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PICU fellows will supervise the care of all patients in the PICU. Emergency medicine interns and anesthesia fellows should follow patients as the primary physician. Other visitors (surgical, dental, etc) may tailor their experience to their needs. Students who may rotate through the PICU include 4th year subinterns and 3rd year students who are in their required Child Health 1 rotation. PICU subinterns will follow their patients as the primary physician, under the supervision of the residents and attending physicians. Subinterns are expected to function as the patients “intern”. Third year students will follow patients under the supervision of one of the pediatric residents, and will have greater supervision than do the subinterns. The 3rd year students are expected to attend all required student lectures for their CH1 rotation. Admission and Discharge Any child requiring pediatric intensive care must be admitted to PICU. This is accomplished by calling the PICU attending physician. If a bed is available the patient may be admitted. If the PICU is full, and all beds are occupied, then the physician wishing to admit a patient to the PICU must contact the PICU attending. The critical care attending will then make the disposition regarding discharge of another patient from the PICU after appropriate consultation with the patients primary service and the PICU nursing staff, or other appropriate disposition. There are policies in place regarding triage of surgical and medical patients that are used when beds or nurses are scarce. These policies are necessary to insure optimum care for all children who require pediatric intensive care. Type of Patients admitted to the PICU Medical patients from the ED. The ED will contact the PICU attending. The intensivist is the attending of record Medical patients from the floor. The floor attending or resident will contact the PICU attending who will decide about transfer, then call the PICU charge RN and resident. The intensivist is the attending of record Medical patients transported in for outside institutions. The PICU attending will contact the PICU charge RN and resident about the admission. The intensivist is the attending of record Cardiac patients may be admitted from the OR, the floor, the ED, or DNCC. If they are immediately post or pre-operative, the primary service is Pediatric Cardiac Surgery, with medical consultation. Functionally, these patients are managed on an hour-to-hour basis by the PICU attendings. Pediatric residents are the primary residents for the pediatric cardiac surgery patients. If they are not pre or post-operative patients (i.e., they are medical cardiac patients), the attending of record is the PICU attending and cardiology is a consulting service. Surgical patients from the ED or the floor. The surgical attending or resident must contact the PICU attending to admit a patient to the PICU. The surgical attending is the attending of record. The PICU acts as a consultant for medical issues. Surgical residents write admission - 6 - orders. The degree to which the surgical services manage the medical issues of their patients will depend on the service and the patient. Surgical patients from the OR. Surgical attending is the attending of record. The PICU acts as a consultant for medical issues. Surgical residents write admission orders.
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