TABLE OF CONTENTS



TABLE OF CONTENTS

1. Departmental Overview

1. Purpose and use of manual

2. Mission Statement

3. Philosophy and Objectives

4. Organizational Chart

5. Scope of care and services

6. Standards of Care

2. Personnel

1. Job Descriptions

2. Orientation Plan

3. Recruitment/Selection

4. Performance Assessment

3. Administrative

1. Administrative Meetings

2. Operations

1. Equipment

2. Medical Gases

3. Electrical Safety

4. Supplies and Equipment

4. Education

1. Non-Employee Training Guidelines

1. Rotations

2. Medical students

3. Internships

4. Fellowships

5. Residencies

6. Guidelines for research

5.0 UTMB Policies and Procedures

5.1 Promotion/Reclassification

5.2 Appeal/Grievance

5.3 Corrective/Disciplinary Action

5.4 Employee Scheduling

5.5 Times and Attendance

5.6 Safety

5.7 Security

5.8 Employee Breaks

5.9 Smoking

5.10 TDCJ Guidelines

5.11 Quality Management Program

5.12 Conscious Sedation

5.13 Universal Precautions

5.14 Emergency Operations

5.15 Epidemiology Policies

1.0 DEPARTMENTAL OVERVIEW

1.1 PURPOSES AND USE OF THIS MANUAL

It is the purpose of this manual to set forth the minimum requirements for safe, modern, and ethical provision of anesthesia, whether it be for diagnostic, therapeutic, invasive, or surgical procedures.

2. MISSION STATEMENT

The mission of the Anesthesiology Department at the University of Texas Medical Branch at Galveston is to ensure accessible, comprehensive, high-quality anesthesiology services in a safe and supportive environment, while simultaneously promoting excellence in research and education.

Specifically, the Anesthesiology Department is dedicated to:

➢ Providing state-of-the-art anesthesiology and critical care services to all patients who are eligible to receive them.

➢ Providing premier educational and research programs in conjunction with our affiliated institutions.

➢ Serving as a major tertiary referral center for anesthesiology and critical care services.

3. PHILOSOPHY AND OBJECTIVES

1. Anesthesiology is a discipline within the practice of medicine specializing in the medical management of patients who are rendered unconscious and/or insensible to pain and emotional stress during surgical, obstetrical, and certain other medical procedures. The practice of Anesthesiology includes preoperative, intraoperative, and postoperative evaluation and treatment of these patients. This includes the protection of life functions and vital organs (e.g., brain, heart, lung, kidney, liver) under the stress of these same procedures.

2. A competent anesthesiologist is a physician from whom one can expect:

➢ Medical Judgment – availability of mature medical decision making applicable to solutions of medical problems associated with patient care as related to the practice of the specialty;

➢ Technical Ability – facility in providing all technical services likely to be required in the practice of the specialty;

➢ Scholarship – the talent, training, and habits of study necessary for evaluating and appropriately applying knowledge;

1.4 ORGANIZATION CHART

Organizational Chart

Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas

1.5 SCOPE OF CARE FOR ANESTHESIOLOGY DEPARTMENT

The scope of care in the Anesthesiology Department is the preoperative evaluation, intraoperative management, and postoperative recovery of patients undergoing anesthesia and surgery. Additionally, the Anesthesiology Department maintains a major role in the direction of the Surgical Intensive Care Unit (SICU) and Ambulatory Surgery Services. The department also operates a Pain Management Clinic, provides anesthesia and analgesia for obstetrical patients, and serves as a consultant in airway management. The department advises UTMB on the provision of moderate sedation at various locations throughout its hospitals.

1.6 STANDARDS OF CARE

The following standards apply to all anesthesia care although, in emergency situations, appropriate life support measures take precedence. These standards may be exceeded at any time based on the judgment of the responsible anesthesiologist. They are intended to encourage high quality patient care, but observing them cannot guarantee any specific patient outcome. They are subject to revision from time to time, as warranted by ongoing developments in practice and technology.

1. Pre-operative Testing

Preanesthetic laboratory and diagnostic testing are often essential; however, no routine laboratory or screening test is necessary for the preanesthetic evaluation of patients. Appropriate indications for ordering tests includes the identification of specific clinical indicators or risk factors (e.g., age, pre-existing disease, surgical procedure). Individual surgeons and anesthesiologists should order test(s) when, in their judgment, the results may influence decisions regarding risks and management of the anesthesia and surgery.

