Roster Rules for ICU Junior Doctors 2020

(Current as at 10/12/2019) - Master document stored on ICU Hub
Period of application: 03/02/2020- 31/01/2021

Roster overview
  • The roster is a balance between ICU service provision for the Loddon Mallee region, work-life balance, staff-centred care, health service and College of Intensive Care Medicine credentialing, and EBA compliance
  • The roster and set of rules has been developed through consultation in 2019 with junior medical staff in ICU, the Medical Workforce Unit (MWU) and ICU consultants.
  • This set of roster rules is informed by the following documents:

Roster maintenance
  • Regular meetings occur with MWU and the ICU Clinical Unit Heads and Supervisors of Training to help support the coordination of the ICU rosters
  • A monthly 15-minute meeting during 1st Wednesday of the month before rostered Training Time will be held for ongoing discussion of roster and work-related issues
  • The HMO Coordinator, in consultation with the ICU Clinical Unit Head, develops the initial roster template and pattern for each term, based on submitted leave
  • Ongoing  roster coordination is the responsibility of HMO Coordinator and will incorporate the feedback from regular meetings with ICU representatives

Roster publication
  • The ICU roster is published as a PDF on the Medical Portal by MWU – this is the official roster
  • A (less accurate) version is found on ‘FindMyShift’ to enable visibility of all rostered levels of medical staffing

Roster pattern
  • The ICU Registrar roster is based on a pattern of ‘7-on/7-off’ of rotating shifts.
  • The Outreach Registrar shifts are to be utilised to cover leave internally, if roster gaps occur due to approved leave in the pattern
  • The Registrar due to be on Outreach shifts (as per roster pattern) may have their roster adjusted to backfill the Registrar on leave if required, prior to the roster being published.
  • Consideration of equity of access to all shifts is given for training and well-being purposes, while also considering operational requirements and service delivery.

Training Time
  • Training Time is incorporated into each individual’s roster for a total of 5 hours per week
    • On-site training time: Wednesday 1200-1700
      • Consultant-supervised
      • All who are not on leave or on night shift expected to attend and rostered to reflect this
    • Off-site training time
      • This is allocated to rostered fortnights with Outreach shifts to compensate for not attending when rostered to night-shift weeks
      • This is not allocated when on planned leave weeks (however each individual day is paid at 8.6 hours or 43 hours per week as per EBA)

Planned leave management
  • Planned leave is to be allocated on a “first-come, first-served” basis for all of 2020 once the term 1 roster has been published.
  • Leave requests can be submitted at any time from time of accepting offer to final day of contract. Registrars will be notified in writing as to whether their request has been approved within 14 days, as per EBA requirements.
  • Rotational staff are notified at the same time as locally employed staff in writing with appropriate forms included in the notification
  • ICU is a 24/7 shift-working rotation.
    • Due to ICU service requirements, the roster does not allow for “Not Available” to be noted on the published roster.
    • To protect weekends or important dates for personal reasons (i.e. member of wedding party), please submit an annual leave request for these dates
    • If the roster pattern determines these are days off, the leave balance of the Registrar will not be reduced, however the leave will still be noted on the roster.

Planned leave prioritisation sequence
  1. With notification to incoming Registrars of the process for leave applications and appropriate forms, a date will be set, for example, 4 weeks from time of email, for registrars to apply for leave.
  2. Within that time frame, leave will be allocated based on the type of leave request
    1. First priority: professional development leave (exam, conference, seminar)
    2. Second priority: annual leave requests
  3. Subsequent to this initial period, leave will be approved based on first completed requests

Planned leave Registrar backfill
  • Only 1 Registrar will be approved for planned leave (annual or PD leave) at any one time to enable safe backfill of posts by the Medical Workforce Unit.
  • Where conflicting leave requests have been made, this will be escalated to, and addressed by, the Clinical Unit Head.

