Please ensure you have CPRS access (Ideally do this on a weekday since it’s easier to contact the people to reactivate your account should you need to).
Please review the central line, arterial line, thoracentesis, paracentesis, and lumbar puncture articles and videos to start learning the basics of the procedures (see “Resources” tab).
The CCU attendings have a phone that they carry and handoff. This is a direct line to the attending. Please save this in your contacts before starting the rotation: 352-316-0743
The MICU resident phone number is: 352-890-4250
The charger for the phone is located in the call room, and extra batteries for the CISCO phone are located in the MICU (ask the clerk).
All ED calls/consults need to be seen and staffed with an attending within 30 minutes.
CCU rounds at 8am every morning. All residents should be present for the CCU rounds with the attending by this time. Please let me know if you are not starting by 8am.
For transfer orders, please be sure to reconcile orders before transferring patients out of the MICU to Acute Care or Step-Down. It is NOT the responsibility of the accepting team to reconcile orders (e.g., change vitals from q1 hour to q4 hours, continuous BIPAP to BIPAP while sleeping, etc.) and instead the duty of the MICU/CCU residents.
You are required to report to EVERY CODE BLUE/CODE ASSIST and RRT while you hold the RRT/CODE phone/pager.
After any code blue, please ensure one person from the VA MICU team completes a “Code Blue Summary Note”.
Either the MICU fellow or resident can be the author of the note, but ideally the MICU fellow should write the note since he/she is more knowledgeable about codes and critical care.
If the fellow is not able to write the note (i.e., not part of the code, busy with another task, or requests the resident write the note), then the resident or even the attending can write the note.
Please utilize the VA MICU signout document.
The expectation is that you give a written sign-out to the incoming resident with a brief history, pertinent parts of the hospital course and the plan. Please remember that we are a team and to function at our best, communication is key.
To help the day residents, the night resident should use the VA MICU Night Shift Signout document to fill in vitals, I&Os, etc. for all the patients to help facilitate pre-rounding for the day team.
You MUST be available to come in during your short call shifts, otherwise we will start doing random checks to ensure you are here for every scheduled call day.
The short-call resident will be used as a backup resident when all other back up residents have been exhausted. This means that all the expectations of a backup resident applies to the short call resident (i.e., expected to be able to get to the hospital within 30 minutes, phone on with emergency bypass of chief numbers, answer first call from a chief, not intoxicated).
Please do not forget to write a sign-out to the oncoming resident when you are transitioning off service.
The CCU attendings have a phone that they carry and handoff. This is a direct line to the attending. Please save this in your contacts before starting the rotation: 352-316-0743
In order to facilitate getting patients out of the ED in a timely fashion and admitted to the CCU (goal is <1 hour), the following work flow has recently been approved by both the EM and Cardiology Departments:
ED attending calls MICU resident (YOU!) to evaluate patient for potential admission to the CCU
You discusses the patient with the CCU attending to determine if they are appropriate for admission to the CCU
This replaces the old workflow in which a consult to the cardiology fellow was required for admission to the CCU
If there is no LST note documented, please ensure that you complete one upon admission. If a patient already has a Life Sustaining Treatment (LST) note documented in the chart, then simply confirm these wishes with the veteran and proceed with the rest of your admission. For patients who are full code, indicate that in the note and do not place any specific orders for these patients. For patients who are DNR/DNI and/or have specific long-term wishes (i.e., no dialysis, enteral nutrition, etc.), please click the appropriate radio buttons on the LST note to ensure the correct order(s) open for the patient and then sign these orders. See the attached LST Template for more information.
**IMPORTANT**: if a patient chooses to rescind his/her DNR/DNI status, make sure you complete a new LST note but also ensure you delete/discontinue any prior DNR/DNI orders
All DC summaries should be completed within 24 hours of discharge. CPRS has a DC summary template - please use this and do not alter it. Make sure you tag the patient’s PCP after completing the DC summary.
When admitting or transferring patients who may require treatment for alcohol withdrawal, please utilize the following protocols based on the patient’s level of care:
SDU (2 West) and MICU: mMinds
Floor: CIWA
Do not discontinue MRSA nares swabs on patients admitted or transferred to the MICU (even if it has already been completed during the patient’s admission).
Whenever the "test" code blue, RRT, and sepsis alerts are sent out, please "accept" the response.
Infection Control is asking that we avoid having any food/drinks within the VA MICU patient care and work areas. You can have your food and drinks either in the staff lounge or in the call rooms, but not in the central workstations.
Lastly, please remember that the MICU call room cleanliness is your responsibility – please tidy up and clean out the fridge on a regular basis (at least weekly)