LINES OF RESPONSIBILITY FOR PATIENT CARE

A. Ambulatory setting: The trainee in Clinical Cardiac Electrophysiology will have an arrhythmia clinic 1/2 day per week, supervised by a faculty electrophysiologist. On these occasions, the trainee will independently obtain the appropriate history, perform the appropriate physical examination, interpret the ECG's and other pertinent tests, and formulate both an assessment and a plan. The trainee will dictate a record of the office visit, and discuss the cases with the supervising faculty electrophysiologist assigned to the ambulatory setting for that half-day. Some of the outpatients in this clinic are there in preparation for an electrophysiologic procedure (for example permanent pacemaker insertion or radiofrequency catheter ablation). The trainee will carefully discuss the risks and benefits of the procedure with the patient, obtain informed consent, and fill out the appropriate paperwork for the same day admission including preoperative orders. If at all possible, patients who see the trainee in the ambulatory setting will return to the trainee in follow-up, to provide continuity of care and experience in the longitudinal follow-up of the cardiac electrophysiology patient.

B. Electrophysiology Laboratory: The trainee will write pre-operative and post-operative orders on all patients having invasive procedures or operations in the electrophysiology laboratory. In addition, the trainee will prepare the report of the procedure or the operative note. The trainee is the prime operator on all of these cases, supervised by the faculty electrophysiologist assigned to the electrophysiology laboratory that week.

C. General medical floors and acute care units: Some of the patients in these settings will be from the clinical electrophysiology service (with a faculty electrophysiologist as an attending physician), and some will be patients with non-electrophysiology attendings who have requested a consultation from a clinical electrophysiologist. The trainee in Clinical Cardiac Electrophysiology will follow to hospital discharge those patients who require invasive diagnostic or therapeutic procedures, and will also follow a proportion of the remaining patients depending on the workload in the electrophysiology laboratory. Since these patients are cared for by Internal Medicine residents, the trainee in Clinical Cardiac Electrophysiology will defer order-writing to the Internal Medicine residents, excepting pre-operative and post-operative orders in patients coming to the electrophysiologic laboratory. However, the fellow in Clinical Cardiac Electrophysiology will write progress notes on these patients, and will communicate with the Internal Medicine residents directly if an urgent change in therapy is indicated requiring prompt order writing. These activities are supervised by the faculty electrophysiologist assigned to the electrophysiology service for the week, who is not the same faculty member assigned to the electrophysiology laboratory.