2. Basic Standards for Preanesthesia Care

1. An anesthesiologist shall be responsible for determining the medical status of the patient, developing a plan of anesthesia care, and acquainting the patient or responsible adult with the proposed plan.

2. The development of an appropriate plan of anesthesia care is based upon:

a. Reviewing the medical record.

b. Interviewing and examining the patient to:

i. Discuss the medical history, previous anesthetic experience and drug therapy.

ii. Assess those aspects of the physical condition and concurrent health problems, which might affect decisions regarding perioperative risk and management.

c. Obtaining and/or reviewing tests and consultations necessary to the conduct of anesthesia.

d. Determining the appropriate prescription of perioperative medications necessary to the conduct of anesthesia.

e. Discuss with each patient the appropriate anesthesia options and risks.

The responsible anesthesiologist shall verify that the above has been properly performed and documented in the patient’s record.

1.6.3 STANDARDS FOR BASIC ANESTHETIC MONITORING

1. Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics, and monitored anesthesia care.

a. Patient status can change rapidly during anesthesia and necessitates the need for continuous monitoring of the patient. In the event there is a direct known hazard, e.g., radiation, to the anesthesia personnel, which might require intermittent remote observation of the patient, some provision for monitoring the patient must be made. In the event that an emergency requires the temporary absence of the person primarily responsible for the anesthetic, the best judgment of the anesthesiologist will be exercised in comparing the emergency with the anesthetized patient’s condition and in the selection of the person left for the anesthetic during the temporary absence.

2. During all anesthetics, the patient’s oxygenation, ventilation, circulation, and temperature shall be continually evaluated.

3.

a. Oxygenation

➢ Inspired gas: During every administration of general anesthesia, the concentration of oxygen in the patient breathing system shall be measured by an oxygen analyzer with low oxygen concentration limit alarm in use.

➢ Blood Oxygenation: During all anesthetics a quantitative method of assessing oxygenation such as pulse oximetry shall be employed.

b. Ventilation

➢ Every patient receiving a general anesthetic shall have the adequacy of ventilation continually evaluated. While qualitative clinical signs such as auscultation of breath sounds, observation of the reservoir breathing bag and chest excursions may be adequate, quantitative monitoring of the CO2 content and/or volume of expired gas is encouraged.

➢ When an endotracheal tube is inserted, its presence in the trachea must be confirmed by clinical assessment and by identification of carbon dioxide in the expired gas. Continual end-tidal carbon dioxide analysis, in use from the time of endotracheal tube placement, until extubation or initiating transfer to a postoperative care location, shall be performed using a quantitative method such as capnography, capnometry, or mass spectroscopy.

➢ When ventilation is controlled by a mechanical ventilator, there shall be continuous use of a device that is capable of detecting disconnection of components of the breathing system. The device must give an audible signal when its alarm threshold is exceeded.

➢ During regional anesthesia and monitored anesthesia care, the adequacy of ventilation shall be evaluated, at least, by continual observation of qualitative clinical signs.

c. Circulation

➢ Every patient receiving anesthesia shall have the electrocardiogram continuously displayed from the beginning of anesthesia until preparing to depart the anesthetizing location.

➢ Every patient receiving anesthesia shall have arterial blood pressure and heart rate determined and evaluated at a minimum of every five minutes.

➢ Every patient receiving general anesthesia shall have, in addition to the above, circulatory function continually evaluated by at least one of the following: palpation of the pulse, auscultation of heart sounds, monitoring of intra-arterial pressure, ultrasound peripheral pulse monitoring, or pulse plethysmography or oximetry.

d. Body Temperature

➢ There shall be a readily available means to continuously measure the patient’s temperature. When changes in body temperature are intended, anticipated or suspected, the temperature shall be measured.

e. Anesthesia for Electroconvulsive Therapy (ECT)

In accordance with the Texas Administrative Code (TAC), Title 25, Part II, Chapter 405E, in addition to routine anesthetic monitoring as described in 1.6.3, all patients for ECT shall have a serum pseudocholinesterase level documented if there is no record of previous testing or no documentation of prior successful use of muscle relaxants (succinylcholine).

