pre-round/rounds

The Post-Call Resident assigns MICU patients to the oncoming MICU Team Intern/Resident pairs using the principles of even distribution, continuity of carebased on the admitting Intern/Resident pair, and the intern’s role as the primary presenter of patients. Interns will be assigned patients first, with a maximum of 4 patients per intern. Residents will be assigned sole responsibility for the remaining patients assigned to their pair.

The Short-Call resident will not be assigned sole responsibility for presenting patients but will preround on patients and be back up for their intern/student presentations. Interns pick up a new patient list and get sign-out about overnight events at 0630 from the Post-Call Intern and Residents do the same with the Post-Call resident at 0700. The housestaff should update the sign-out for any patient that they admit prior to patient handoff. Morning Rounds (0800) count as a formal sign-out.

patient assignments / hand-off
pre-rounds

The Fellow gathers necessary information to lead rounds and to ensure urgent patient issues are addressed prior to the start of rounds. Residents, Interns, and Medical Students are expected to obtain a comprehensive understanding of all information related to the patients assigned to their intern/resident pair. Residents after preparing their own presentations, should be available to interns and students for practicing of presentations and discussion of issues. This should allow all team members to prepare presentations that are fluent, concise, accurate, and comprehensive. Presentations will articulate a coherent systems-based assessment, differential diagnosis and plan. Clinical Data

 

Collection Methods include:

  • CPRS is the main EMR for notes, Labs (check trend & cumulative), microbiology/cultures, Imaging (CXRs, ECG, reports) and Medications (antibiotics day#, use of prn meds)

  • ICCA (separate system) is the main EMR for nursing (ICU only) tasks: vitals (Tmax, BP range, HR range, RR, O2 sat, and I/O’s hourly/net), last bowel movement, and lines

  • Patient exam (lines, drains), monitors, and vent settings (TV/RR, PEEP/FiO2, Pressures)

  • Bedside Nurse-overnight events and current concerns

  • Telemetry

  • Sign-out / Sign-out sheet can be accessed through CPRS → Tools → Hand-off

rounds

The Fellow and/or Attending leads daily MICU Multidisciplinary, afternoon, and evening rounds ensuring the establishment of a common assessment and plan of care for each patient across the multidisciplinary team. The Fellow/Attending should ensure maximal representation/participation of multidisciplinary team members (charge nurse, primary nurse, pharmacist, respiratory therapy, etc) at rounds.

 

Interns and medical students will present their assigned patients and Residents will serve as backup for presentations. Team members should interject as necessary to correct, clarify, and elaborate on incorrect or ambiguous information.

 

The Pre-Call resident (M-W)/Post-call resident (Th-Sun) will perform chart review and order placement during rounds. The Short-Call resident will evaluate/admit any patient consults and respond to any codes while the team is rounding. Presenters will bring copies of ECGs or telemetry event strips to rounds. MICU Team Physicians will take notes of the to-do’s for ALL patients on the service, not just their own. Remember, rounds = signout!

team-huddle / post rounds

After rounds, residents will distribute and oversee intern and medical student work and serve as the primary provider responsible for direct patient care. Go over sign-out on all of your patients with your intern and update HAND OFF while intern completes tasks. Supervise your intern’s sign-out to the long-call team. Pre-Call resident assumes care of the Post-Call team’s patients once they depart and carry out all attendant tasks.

typical timeline

0630-0800 

Patient assignments/Pre-rounding (Residents arrive at 0700)


0800-1030

Multidisciplinary MICU Rounds
Daily Academics (see Critical Care Service Intranet for Schedule)


1400-1430

Long-call Resident Sign On from Short-call resident and begin taking admissions (attending supervised)

 

1630-1700

Afternoon Rounds (Attending, short-call and long-call residents and interns will be present for rounds, which are Fellow sign-out)


2130

Evening check-in (RTL) between resident and Fellow (in person M-F and by phone on weekends)

patient monitoring guidelines

Monitor Patient appearance, vital signs, urine output, telemetry, labs, and response:

  • Interns - hourly for every patient

  • Resident - hourly for new ICU admissions/major changes (1st 4 hours), then every 2 hours

  • Fellows - will assess patients prior to AM, midday, and evening rounds and ad lib according to patient status and progression