Structure & Schedule

Each new patient should have a complete H&P including information from the ambulance run sheet, prior hospitalizations, meds, etc. Ideally, the intern or student will go over the H&P with the resident prior to presenting the case. Rounds with the Attending begin at 9:30, though this could be earlier or later at the request of the team depending on patient load. After seeing all new and old patients, and noon conference, we will then have either ICU lecture (please read the appropriate section of the syllabus or assigned reading prior to the lecture) or mock code practice/Simulation Lab.

Evening rounds on weekdays’ occur at 4:30 or 5:00 pm to be sure that all the patients are “tucked in”. There is no night call so the Code resident should turn over the code beeper to the on-call resident and the intern should turn over the intern code pager, and update sign out prior to leaving. Each resident and intern will get one day off per week, with the service being covered by the remaining team members. This schedule will vary depending on patient needs and load.

Tips for Presenting an ICU Patient

For follow-up patients, please present in a S-O-A-P note fashion. System-based approach is also acceptable but list the systems in order of importance if you choose this style. While presenting objective data – such as the vital signs, or the CBC – please save discussion of this data for your assessment and plan. Time allotment on rounds for follow-up patients: 6-7 minutes of total presentation time by the resident/intern. Interns and medical students, please review your entire presentation – including assessment/plan – with the resident or fellow prior to presenting on rounds.

For new ICU consultations, please obtain “extended information,” as one would for a standard H & P. This includes PMH, SH (including drug/alcohol use), FH, allergies, medications at home, etc. The HPI should include how the patient presented, what EMS interventions occurred, “down time” (if relevant), what the ER course was, and what initial therapies (if any) the patient received upon arrival to the ICU. Time allotment on rounds for initial presentation of a patient: 15 minutes (approximately) by the resident/intern.

MICU Syllabus

The syllabus is updated approximately every 12-18 months. It is designed to be a reference source for the many different critical care issues that you may encounter in the ICU. Please bring the Table of Contents with you on rounds and the Attending will refer you to appropriate articles regarding your patients’ issues as needed. The core articles, which everyone should read, are the first 15 articles in the beginning. The Syllabus is available on the AHS intranet; AHS website – Divisions – Critical Care-HGH MICU or available to download. We are developing test modules that will match the core articles and ABIM knowledge base to allow self learning for house officers who are at different stages of the rotation. If you find an article which you think should be in the syllabus, either as a new article or to replace an existing one, please forward it to Dr. Chen. Thank you in advance for helping to keep our syllabus current.

Evaluation

Your Attending will sit down with you at the end of the rotation for mutual feedback. The attending will also provide feedback on an ongoing basis to enhance patient care and your growth.

Questions/Concerns

If you have any questions or concerns during the rotation with your colleagues, staff, attending, or others, please bring these to the attention of your attending, the ICU director, or Chief of Medicine early on, so that we can make this a valuable and pleasant learning experience.