1.6.4 BASIC STANDARDS FOR POST ANESTHESIA CARE

1. All patients who receive general or regional anesthesia, or monitored anesthesia care shall receive appropriate post anesthesia management.

a. A Post anesthesia Care Unit (PACU) or an area, which provides equivalent postanesthesia care, shall be available to receive patients after surgery and anesthesia. All patients who receive anesthesia will be admitted to the PACU except by specific order of the anesthesiologist responsible for the patient’s care.

b. The medical aspects of care in the PACU shall be governed by policies and procedures, which have been reviewed and approved by the Department of Anesthesiology.

c. The design, equipment and staffing of the PACU shall meet requirements of the facility’s accrediting and licensing bodies.

d. The nursing standards of practice shall be consistent with those approved by the American Society of Post Anesthesia Nurses (ASPAN).

2. A patient transported to the PACU shall be accompanied by a member of the anesthesia care team who is knowledgeable about the patient’s condition. The patient shall be continually evaluated and treated during transport with monitoring and support appropriate to the patient’s condition.

3. Upon arrival in the PACU, the patient shall be re-evaluated and a verbal report provided to the responsible PACU nurse by the member of the anesthesia care team who accompanied the patient.

a. The patient’s status on arrival in the PACU shall be documented.

b. Information concerning the preoperative condition and the surgical/anesthetic course shall be transmitted to the PACU nurse.

c. The member of the anesthesia care team will remain in the PACU until the PACU nurse accepts responsibility for the nursing care of the patient.

4. The patient’s condition shall be evaluated continually in the PACU.

a. The patient shall be observed and monitored by methods appropriate to the patient’s medical condition. Particular attention should be given to monitoring oxygenation, ventilation, circulation, and temperature. Pulse oximetry shall be employed in the initial phase of recovery.

b. An accurate written report of the PACU period shall be maintained. Use of an appropriate PACU scoring system is encouraged for each patient on admission, at appropriate intervals prior to discharge, and at the time of discharge.

c. General medical supervision and coordination of patient care in the PACU shall be the responsibility of the anesthesiologist in charge of the daily schedule in consultation with the faculty anesthesiologist who supervised the anesthetic.

d. There shall be a policy to assure the availability in the facility of a physician capable of managing complications and providing cardio-pulmonary resuscitation for patients in the PACU.

5. A physician is responsible for the discharge of the patient from the post anesthesia care unit.

a. When discharge criteria are used they must be approved by the Department of Anesthesiology and the medical staff. They may vary depending upon whether the patient is discharged to a hospital room, to an intensive care unit (ICU), or home.

b. In the absence of a physician responsible for the discharge, the PACU nurse shall determine that the patient meets the discharge criteria. The name of the physician accepting responsibility for the discharge shall be noted on the record.

1.6.5 INFORMED CONSENT

1. As a general rule, patient consent must be obtained prior to the performance of any anesthetic or the administration of blood products. Informed consent should include:

➢ The general nature of the contemplated anesthetic.

➢ Discussion of anesthetic options available for the patient.

➢ The benefits, risks, discomforts, and potential complications related to the anesthetic that may be reasonably expected.

➢ Signature of the patient or the person authorized to sign on the patient’s behalf, the signature of the practitioner who obtains the consent, and the signature of the person witnessing the consent.

2. Cross reference IHOP 9.3.17 for complete overview of informed consent policies and application in special or unusual circumstances.

0. PERSONNEL

1. JOB DESCRIPTIONS

1. DEPARTMENT CHAIR

1. Primary Function

The Chair of the Department of Anesthesiology will be selected and appointed by the Dean of Medical School in accordance with the Bylaws of the Medical Staff. The Chair’s responsibilities shall include, but are not necessarily limited to:

a. Integration of the Department into the primary function of the hospital

b. Recommendation privileges for all individuals with primary anesthesia responsibility. These privileges shall be processed through established medical staff channels.

c. Recommending the availability of a sufficient number of qualified personnel to provide the services needed for the daily surgical schedule and 24-hour, 7-day-a-week availability of anesthesia care.

d. Recommending the amount of space and other resources needed by the department.

e. Continuing evaluation of the professional performance of all individuals who have delineated clinical privileges in the department.

f. Recommending to the administration and medical staff the type and amount of equipment necessary for administering anesthesia and related resuscitative efforts, ensuring through at least annual review that such equipment is available.

g. Development of regulations concerning anesthetic safety.

h. Ensuring that important internal processes and activities (those that most affect patient outcomes) throughout the organization are systematically assessed and improved.

i. Participation in the development of policies relating to the functioning of anesthetists and administration of anesthesia in various departments or services of the hospital, including participating in the hospital’s program of cardiopulmonary resuscitation.

