be followed by the on-call fellow rounding in the unit
and on consults). Patients who require 1st time BiPAP for a pulmonary issue can be admitted to the
Pulmonary unit (not for heart failure, not for patients with a private pulmonologist).
6. The on-call fellow is not responsible to complete the admission for patients admitted to the
Pulmonary/RCU unit from 5PM-7AM. These admissions will be done by hospitalist or housestaff. If a
hospitalist does the H&P, then the case will not be reviewed with the fellow overnight. If housestaff
perform the H&P, then the fellow will get called to discuss the case and plan. The on-call fellow must
inform the Pulm/RCU fellow in the morning regarding all patients admitted overnight (whether by
hospitalist or housestaff).
7. For any issue that requires the fellow to return to the hospital, the on-call attending needs to be
notified.
8. Any consultations completed must be presented to the attending over the phone. If necessary the
attending will come in as well.
9. If the fellow spends several hours in the hospital after 12AM, they must contact the chief fellow and
not return to the hospital unless a sufficient rest period has taken place.
10. All non-emergent consults need to be given to the consult fellow early the next morning (or consult
attending at NS during the weekend).
11. Any issues regarding patients of our attendings (faculty practice) that occur while on-call must be
addressed appropriately and then communicated to the concerned attending on the next working day. Email is the preferred method of communication. The subject must include “PHI” as the information being
passed via e-mail is protected health information.
CALL- NS
1. Call at NS officially begins at 5pm and ends at 7am. Accordingly, weekend call is from 5PM Friday to
7AM Monday.
2. NS Weekend call involves rounding in the MICU and seeing MICU consults from 7AM-6PM. The
pulmonary service patients will be seen by the on-call Pulmonary consult/ACCT attending, including any
new pulmonary consults during the day. The fellow will continue to cover the answering service from
5PM-7AM. Pulmonary consults called during this time will be seen by the attending in the morning unless
the consult is emergent and needs to be seen that night. The on-call fellow must inform the attending in
the morning of any consults called overnight.
3. Pulmonary consults may be requested during nights and weekends. Consultations requested during
those hours are usually called through the service. It is the responsibility of the on-call fellow to
determine if the patient needs to be seen that night or if the consult can wait until morning. Detailed
information needs to be requested in order to make a safe decision. When in doubt it is better to go in
and see new consults. One exception to this rule is consults requested by the obstetric service, which
must all be seen as soon as possible. The fellow must discuss all urgent and OB consults with the on-call
attending.
4. For any issue that requires the fellow to return to the hospital, the on-call attending needs to be
notified. Any consultations completed must be presented to the attending over the phone. If necessary
the attending will come in as well.
5. If the fellow spends several hours in the hospital after 12AM, they must contact the chief fellow and
not return to the hospital unless a sufficient rest period has taken place.
6. All non-emergent consults need to be given to the consult fellow early the next morning by 7 AM (or
consult attending at NS during the weekend).
7. Any issues regarding faculty practice patients that occur while on-call must be addressed and then
communicated to the attending the next day via e-mail or phone call. The email subject must include
“PHI” as the information being passed via e-mail is protected health information.
8. If a patient from pulmonary clinic or the faculty practice identifies themselves as one of our patients on
presentation to the ER the pulmonary fellow will be called. The fellow will obtain as much information as
possible from the referring attending and go in to evaluate the patient. If there is any question of
whether the patient needs to be seen after hours this must be discussed with the on call attending.
9. If a patient from the faculty practice is admitted the fellow on call must notify their faculty attending by
8am the latest the next morning, even though the on call attending was notified about the patient. The
same holds true for emergency calls from patients after hours. If any of our patients call the service with a
problem you must let their faculty attending know in the morning by 8am. If the problem is a serious one
you should immediately call the on call attending. Similarly, if a patient calls repeatedly, notify the on call
attending who will decide if the primary faculty attending needs to be called.
CONFERENCES
A detailed conference schedule will be posted on the fellows’ website, but the general conference
schedule is as follows:
Monday:
*8:30 AM – 9:30 AM  Radiology Conference with Dr. Rakesh Shah (1st Floor NS Radiology Dept)
*12:00 PM – 1:00 PM  Ultrasound Conference (Fellows Rm @ NS; Conference Rm @ LIJ on 6th floor)
Tuesday:
8:30 AM – 9:30 AM  Sleep Conference with Dr. Greenberg (Sleep Disorders Center on Community Dr)
*12:00 PM – 1:00 PM  Physiology Conference (Fellows Rm @ NS; Conference Rm @ LIJ on 6th floor)
Wednesday:
7:45 AM – 8:45 AM  Lung Cancer Conference (Monter Cancer Center – Multidisciplinary)
*12:00 PM – 1:00 PM  Case Management Conference (Fellows Rm @ NS; Conference Rm @ LIJ)**
Thursday:
8:00 AM – 9:00 AM  Medicine Grand Rounds (NS – Rusk auditorium; LIJ – Main Conf Rms 2nd floor)
12:00 PM – 1:00 PM  Journal Club or Pathology Conference (notification e-mail will precede conf)
Friday:
8:00 AM – 9:00 AM  Pulmonary, Critical Care, & Sleep Medicine Grand Rounds
* Teleconferenced between NS & LIJ
** Case management conference is presented by the consult fellow at NS & LIJ. Each fellow will present
one case with a maximum of 10 slides on powerpoint. The presentation should not exceed 20 minutes to
allow time for Q&A.
Other conferences: PFTs – small group sessions with Dr. Talwar that will be scheduled by the chiefs
All conferences are mandatory to attend. Only exception to this is if you are the MICU fellow and there is
an on-going emergency that requires your presence in the MICU. If you miss conference for any other
reason, please call one of the chief fellows and let them know. The MICU fellow is exempt from radiology,
sleep and lung cancer conference.
OTHER ISSUES
1. All schedules are final and up-to-date versions are available on the fellows’ website. If you need to
change anything for any reason, please discuss this with your chief fellows. The schedule is
extremely tight and any change potentially affects someone else in the schedule. There are clinics,
lectures, weekends, vacations, etc to cover.
2. When requesting a change in schedule, you must first take a look at the block schedule, clinic
schedule, and pulmonary rehab schedule to make sure that you are not scheduled for any of these
mandatory assignments prior to making a change. A schedule change request form will need to be
completed and signed by the Program Director.
3. All fellows work as a team and are here to help each other out. If there are any issues, please always
feel free to discuss the matter with the chief fellow and / or the program director as needed.
Welcome to our team!