3. Medical Direction

1. General. The medical direction of University of Arkansas for Medical Sciences Medical Center is governed by the bylaws of the University Medical and Dental Staff which have been approved by the University of Arkansas Board of Trustees (Medical staff Bylaws/Rules and Regulations MS 2). The word "staff" includes all physicians, dentists, consulting scientists and affiliate staff who are privileged to write orders, to admit or assist in the admission and/or treatment of patients in the University of Arkansas for Medical Sciences Medical Center.  A database describing each individual Physician's Privileges is maintained in the Physician Professional Services Office and is available during non-business hours by contacting the ADON on duty.

1. The staff physicians are responsible for residents, interns, and medical students who rotate through their respective areas.
2. Medical fellows, residents, and interns are post-graduate students in the College of Medicine who are licensed to practice medicine, but do not hold faculty rank. They may write orders and be designated by their Department Chairman to participate with medical students’ practical learning experiences.
3. It is not uncommon for upper class residents to be preceptors to interns and/or medical students. Medical students are graduate students in the College of Medicine who are not licensed to practice medicine. They may write or electronically enter Doctor’s orders. However, prior to implementation, their orders must be co-signed on the paper medical record or suspended on the electronic record until review by a licensed physician occurs. Refer to Questions Regarding Medical Orders/Care Addendum M.1 for questions regarding medical orders/care.

2. Consultants. It is the duty of the Hospital Medical Staff to request consultation as needed. Physician consultation must be obtained by physician order from a patient’s primary service physician. The employee transcribing this order is responsible for notifying the consulting service that this order has been written. Transcription of a consultation order also includes placing a consultation sheet (Med. Rec. #75) in the patient’s medical record. Consultation orders which are written after hours or on weekends or holidays are processed through a service-defined mechanism. Physician orders for consultation on Patient Care Units are communicated to the appropriate department by nursing personnel.

Nursing consultations may be requested by nurses or physicians. Nursing consultants document care given and recommendations.

3. Attending Physicians. The attending physician is the person responsible for the admission and discharge of a patient on a clinical service. At University of Arkansas for Medical Sciences Medical Center, the attending physician is the staff physician assigned to the clinical area. He/she may delegate the duty of admitting the patient to residents and medical students. It remains, however, the attending physician’s responsibility to follow up on the care of the patient. He/she must visit the patient and review the medical record at least once every 24 hours. The attending physician has a responsibility to see that orders and other documentation (histories and physicals) are in compliance with the Rules and Regulations of the Medical and Dental Staff bylaws and are complete.

The attending physician should be available to the nursing staff to help solve clinical problems and share expertise. At University of Arkansas for Medical Sciences Medical Center, an attending physician is on 24-hour call. Physician call schedules are available on the patient care units and clinics. These lists include the mechanism for reaching the physician in an emergency. Clinical areas are notified when changes in the call schedule occur.

Physician On-Call Hospital Policy

4. Collaboration. To facilitate the functions of the patient care areas, Directors and Clinical Services Managers meet as necessary with Medical Department Service Chiefs, Staff Physicians and House Staff. These meetings provide the opportunity to apprise one another of decisions and/or problems that might affect patient care. The Chiefs of Service or their designees are involved in the development of written unit standards and in the selection process for Clinical Services Manager positions on their respective services. Chain of Command Policy

New physician staff are introduced to the physical environment, philosophy and mode of nursing practice through orientation occurring at the beginning of their tenure. To promote collaboration, each patient care area has an identified mechanism so that physicians may readily identify the nurse caring for their patients. Information is shared and interdependent patient care issues are discussed at the time of the doctor-patient visit.

The PNO collaborates closely with the UAMS College of Nursing to provide optimal learning experiences for their students and to encourage the educational process within the department. Further collaboration occurs through mutual participation on governance councils, joint appointments to faculty/staff positions, faculty/nursing management council meetings.

H.11  Students from UAMS College of Nursing Having Learning Experiences in University Hospital