2. Specific Duties

a. Reporting as required to the Credentials Committee, Quality Improvement committee, Safety Committee, Infection Control Committee, and Operating Room Committee.

b. Establishing quality standards for the anesthesia department.

c. Specific duties as provided in the Bylaws.

In the absence of the Chair, the Vice-Chair for Clinical Affairs shall assume all the responsibilities of the Chair as provided by the Bylaws

2. PHYSICIAN ANESTHESIOLOGISTS

Staffing for the delivery of anesthesia care shall be related to the scope and complexity of the services offered. Anesthesia care shall be provided by anesthesiologists or supervised trainees in an approved educational program. A qualified anesthesiologist shall be available to provide anesthesia care for patients whenever it is required in the hospital. Except for specific emergency situations, the administration of anesthesia shall be limited to areas where it can be given safely, in accordance with the policies and procedures of the Anesthesiology Department.

1. Primary Function

a. Perform accepted procedures commonly used to render patients insensible to pain during the performance of surgical, obstetrical, and other pain-producing clinical maneuvers, and to relieve pain-associated medical syndromes.

b. Support life functions during the period in which anesthesia is administered

c. Provide consultation relating to various other forms of patient care, such as respiratory therapy and problems in pain relief.

2. Specific Duties

a. Preoperative evaluation and reasonable explanation to the patient of the proposed anesthetic procedure.

b. Pre-medication of the patient if needed.

c. Administration of anesthesia to the patient on the basis of the ASA standards and guidelines: i.e., the anesthesiologist will be personally responsible for the conduct of the selected anesthetic and will be immediately available at all times to fulfill this responsibility.

d. Will make a documented postoperative visit or visits as indicated.

3. CERTIFIED REGISTERED NURSE ANESTHETISTS AND ANESTHESIA ASSISTANTS

Delegation of functions to non-physician personnel should be based on specific criteria (i.e., the individual’s education, training, and demonstrated skills) approved by the medical staff on the recommendation of the physician responsible for anesthesia care. Such criteria should include competence to follow the anesthesia plan prescribed by the anesthesiologist and the technical ability to:

1. Induce anesthesia under the direction on an anesthesiologist.

2. Maintain anesthesia at prescribed levels.

3. Monitor and support life functions during the perioperative period.

4. Recognize and report to the anesthesiologist any abnormal patient responses during anesthesia.

1. ORIENTATION PLAN

All new hires in the Department of Anesthesiology are required to attend the UTMB orientation program as outlined by the University. New faculty are oriented to the Department, and the Operating Room Suites by the Vice -Chairman for Clinical Affairs or his designee. Additionally, the Administrator of the department meets with all new hires to review administrative policies, and responsibilities of the faculty, and the departmental benefits.

2. RECRUITMENT AND SELECTION

The Department of Anesthesiology complies with the Policies and Procedures of the University of Texas Medical Branch at Galveston for the recruitment and selection of all employees. Faculty members are recruited via word of mouth, or through advertisements in appropriate publications.

3. EMPLOYEE PERFORMANCE ASSESSMENT

1. Classified personnel have their performance appraised in accordance with the UTMB Human Resources policies and procedures for classified personnel.

2. Administrative and Professional personnel have their performance appraised in accordance with the UTMB Human resources policies and procedures for Administrative and professional personnel.

3. Residents and fellows, as well as CRNA’s and Anesthesiology Assistant P.A.’s, are evaluated daily by the faculty. Resident and Fellow evaluations are reviewed and acted upon by the Clinical Competence Committee.

4. Each member of the faculty has their performance appraised on an annual basis. They are evaluated on their performance as it relates to their leadership, effectiveness, clinical effectiveness, clinical effectiveness, educational effectiveness, and research effectiveness. Each member of the faculty is anonymously evaluated by the residents for their educational skills, us of sound medical judgment, clinical knowledge, etc. Self-evaluations, and peer evaluations are part of the overall assessments process.

0. ADMINISTRATIVE

1. ADMINISTRATIVE MEETINGS

The Department of Anesthesiology conducts several regularly scheduled meetings to discuss matters of administrative concern, these include:

1. Faculty Meetings are held each month. The purpose of this meeting is to keep the faculty informed regarding all areas of departmental and institutional importance, administrative, clinical, education, and research. These meetings also provide an opportunity for the faculty to have input regarding matters that concern them.

2. Chairman’s Advisory Committee meetings are held weekly. Their purpose is to discuss those issues affecting the department and the institution to develop and approve plans, and implement actions necessary to carry out those plans.

