PICU Resident Survival

Resident-to-resident PICU Survival Guide

Updated 9/16

AM sign-out and pre-rounding

· If you are NOT on call, show up at 6:00. If you are ON call, show up at 6:30.

· Quickly review the interval history prepared by the overnight resident for your patients.

· Check in with the overnight resident for verbal clarifications if needed on the overnight events (typically active or new patients).

· Triage your pre-rounding process with sick kids first, because if you run out time the least sick kids are easier to review and assess on the fly. Triage your pre-rounding so that ill patients and cardiac patients are done first. This way if you run out of time, the non-cardiac surgical patients are easiest to assess on the fly (during rounds).

· Examine your patients while the night nurse is still present because the night nurse can give you a big picture of the night events for your patient (they start signing out to day nurse at 7am).

· EPIC trolling and prepping notes. If your notes have automatic refreshable links as able this is faster. For example, any “dot” phrases that include “@RESUFAST@” such as “.lastcbc” will automatically refresh to import the newest CBC.

· Before rounds, put in transfer orders for patients expected to transfer out that day. This puts in the bed request and speeds up the process.

· If you cannot pre-round on everyone and you cannot decide who needs to be rounded on, ask the overnight attending. In general, Sickest>less sick, Medical or Cardiac>other surgical>other surgery expecting to transfer out that day.

DON’T

· Show up earlier or later than above times. If you show up late this limits your fellow resident’s pre-rounding ability because they are covering your patients in your absence. If you show up too early on your call days, you will end up breaking duty hours.

· Don’t get full verbal sign out for all patients because for the less active patients, reading the prepared interval history should be sufficient and therefore not cut into your pre-rounding time.

Rounds Start at 7:30 am with the cardiac team (Monday-Thursday, on Fridays Cardiac team shows up around 8:30am). Rounds then conclude with the medical PICU patients, sickest first.

Weekend Rounds start with cardiology at 8 am.

· Overnight resident all new patients from overnight.

· Primary resident presents starting with the vital signs. It is okay for less sick patients to say “stable or within normal limits”

· Residents not presenting: Pull up xrays, put in orders, update the list

· Before assessment and plan, ask for nursing input.

· Make assessment and plan knowing that the attending will have different ideas.

· Resident on call that day updates sign out.

· After assessment and plan: Order read back with closed loop communication before signing orders. If post-call patient being presented, the resident on call will go over to-do’s for the day. THIS IS YOUR SIGNOUT. Post-call resident should not need to check in again.

DON’T

· Work on notes during rounds or pre-round on your patients.

After rounds

· Post call person finishes notes and leaves by 10:30

· Other residents call consults, put in any orders that were unable to be done during rounds, put in TPN orders (dietician’s sometimes help with this)

DON’T

· Stay past 10:30 to finish notes, call consults or such. These can be done by the day team.

· Post call residents shouldn’t need to do a verbal sign out because your fellow residents were taking notes during rounds and updating the sign out list.

During the day

· Follow up the “to do’s” and work towards the main goals for patients

· Prep H&Ps for the expected patients. If they show up at sign out this makes it a lot easier.

· Prep your notes for the next day, especially update the interval hx from the daytime. This is helpful for the overnight resident if you’re able to do this.

· Prepare/update your transfer notes for patients expected to transfer out within the next couple days.

· Teaching if there is downtime.

PM sign out is at 4:30.

Overnight on call

· Prep the notes for the next morning, putting in the interval hx. This can be done throughout the night (just make sure the time and date are changed the next morning in the right upper hand box of the note box). Only big events should be recorded in the interval events.

· Put in transfer orders in the morning for patients expected to transfer that day.

· Night round with the attending and charge nurse. This is a good opportunity to update the interval history.