Planned leave HMO backfill
  • General Stream HMOs in ICU are backfilled from the MWU HMO relief pool, managed by the Medical Workforce Unit
  • Critical Care Stream HMOs take their annual leave when allocated to their Anaesthetic rotation
  • Professional Development leave for HMOs can be backfilled with HMO Relievers or the 3/4 HMO pattern adjusted to work around requests
 
Shift swaps
  • Registrars or HMOs may request shift swaps for individual shifts or runs of shifts utilising the Medical Workforce Unit shift swap process, which requires:
    • mutual agreement and authorisation between both parties
    • completion of forms located on the Medical Portal intranet page
  • For equitable access to shifts, a ‘like-for-like’ shift swap is preferred, especially in blocks
  • Shift swaps must occur within the same pay period fortnight unless approval received from Medical Workforce Unit
  • Shift swaps may not be approved if they are deemed to be unsafe working hours or reduce the ICU to unacceptable staffing levels
  • The completion of the shift swap form is a request only and final approval is required by the Medical Workforce Unit

Unplanned leave management
  • Any staff member who is taking unplanned personal leave should, at their earliest possible convenience contact (24/7):
    • MWU person on-call by telephone
    • On-call ICU consultant by telephone
  • Planned requests for personal leave can be made through the MWU
  • Cover for unplanned leave (personal leave) is aimed to be covered internally first
  • On certain occasions, current staff may be requested to adjust their roster to ensure service provision is maintained (within EBA limits).
  • A request is made by MWU to existing ICU staff, with support of the on-call consultant
    1. Requests need to be made within the context of EBA safe hours considerations
    2. Working above contracted hours will be paid as per EBA
    3. The employee has a right to refuse the requested shift, as per EBA

Unplanned leave Registrar backfill
  1. ICU ward registrar options for backfill
    1. Reallocate Outreach registrar of the days in question to ICU ward registrar position (if Outreach registrar is rostered on) and request them to work longer shift           
    2. MWU to request registrars rostered off to pick up existing shift at short notice or swapping of existing shifts to fill gap
    3. If time permits, send shifts available to BH casual ICU Registrar pool
    4. Intensive Care Unit to manage internally with Consultant cover if no Registrar cover available
  2. ICU night registrar options for backfill
    1. Request Outreach registrar of the days in question to move to night registrar position (if Outreach registrar is rostered on) and request them to work longer shifts
    2. MWU to request registrars rostered off to pick up existing shift at short notice or swapping of existing shifts to fill gap
    3. If time permits, send shifts available to BH casual ICU Registrar pool
    4. Intensive Care Unit to manage internally with Consultant cover if no Registrar cover available
  3. ICU Outreach registrar - no request made to fill shift

Unplanned leave HMO backfill
  1. ICU ward HMO options for backfill
    1. MWU to request HMOs rostered off to pick up existing shift at short notice or swapping of existing shifts to fill gap
    2. Review availability of other HMOs either on Reliever term or other rosters for availability and contact to see if able to pick up shift
    3. If time permits, send shifts available to BH casual HMO pool
    4. Intensive Care Unit to manage internally with Registrar & Consultant cover if no HMO cover available
  2. ICU night HMO options for backfill
    1. MWU to request HMOs rostered off to pick up existing shift at short notice or swapping of existing shifts to fill gap
    2. Review availability of other HMOs either on Reliever term or other rosters for availability and contact to see if able to pick up shift
    3. If time permits send shifts available to BH casual HMO pool
    4. Intensive Care Unit to manage internally with Registrar & Consultant cover if no HMO cover available

Communication of service gap
  • A standardised and structured communication template is used to communicate all changes to roster including updates for service
    1. Absence of all ICU registrar or HMO roles on a shift
      1. MET response arrangements
      2. Code Blue arrangements
      3. Referrals and ward support arrangements

Contributors - November 2019
Kath Creme (MWU HMO Coordinator)
Hannah Cole (MWU Manager)
Dr Jason Fletcher (ICU Clinical Unit Head)
Dr Cameron Knott (ICU Deputy Clinical Unit Head)
Dr Jacqueline Dirou (2019 ICU Registrar)
Dr Caitlin Young (2019 ICU Registrar)