3. Education Committee meets monthly to coordinate the resident education programs in the Department of Anesthesiology.

4. Quality Management Committee meets monthly to review all mortality, critical incidents and complaints occurring on patients directly under the care of our department.

5. Other committees: Various members of the faculty and staff of the Department of Anesthesiology serve as active members of several Medical School, Hospital, Practice Plan, and/or Institutional Committees including but not limited to the following:

Operating Room Committee

Transfusion Committee (Hospital)

Executive Committee of the Medical Staff

CPI Committee (Hospital)

Quality of Care Committee (Hospital)

3.2 OPERATIONS

3.2.1 Equipment

1. Anesthesia apparatus must be inspected and tested by anesthesia provider prior to being put into use. If a defect is discovered, the equipment must be replaced or not put into use until the defect is corrected.

2. Oxygen and nitrous oxide cylinders will be maintained on each anesthesia machine and be ready for use in case of emergency.

3. Lubrication of regulators and fittings will be avoided. Oil, grease or flammable liquids will not be permitted to come into contact with oxygen cylinder valves, regulators and gauges.

4. Cylinder valves will remain closed except when in use, then opened fully.

5. Empty cylinders will not remain on anesthesia machines. Cylinders will be replaced immediately will full tanks suitably marked.

6. Unapproved or equipment without prior inspection will not be permitted in patient care anesthesia areas.

7. Each anesthetic gas machine will have a pin-index safety system to prevent the cross connecting of gasses.

a. All piped-in gasses will have a pin-index system with appropriate alarm system.

8. All anesthesia machines and piped-in gas pin-indexing systems will be equipped with an audible alarm sounding if oxygen is not flowing in addition to anesthetizing gases.

9. All anesthesia machines will have a gas-scavenger system connected to suction that is not vented into the air conditioning system.

3.2.2 Medical Gases

1. All anesthesia personnel will familiarize themselves with the rate, volume, and mechanism of air exchange within the surgical, recover, and intensive care unit areas.

2. Only non-flammable anesthetic agents will be used for anesthesia or for the preoperative preparation of the surgical field.

3. All freestanding cylinders, whether empty or full, shall be chained or supported in a cylinder cart.

a. Small cylinders of oxygen or other non-flammable gas required during patient transport may be used when safely affixed to the patient’s bed or gurney.

4. Full tanks will be stored separately from empty tanks and each storage area will be appropriately marked.

5. All cylinder storage areas will have controlled access to be protected from extreme heat and cold.

6. Personnel concerned with the use and transport of cylinders shall be instructed in the proper handling of gas cylinders.

7. All cylinders and associated equipment intended for use in an anesthetizing area must be properly labeled by the manufacturer.

3.2.3 Electrical Safety

1. All electrical equipment will be tested by the Department of Engineering prior to being put into use and then at regular intervals, not to exceed six (6) months, unless an indicated inspection is justified by previous experience or manufacturer’s recommendation.

2. All equipment will be fitted with three-prong grounding plugs, and cords will be standardized according to current National Fire Protection Agency regulations.

3. With the exception of certain radiological equipment and fixed lighting more than five (5) feet above the floor, all electrical equipment in the operating room suite shall be on an audio-visual line isolation monitor.

a. When this device indicates a hazard, the use of any electrical equipment will be avoided if at all possible, particularly the last electrical item put into use, as well as any item not required for patient monitoring or life support.

b. Following the completion of the procedure, the area from which the signal emanated will not be used until the defect is remedied.

c. All personnel working in these areas will be familiar with the procedure to be followed.

3.2.4 Supplies and Equipment

1. The minimum supplies and equipment necessary for the administration of anesthesia and for related resuscitative efforts include, but not necessarily limited to:

a. Sphygmomanometers and stethoscopes – regular and esophageal;

b. Gas machines with oxygen supply, alarm and scavenger system;

c. Anesthesia machines will be inspected on a semi-annual basis by the contracted biomedical corporation representative.

3.2.5 Controlled Substances

1. All personnel in the Department will adhere to the Pharmacy's policies and procedures regarding the dispensing, administration, wasting, and return of controlled substances.

2. Controlled substances are never to leave the hospital premises.

3. Controlled substances cannot be stored in lockers or offices.

4. Before leaving the hospital, each individual must reconcile the records for all controlled substances for which they are responsible. All drugs must have been administered, wasted, or returned before a member of the Anesthesiology Department leaves the hospital premises. Controlled substances cannot be transferred to another member of the department.

