||On arrival, the SICU resident evaluates prior assigned patients and new admissions. The following checklist may be advantageous.
- Speak to the critical care nurse and the SICU call resident about problems that have occurred over night.
- Examine the patient
- Examine the ventilator
- Review the graphic pulmonary artery tacing and EKG/telemetry tracing.
- Review the flow sheet for essential information
- Write the SICU Progress Note
- Give the note to the SICU Attending at the conclusion of the rounds
||SICU Attending Rounds
- Effective bedside communication of the patient's exam, database, and development of the Problem List is and art form (particularly if done well). Presentations will be trustworthy, complete, but succinct. Most attendings will appreciate a well-reasoned diagnostic and therapeutic plan of management at the conclusion of the presentation.
- The "style" of bedside presentations vary, and, quite frankly should be developed using guidelines provided the SICU attending.
- The SICU is commited to a multi-disciplinary style of care. It is expected and encouraged that the SICU nurse, pharmacist, and nutritionist will contribute sage observations.
- At the end of each patient discussion, orders for implementing the diagnostic and therapeutics plans should be written. The tactical plan for the day should be clear.
- Lab tests are written only as required. It is not acceptable to write for labs for an unspecified period. For example, a CBC every AM is costly and often generates unneeded information.
- At the end of rounds, the tactical plan for the day should be clear. Common diagnostics orders (if indicated) could include the next day's lab studies and the needed hemodynamic data (i.e., frequency of hemodynamic profiles, arterial blood gases). Chest x-ray requests should be completed for the next day at the end of rounds.
- Common therapeutic orders include the ventilator prescription, fluid orders, and changes in drug therapy. All ventilator prescriptions are written on the ventilator order sheet. It is reasonable practice to review and revise all IV fluid orders daily. Alimentation daily orders should be written by 1200 hours. Always review the medication sheet daily for unnecessary drugs.
- Deferring orders until the end of rounds delays care. Care delayed is care denied...
- At the end of rounds it is helpful to schedule procedure times with the SICU nurses. This helps in terms of procuring necessary equipment and effiencient use of time.
|SICU Fellow Lecture Series
||SICU Noon Seminars ( see monthly calendar for details )
||Check out rounds
- Effective chek out rounds communicate the major problems, plans, and anticipated concerns for any patient. The emphasis is on succinct presentations.
- Residents and medical students should not leave until all procedures and notes are completed and in the medical record. The care of unstable patients takes priority.
|1500 hours et al
||New admissions and bedside evaluation of concerns.
||The call residents should walk to each bay to confirm "equanimity." Commonly, SICU attending physicians will call for a progress report. Astute residents will always be prepared.