When should Supervising Prescriber be changed for Inpatients?

Question: When is it most important for trainees to manually set/confirm their Supervising (Authorizing) Prescriber in inpatient settings?

Context: Trainees (medical students and residents) select a "Supervising Prescriber" when logging on to Connect Care, as previously posted. Usually this is straightforward. There will be an attending or most responsible physician for the inpatient ward or the inpatient consultation service that the trainee is assigned to on a given day. However, there are also situations where a trainee is responsible for a particular inpatient ward and that ward has patients assigned to multiple attending physicians. It can be inconvenient to interrupt workflows to switch supervising providers when rounding on patients.

Answer: In can help to be aware of the intent and impact of a supervision relationship. While professional regulations require trainees to document and order under a licensed physician, in some cases this can be inferred and there is less functional impact to changing supervisors in Connect Care. However, in other cases it is essential to explicitly identify the supervising provider, as this determines how results and reports are delivered:

Note: selection of a Supervising Provider ceased to be part of trainee logons as of December 8, 2020. Please see the Manual for information about how this workflow is largely automated. The rest of this posting still applies.

• Inpatient Consults: when a trainee is serving on an inpatient consultation service and helps with a consult in the emergency room, it may be appropriate to select an authorizing prescriber other than the system default (attending prescriber). When working in ER on behalf of an inpatient consultation services, some ordered tests may be more appropriate for the consulting prescriber to follow.

• Inpatient Ward: inpatients may be on a ward where there are patients admitted under different attending physicians. Inpatient laboratory results are not routed to In-Baskets unless the result is delayed until after the patient is discharged. Even then, they route to the inbox of the attending physician at the time of discharge. Critical results get called to the responsible provider, who will be the selected Supervising Provider. Accordingly, if a trainee elects to do ward rounds under a single Supervising Provider (e.g., the provider on call to cover that ward at night), know that the Supervising Provider will get called for critical results and be sure that is acceptable to the service that the trainee is working on. Of course, the best practice is to follow instructions for quickly changing Supervising Provider when moving to a patient with a different attending.
• Manual: Trainee Prescriber Roles
• Tip: Changing an Authorizing Prescriber
• Crib-Sheet: Multi-Supervisor Scenarios