4.0 Education

4.1 Non-Employee Training Guidelines

Rotations

I. General

Rotations are structured in accordance with the guidelines of the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee (RRC) for Anesthesiology. (1996 revision). All rotations within the Department of Anesthesiology are reviewed by the Education Committee on a yearly basis. The performance of individual residents is monitored by the Clinical Competency Committee (CCC) who review all unsatisfactory evaluations give by rotation directors. The timing of required rotations and their content is reviewed by the Education Committee on a yearly basis.

II. Required Rotations

Day Surgery Unit/ Outpatient evaluation

Cardio thoracic anesthesia

Obstetrical anesthesia

Neuroanesthesia

Pediatric Anesthesia (UTMB; Shriners’ Burn Institute – Galveston TX, Driscoll Children’s Hospital – Corpus Christi, TX)

Pain management

Post-Anesthesia Care Unit

Critical Care Medicine

III. Elective Rotations

Advanced clinical experience is available in all subspecialties at UTMB as recommended in the ACGME guidelines. Additional external rotations include:

Pediatric Anesthesia (Shriners’ Burn Institute – Galveston TX, Driscoll Children’s Hospital – Corpus Christi, TX, Texas Children’s Hospital – Houston, Texas)

Pain Management (MD Anderson Hospital – Houston, TX)

Cardio thoracic anesthesia (Texas Heart Institute – Houston, TX)

Thoracic Anesthesia (MD Anderson Hospital – Houston, TX)

Medical Students

1.First and Second year curriculum. The faculty of the department of anesthesia are responsible for participating in the first and second year curriculum to the extent required by the Medical school. This includes but is not limited to facilitating Practice of Medicine (POM) and Problem Based learning discussion (PBLD) courses

1. Core Curriculum lectures. The faculty of the department of anesthesia are responsible for the series of lectures covering preoperative evaluation, intraoperative physiology and postoperative management of the surgical patient. These lectures are given to 3rd year medical students during their surgical clerkship.

2. 1st year Anesthesia rotations. The following rotations are available to 1st year medical students as electives:

One month elective in Clinical Anesthesia

Two month elective in Research in Anesthesia

3. 4th year Anesthesia rotations: The following rotations are available to 4th year medical students as electives:

Research in anesthesiology

Surgical Intensive Care Unit

Pain Management

Obstetrical Anesthesia

Cardiovascular Anesthesia

Clerkship in Anesthesia

Acting Internship in Anesthesia

Internships. The internship for residents entering the four year residency is under the supervision of the director of the residency. Interns complete twelve months of clinical rotations outside the department of anesthesia during their PGY-1 and PGY-2 years. The residents receive evaluations from the supervising faculty at the conclusion of each rotation. All unsatisfactory evaluations are reviewed by the CCC in addition to the director of resident education. Rotations are scheduled with the following departments or sections:

Medicine (ward, cardiology, pulmonary, outpatient clinics, consults)

Surgery (ward)

Pediatrics (Pediatric ER, Infant Special Care Unit)

Emergency Medicine

Oral Surgery

Fellowships

The department, from time to time, may offer fellowship in Pedi, Cardiovascular, Pain, and ICU.

Residencies. The Department of Anesthesia is an ACGME accredited residency program.

Guidelines for research. Research opportunities are available to senior residents. All projects are subject to the guidelines of the Institutional Review Board (IRB).

5.0 UTMB Policies and Procedures (All sites accessed08/03)

1. Promotion/Reclassification



2. Appeal



3. Grievance



5.4 Corrective/Disciplinary Action



4. Employee Scheduling



5.5 Time and Attendance

5.6 Safety



5.7 Security



5.8 Employee Breaks

5.9 Smoking



5.10 TDCJ Guidelines

11. Quality Management Program





5.12 Moderate Sedation

5.13 Universal Precautions



5.14 Emergency Operations



5.15 Epidemiology Policies

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Chairman

Vice Chair

Clinical Affairs

Subspecialty Divisions

Administrative Associate

Vice Chair

Education

Departmental Administrator

Anesthesiology Specialists

Editorial Office Director

Secretarial Support

Educational Support

Technical Support

Resident Coordinator

Administrative Manager

(Office Manager)

Medical School Training

Resident Education Programs

Surgical Intensive

Care Unit

Cardio thoracic Anesthesiology

Obstetrical Anesthesiology

Pain

Management

Shriners’ Burns

Hospital

Medical Director

Operating Rooms

Pediatric

Anesthesiology

Pre-Screening

Clinic

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