GW-ICU orientation

Welcome to your rotation in the George Washington ICU. For specific questions regarding schedules & ICU protocols please visit “gwicu.com”

Daily Resident/Intern Schedule

Arrive at 6 AM

Lecture M-F at 8 AM

    6th floor conference room

    This means you must finish pre-rounding by 8 AM

Rounds start on the 6th floor at 8:30 AM

     2 computers need to be on rounds

     Non-call resident/intern places orders while on rounds

     Non-call senior resident holds the fellow, resident and intern phones

ICU Team Check-In approximately 3:30 - 4PM

-At Check-In please make sure the following are complete for your patient:
        
Tasks, Procedures & notes for the day

Transfer summaries

CORES has been updated/summarized

        Information to present at Check-In:

                Any updates or significant events

If patient is on drips (sedatives, pressors, etc) you need to have the most recent rate of infusion

To do list (pending labs, recs, I/Os, etc) for the on-call team to follow-up

During Check-In the on-call resident, intern, and fellow do not answer phones

        On a busy call day, others may be asked to stay to help call team with admissions

        Any pending tasks must be completed after check-in prior to leaving for the day

7 PM sign out for on call people (please be prompt)

      Location: 4th floor ICU staff lounge

      ICU Intern should print and bring 4 copies of updated ICU 4, 5 & 6 sign-out

      Day Fellow presents to night fellow, charge nurse, & on call attending

      ICU resident (on call) stationed at the computer to place orders

      ICU intern (on call) holds all MD phones.  

 

On-Call Team Schedule

Mondays-Friday

On-call Resident/Intern are expected to arrive at 8am for lecture.  

On Call resident/intern are NOT expected to preround

On-Call team admits after rounds (~12pm) until 7am the next morning

Post-call resident/intern are assigned ICU 6 pts and are dismissed to complete final tasks by 10am.  Sign-out to team no later than 12pm (24+4hrs)

Weekends/Holidays

        On-Call Resident/Intern arrive at 6am and ARE expected to preround

        Rounds begin at 8:30am

        Post-call resident/intern are assigned ICU 6pts.  Sign-out to team no later than 10am.

At 12pm (after rounds) on ALL days, the on call team will receive sign out from ICU 2 team of any patients admitted to ICU 5 or 6 during the morning.  

Any patients admitted to ICU 2 will be signed out to ICU 2 Team upon arrival to unit. On-Call resident/intern is still expected to place admission orders and complete H&P.

 

Depending on patient acuity overnight, naps will be encouraged at the discretion of night fellow.

Please start post-call progress notes early and complete them prior to rounds on post-call day to ensure timely sign-out within 24+4 hours.

At the fellow’s discretion: ICU2 Team can assist with post-call emergent procedures (7a-12p).  All other non-emergent procedures can be signed-out to call team

Weekend Rounder

Role: to decrease the number of notes for post-call resident/intern so they can sign-out on time.

Comes in only to pre-round, write notes and can leave after rounds on weekends/holidays.

Not guaranteed to have rounder every weekend day.

This person may either be an intern or a resident

Students

The students on ICU will be Acting Interns.

They should be assigned to 1 patient during their first 3-4 days on service. After that they may be assigned to 2 and even 3 patients by the end of the rotation.

They should only be assigned to patients covered by residents, (not interns).

Residents must still write a note on all patients they are assigned to, whether they are covered by a student or not.

Students may perform procedures under supervision by senior residents or fellows.

Students should help write orders during rounds and should follow up on studies, etc in the afternoon the same way the interns and residents do.

Rounds

Rounds start at 8:30 AM on ICU-6

2 computers need to be on rounds

Non-call resident/intern place orders while on rounds

Non-call senior resident holds the fellow, resident and intern phones

Present patients by system

“Mr. Smith is a 55 y.o. male patient admitted for septic shock, currently on mechanical ventilation.

OE: “overnight events”  when pre-rounding on your patient be sure to talk w/ the night nurse before he/she signs out at 7AM

Neuro: sedated on propofol, follows commands when sedation is held

CV: MAP > 65 on levophed at 3mcg/min"

You are responsible for your patient. If the attending/fellow says on rounds that the patient needs a dobohff placed and peripheral IV access this is your responsibility to make sure these tasks are completed.

Admissions/Transfers

Admissions/Consults will originally be presented to the fellow

Once there is an admission you should see them and contact the fellow w/in 30-60 min. This may vary depending on how sick the patient is.

Fellow will go over the plan and review orders w/ admitting team.

All new admissions from the ER/outside hospitals/psych unit or ARU need an H&P. All transfers from the floor or from PACU can have an accept note.

Transfers out of the ICU

When a decision is made on rounds to transfer a patient out this should occur immediately after rounds or even during rounds if feasible.

Surgical services (GSx, NSx, TSx, ENT, OB, Ortho) follow their patients while they are admitted in the ICU thus, no transfer summary is needed.

Transfers to medicine require transfer summaries if the patient has been in the ICU for > 96 hours.  **A Transfer summary is just that - a brief summary of the events and thought process for the management of the patient (by problem or system).  Do NOT copy-and-paste the day-by-day plan.**

If you know your patient is on the list to be transferred out of the ICU in the near future please have the transfer summary prepared.

"When to ask for help and who to call"

As a rule of thumb for any minor questions ask an upper level resident

Call the fellow/attending if any life threatening problems arise or if a major decision regarding patient care must be made

     i,e. hypotension, airway issues/respiratory failure, massive GI bleeding,etc

Procedures:

Sterile technique and call a time-out

If you are not “signed off” on a procedure, someone who is must supervise you performing the procedure i,e. fellow, attending, or surgical/medical resident, advanced practitioner.

For central lines please assure that the line is secured w/ at least 3 sutures and a biopatch is placed.

Notes:

Please open notes and assign them to the appropriate attending prior to starting AM rounds.

This is so the attending can start their notes attached to your daily progress note. Please note that nothing needs to be written, merely the document needs to be opened.

Procedure notes must be completed immediately following the procedure.  Click the appropriate link in the note to open up the template for each specific procedure.  

List:

CORES & ICU Census are the 2 lists that we use.

CORES is where we place the patient’s hospital course summary and do list. It is also important that the resident/intern keep the patient’s MAR updated by removing any drips or medications that are no longer active.

The daily patient assignments are kept in the K: drive under ICU Census and are done by the night intern with resident/fellow supervision as needed.