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Appendix D Glossary, Acronyms, and Abbreviations GLOSSARY Actigraphy: A relatively non-invasive method of monitoring human rest and activity cycles. A small actigraph unit (often in a form similar to a wrist-watch), is worn by someone to continually measure motor activity. The data are later transmitted to a computer where it can be analyzed. Ad libitum: The means of performing an activity, such as sleep, at one’s own discretion. Adaptability: In teamwork, an ability to adjust strategies based on informa- tion gathered from the environment through the use of backup behavior and reallocation of intrateam resources. Altering a course of action or team repertoire in response to changing conditions (internal or external).1 Adverse Event: An unintended physical injury resulting from or contrib- uted to by medical care rather than the underlying condition of the patient, that requires additional monitoring, treatment, or hospitalization or results in death. Not all adverse events are caused by errors.2 Attending physician: A physician who has completed his or her medical residency and is fully licensed to practice medicine independently. Attending physicians serve as supervisors to residents as they complete their training and bear responsibility for the clinical work of residents that are assigned to their team. Backup behavior: Ability to anticipate other team members’ needs through accurate knowledge of their responsibilities. This includes the ability to 

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4 RESIDENT DUTY HOURS shift workload among members to achieve balance during high periods of workload or pressure.1 Burnout: A state of exhaustion or extreme fatigue accompanied by three common symptoms: (1) emotional exhaustion—depleted energy from over- whelming work demands, (2) depersonalization—personal detachment from one’s job or surroundings, and (3) lack of personal accomplishment due to self-perceptions of inefficiency. Competencies: Specific knowledge, skills, behaviors, and attitudes and the appropriate educational experiences required of residents to complete graduate medical education (GME) programs.3 Cross-coverage: The availability of other residents to care for admitted patients when the resident who has had primary responsibility for these patients’ care is not on duty. Didactic: A kind of systematic instruction by means of planned learning experiences, such as conferences or grand rounds.3 Duty hours: Applied to medical residents, this means all time spent in clinical and academic activities related to the program, that is: patient care (both inpatient and outpatient), administrative duties relative to patient care, provision for transfer of patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.3 Extended duty period: Also known as “long call,” refers to the 30-hour (24 + 6) maximum continuous duty period allowed under the 2003 Accredita- tion Council for Graduate Medical Education (ACGME) limits. Float (day or night): A shift of residents that are not assigned to a single service but “float” across services or teams to help with admissions and follow-up. Handover: The transfer of physician responsibility for a patient’s care along with the transfer of patient information from one healthcare pro- vider to another. Also, commonly referred to as a “handoff,” “transfer,” or “sign-out.” Health care safety net: Those providers that organize and deliver a signifi- cant level of health care and other related services to uninsured, Medicaid, and other vulnerable patients.4 Long call: Also known as “extended duty period,” refers to the 30-hour (24 + 6) maximum continuous duty period allowed under the 2003 ACGME limits.

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 APPENDIX D Midlevel provider: A term used to categorize clinicians such as nurse prac- titioners (NPs) and physician assistants (PAs). Midlevel providers are often referred to as physician extenders. Mutual performance monitoring: The ability to develop common under- standings of the team environment and apply appropriate task strategies to accurately monitor teammate performance.1 On call: Duty hours beyond the normal workday when residents are re- quired to be immediately available in the assigned institution. Also referred to as in-house call.3 Percutaneous injuries: Injuries that penetrate the skin (e.g., needlesticks, cuts). Physician extender: A term used to categorize clinicians such as nurse practitioners (NPs) and physician assistants (PAs). Physician extenders are often referred to as midlevel providers. Preventable Adverse Event: An adverse event attributable to error.2 Resident: Any physician enrolled in a GME program. A resident has received a medical degree and practices medicine under the supervision of fully licensed physicians, in an accredited graduate medical education hospital or clinic, as a physician in training. These trainees are often referred to by their training year, PGY-1 being a first year resident (also know as postgraduate year one, or an intern), PGY-2 a second year resident, and so forth through PGY-6. Shift: A scheduled period of work, whether during the day, evening, or night. Task-tailored substitute: The lowest-qualified-level personnel to whom non-educational patient care responsibilities can be transferred. Team: A distinguishable set of two or more people with specific roles and boundaries interacting toward a common goal on tasks that are interdepen- dent and are completed within a larger organizational context.5 Team leadership: Ability to direct and coordinate the activities of other team members; assess team performance; assign tasks; develop team knowl- edge, skills, and abilities; motivate team members; plan and organize; and establish a positive working atmosphere.1 Team orientation: Propensity to take other’s behavior into account dur- ing group interaction and belief in the importance of the team’s goals over individual members’ goals.1

