Substantial Disruptions in Patient Care and Education Policy
1. Scope
All residents and fellows participating in University of Washington School of Medicine (UWSOM) graduate medical education (GME) training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), Commission on Dental Accreditation (CODA), and Fellows Non-ACGME in non-ACGME accredited clinical training programs. Residents, Fellows and Fellow Non-ACGME in these programs are hereafter referred to as “residents”.
2. Purpose
Outlines institutional responsibilities to addresses support of programs and trainees in the event of a disaster or other substantial disruption in patient care or education. Includes communications, trainee support, continuity of patient care, and ongoing management of administrative functions.
3. Policy
The Sponsoring Institution must maintain a policy consistent with ACGME Policies and Procedures that addresses support for each of its ACGME-accredited programs and residents/fellows in the event of a disaster or other substantial disruption in patient care or education (ACGME Institutional Requirements (IR) 4.14).
There are various types of natural or man-made disasters that disrupt patient care and clinical education. These may include:
- acute disaster with little or no warning (e.g., earthquake or bombing)
- intermediate disaster with some lead-time and warning (e.g., temporary closure of training site)
- social and economic disruption or disaster (e.g., pandemic flu)
This policy addresses disaster and disruption in the broadest terms. Types of communication and response plans may vary depending on the type of disaster and the necessary responses to support continuation of resident well-being, education, patient care, and administrative functions.
The ACGME may invoke the Policy and Procedures to Address Extraordinary Circumstances (ACGME Policies and Procedures Section 23.00) in response to circumstances that significantly alter the ability of a sponsor and its programs to support resident education. This includes program reconfigurations, changes to program complement, and temporary resident transfers.
4. Procedures
A. Resident Support
In the event of a substantial disruption to patient care and education, initial confirmation of resident safety and ongoing support of resident education and wellbeing are of paramount importance to UWSOM and UW GME training programs. Support of residents includes:
- Communications from GME: The GME Office has established a GME Disaster Response Communication Protocol to inform and notify GME administration, program directors, and program administrators of the status of UW residents in the event of an acute disaster. Communication methods may include but are not limited to office phone, cell phone, text messages, emails, Zoom, and / or Microsoft Teams.
- Temporary reassignment of clinical and education sites: In the event of a temporary closure of a training site, the GME Office will work with affected programs to reassign residents to other training sites during the period of closure in order to maintain continuity of educational activities.
- Supervision: Ensuring compliance with existing supervision policies unless exceptions are allowed as directed by the ACGME.
- GME Wellness Service: GME Wellness Service counselors will increase access for counseling visits (e.g., via Zoom), and other support services.
- Clinical and Educational Work Hours Compliance: Residents must remain in compliance with clinical and educational work hours during periods of disaster response and recovery and continue to report their work hours in MedHub during this time.
B. Campus Communications
UW has developed UW Alert to disseminate official information via email, text messages, Facebook, Twitter, the UW Alert Blog, and other means to keep the campus community informed during emergencies and situations that might disrupt normal operations. UW Alert is available to all UW faculty, staff, and students in Bothell, Seattle, Tacoma and at UW Medicine.
5. Continuity of Patient Care
Residents are considered essential personnel. In the event of an acute disaster, or other substantial disruption in patient care or education, residents may be required to report for duty or be available by pager or cell phone. During periods of an extended disruption or disaster, residents may be reassigned to other training sites, services, or patient care areas to support areas of greatest need.
A. University of Washington Policy on Suspended Operations
The President or their designee(s) may declare a temporary suspension of any or all University operations due to an emergency situation that adversely affects University operations, public health, or the well-being and safety of employees and students. However, organizations providing essential services including University Medical Centers, University Libraries, Physical Plant, Residence Halls, and University Police normally will be excluded from any temporary suspension decision.
B. Workforce Allocation During Disaster Response
The Hospital Incident Command System (HICS) will be the organizational structure for disaster response at each of the training sites. All residents assigned to a specific training site are responsible to the respective Incident Commander and/or Medical Care Branch Director at that site as specified in the HICS chart designation. A representative from the GME Office will serve as a member of the UW Medicine ICS team, and will be responsible for cascading workforce allocation planning to GME directors, administrators, and residents.
The Incident Commander and/or Medical Care Branch Director of the HICS will determine as necessary faculty and resident reassignment or redistribution to areas of need, superseding departmental plans for workforce management. Information on the location, status, and availability of residents during disaster response and recovery will be provided by the DIO or designee in coordination with GME administration, program directors and/or chief residents.
6. Administrative Functions
A. Resident Contact Information Updates
Residents will maintain current contact information in the MedHub Residency Management System and in Workday. This information must be updated within 2 weeks of a new resident’s appointment start date and kept up to date as contact information changes.
B. Salary & Benefits
Residents will continue to receive salary/stipends and benefits during any disaster response and recovery period, and/or accumulate salary and benefits until such time as utility restoration allows for fund transfer.
C. Professional Liability Coverage for Volunteer Activities
UW professional liability coverage will be provided to residents acting as volunteers for UWMC-ML, UWMC-NW, HMC, SCH, VA and/or other training sites in the event of a disaster. Adverse events involving patient care must be reported to Health Sciences Risk Management no matter where the volunteer service is rendered.
D. Resident Clinical Assignment Reporting in MedHub
Program administrators will enter resident schedules in MedHub based on resident activity and assignment during disaster response and recovery efforts. Guidelines for entering schedules to account for alternate worksite assignments will be provided by the GME Office. Master rotation schedules will also be used as reference for assessing programs accounting of resident activity during disaster response and recovery.
E. CMS Emergency GME Regulations
The Centers for Medicare and Medicaid Services (CMS) has special rules for emergency Medicare GME affiliation agreements and related GME payments during a disaster. The rule is explained in the Federal Register Vol 43, No. 161, August 19, 2008, pages 48637 – 48650.