Medical Intensive Care Unit

Colleagues,

Welcome to the Medical Intensive Care Unit (MICU)!

You will be starting your rotation the 1st of the month (for interns) and 3rd of the month (for residents) in the MICU.

When interpreting the schedule, R is a 2nd or 3rd year resident and I is an intern. The MICU has 3 teams Orange, Blue, and Silver. Each team has one resident and two interns. There is also a night team with one resident and one intern or 2 residents.

Call schedule:

Admitting day: 7am - 7pm

• On your admission day you will admit patients from 7am to 7pm and sign out to the oncoming night team. The night team will continue admitting patients to your service that you will pick up on your post call day. 

Post call day: 6:30am - 7pm

• You will round starting at 7am with the night team to ensure the night team rounds on all admitted patients overnight and leaves by 9am. You will only round with the night team on overnight admits, once this is complete the Night team will leave and you will continue rounding. 

 Pre-call day: 7am - 5pm 

• The resident/interns will sign out to their fellow at 5pm and the fellow will provide cross cover until 7pm

Night team: 6:30pm - 9am

• • You will receive signout from the late call team on arrival and you will provide cross cover for the MICU patients on 11-4 and 82. There will be a night attending and night fellow present to answer questions provide support, run treatment decisions by, handle codes and assist with unstable patients as needed. The attending can always be called for any reason. The night fellow will have duties outside of the MICU but is also present for support and will be stationed out of unit 82. You will round with the post-call team at 7am on newly admitted patients and are excused after rounds NO LATER THAN 9am.

For Residents:

• There will be 3 total day residents and 2 total night residents. Residents WILL NOT rotate between days/nights.   Residents will manage and run their respective day MICU teams and will be present on all admission days. When one intern is off on a team the resident will cover that interns patients. When admitting, the resident will perform all MICU evaluations under the guidance of the fellow and on call attending. Residents will write acceptance and rejection notes and provide a critical care consultation to the requesting physicians from other locations in the hospital. They will also supervise intern procedures and complete procedures in absence of interns or following intern attempt and failure. Residents will also respond to Code blue alerts within the hospital along with the fellow and attending physician as part of the Code blue team. Residents will work closely with fellows, their interns, and the nursing staff in the MICU to work on workflow through the MICU and help with bed management. Bed management decisions ultimately fall to the attending physician and in their absence the on call fellow. 

For Interns:

• There will be 7 interns total, 2 per team and one night intern. The interns will rotate between days and nights and perform an average of 3-4 consecutive nights with the night resident. During the day their duties include note writing, evaluation and documentation sepsis, procedures, and providing cross coverage. During the MICU rotation, interns are expected to obtain procedural experience with central lines, arterial lines, lumbar puncture, thoracentesis, and paracentesis under the immediate supervision of a resident/fellow/or attending physician who is signed off on these procedures. Interns will transition between admission days, post call days, and pre-call days. On admission days all members of the medical team (resident and interns) will be present.  While on nights interns will perform cross-cover on the MICU patient on 11-4 and 82 and will write H&P’s on new admissions to the MICU overnight. From 7am-9am night interns will participate in sign out rounds with the post call team and will present the patients they admitted overnight. 

ER Interns:

ER interns will be present during your month as well. They will be assigned to work with a specific team.

Specifics:  

All admissions by the day and night team go to the admitting team of that day (ie the overnight patients until 7am go to the team that admitted the day before). Once this team reaches its cap of 14, the admissions carry over onto the next days admitting team.  

Regarding specific orders in the ICU: Please make sure restraint orders are placed in EPIC PRIOR to restraints being placed on your patient. The night intern should also make sure these orders are placed ASAP (for the following day, as restraints have to be ordered daily) when they arrive on the unit. This is a patient safety issue and is reviewed closely by the joint commission. If you are placing admission orders for a patient that is on a vent or you know will need restraints, please place the restraint order set in the admission orders section!

When you are titrating vasoactive medications on your patient please update the order when the change is made and provide documentation of why you are adjusting the dose with a “plan of care” update within the notes section of the chart. This is required by the joint commission so we are able to clearly review cases and determine the thought process behind why certain changes are made.

It is also very important that your active orders are reviewed daily and unnecessary orders are discontinued. If this is not done many un-needed orders are left to clutter the nurses epic work flow and can cause confusion. Nurses will be asking you to clarify/clean up orders each morning on rounds and you should not move on to your next patient until order issues have been clarified.

MICU Morning Report: There will be a brief (10-15min) MICU morning report from 7am - 7:15am reviewing 1-2 new cases or acute overnight events highlighting a critical care education topic. The night team is expected to attend and rounds with the post-call team will start promptly after. 

Progress Notes in the ICU: Please remember that all notes need to be accurately updated daily. Re-read the assessment/plan daily and make sure you remove outdated information and update with the newest plan/medications.

Consents in the ICU: All patients need consent forms filled out prior to procedures being performed. Please make sure you are consenting the appropriate family member for procedures when a patient is unable to consent for themselves. This information is easily found in the treatment team sticky note section under rounding, the facesheet or can be found in the SW’s initial note. An intubation consent is no longer part of the Pan consent order form. This consent should not routinely be filled out at admission to the unit and should be completed by the patient or their surrogate if a need for intubation arises.

Food on the Unit: The short call team should be grabbing food for the MICU teams from the noon conference lunch. This should be eaten in the nurses lounge (not at your computer work station). The code for the lounge is 0307.

Cleanliness on the Unit: Please clean up any drink bottles/food wrappers from around your work space prior to leaving for the day. Any patient identifying information should also be placed in the chart or in the HIPPA compliant shredder box once you are finished reviewing it—Not doing so can be reported to the compliance department as a HIPPA violation.

Most importantly, Infection control on the unit!: ​ Please comply with all infection control precautions while in the unit. If a patient requires full gown/gloves/face mask/cap please make sure you are not only wearing this, but you are wearing it correctly (wash hands before placing on gloves, take off white coat or jacket (including sweatshirts/our UF IM Jackets, etc) prior to placing gown on, and gown is actually tied and secure on you). It is also very important that you thoroughly wipe down the ultrasound with sterile wipes prior to returning it to the nurses station once you complete a procedure. ​