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 RESIDENT DUTY HOURS Teamwork: Set of interrelated behaviors, cognitions (thoughts), and atti- tudes (feelings) held by each team member that combine to facilitate adap- tive, coordinated performance.6 NOTES 1Salas, E., D. E. Sims, and C. S. Burke. 2005. Is there a “big five” in teamwork? Small Group Research 36(5):555-599. 2IOM (Institute of Medicine). 2000. To err is human: Building a safer health system. Washington, DC: National Academy Press. 3ACGME. 2008. Glossary of terms. http://www.acgme.org/acWebsite/about/ ab_ACGMEglossary.pdf (accessed November 7, 2008). 4IOM. 2000. America’s health care safety net: Intact but endangered. Washington, DC: National Academy Press. 5Kozlowski, S. W. J., and B. S. Bell. 2003. Work groups and teams in organizations. In Handbook of psychology: Industrial and organizational psychology. Vol. 12, edited by W. Borman, D. Igen, and R. Klimoski. London: Wiley. Pp. 333-375. 6Salas, E., E. Sims, and C. Klein. 2004. Cooperation and teamwork at work. In Encyclopedia of applied psychology. Vol. 1, edited by C. D. Spielberger. San Diego, CA: Academic Press. Pp. 497-505.

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 APPENDIX D ACRONYMS AND ABBREVIATIONS ACRONYMS AAMC Association of American Medical Colleges ABIM American Board of Internal Medicine ABMS American Board of Medical Specialties ABNS American Board of Neurological Surgery ABSITE American Board of Surgery In-Training Examination ACGME Accreditation Council for Graduate Medical Education ACS American College of Surgeons AE adverse event AHRQ Agency for Healthcare Research and Quality ALOS average length of stay AMA American Medical Association AMI acute myocardial infarction ANSR Americans for Nursing Shortage Relief APDIM Association of Program Directors in Internal Medicine AY academic year BLS Bureau of Labor Statistics CFPC College of Family Physicians of Canada CHGME Children’s Hospital Graduate Medical Education (program) CIR Committee of Interns and Residents CMI case mix index CMS Centers for Medicare and Medicaid Services COGME Council on Graduate Medical Education COTH Council of Teaching Hospitals and Health Systems DGME direct graduate medical education (payment) DO doctor of osteopathic medicine DOD U.S. Department of Defense DSH disproportionate share hospital (payment) ED emergency department EM emergency medicine EOG electro-oculography EU European Union EWTD European Working Time Directive

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 RESIDENT DUTY HOURS FAA Federal Aviation Administration FMCSA Federal Motor Carrier Safety Administration FRA Federal Railroad Administration FTE full-time equivalent GME graduate medical education HCUP Healthcare Cost and Utilization Project HCUP NIS Healthcare Cost and Utilization Project Nationwide Inpatient Sample HHS U.S. Department of Health and Human Services HIPAA Health Insurance Portability and Accountability Act HOS hours of service HRO high-reliability organization HRSA Health Resources and Services Administration ICU intensive care unit IHI Institute for Healthcare Improvement IM internal medicine IME indirect medical education (payment) IOM Institute of Medicine IPPS Inpatient Prospective Payment System (Medicare) IPRO the designated quality improvement organization for New York, Medicaid and Medicare review, and other tasks (originally the Island Peer Review Organization) IV intravenous JC Joint Commission (formerly JCAHO) LOS length of stay MBI Maslach Burnout Inventory MD doctor of medicine MEDPAR Medicare Provider Analysis and Review File NHS National Health Service (United Kingdom) NICU neonatal intensive care unit NIS Nationwide Inpatient Sample (HCUP) NZRDA New Zealand Resident Doctors Association OB/GYN obstetrics-gynecology OJT on-the-job training OSHA Occupational Safety and Health Administration

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 APPENDIX D PAE preventable adverse event PGY postgraduate year PGY-1, PGY-2 postgraduate year 1, postgraduate year 2 of medical residency PICU pediatric intensive care unit PIF program information form RCA root-cause analysis RCPSC Royal College of Physicians and Surgeons of Canada RRC Resident Review Committee SEIU Service Employees International Union TEMIS Trauma and Emergency Medicine Information System U.K. United Kingdom U.S. United States USMLE U.S. Medical Licensing Exam VA U.S. Department of Veterans Affairs ABBREVIATIONS CI confidence interval g grams mL milliliters mph miles per hour ms milliseconds OR odds ratio

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