Teams

• Blue team - the "primary" team in the PICU with the higher acuity, more chronic patients. Will have ~ 70% of the census. 

  • • One attending

    • One fellow

• Red team - the "secondary" team in the PICU with lower acuity, overnight admissions that will have things like bronchiolitis, asthma etc. Will have ~ 30% of the census.

  • • One attending

    • There is a "float" fellow that will help with additional tasks in the PICU, but is not the Red service fellow. 

    • After rounds, the Blue fellow will assume care of all the patients, but there will still be 2 attendings. 

• One resident MUST be dedicated to the Red team. Rotators will start on this team as well (3rd year residents doing a "pre fellow" rotation, outside fellow rotators etc). 

• PCICU- the former CTICU is now a seperate unit and is covered by APPs and Fellows, so no resident coverage at this time. 

Daily Schedule

• 6:30-7:00am: Sign-out from NIGHT resident to DAY team

• 7:00-8:00am: Pre-rounding

• 8:05-8:15am: Morning Huddle (by PICU bed 1, front of PICU)

• 8:15-8:30am: Radiology Rounds, +/- "chalk talk"  lecture

• 8:30-11am: Rounds

• 11-12pm: Consults, Orders, Follow Up

• 12-1pm: ICU resident education (ICURE) lecture (Monday, Wednesday, Friday)

• 2pm: Daily progress notes to be submitted to the on-service attending 

• 1-5:30pm: Admissions, follow up with patients, updating HOTs, updating families, updating fellows, updating nurses

•  5:30-6:30pm: Sign-out DAY team to NIGHT resident

Pre-Rounding

• The single most important thing you can do: GO SEE YOUR PATIENT! DO AN EXAM! LOOK AT THE IV PUMPS/VENTILATOR! WHAT ARE THE NUMBERS ACTUALLY ON THESE PIECES OF EQUIPMENT?!

  • • • • The EMR is NOT updated in real time. If you want to know what your patient is actually getting, you have to go in the room and LOOK.

        • We much rather you NOT have all the “numbers” for rounds, but have instead seen your patient and have an ASSESSMENT and PLAN for the day

• You will document lots of numbers – Vitals, I/Os, labs, imaging – don’t just report these facts but interpret these numbers and how they apply to your patient

Notes/HOT

• You ARE responsible for the daily progress notes depending on the attending; check with the Blue/Red attendings on first day of service

• You ARE responsible for updating the Hand Off Tool (HOT) and the hospital course.

• You ARE responsible for PICU course/transfer note when you transfer a patient to the floor.

• You are NOT responsible for the H&Ps or discharge notes.

***Updating the HOT should be the LAST thing you do in the day: calling consults, placing orders, writing notes, updating the bedside RN, going to your patient to see how they progress throughout the day is your FIRST priority.***

Rounds

• Present to the Fellow!

• Please make sure the following people are present at bedside at time of rounds

  • Bedside nurse

  • Specialty providers (Nephrology for patient on CRRT, Heme/onc for sickle cell/Onc patients)

  • Parents/guardians (if appropriate)

• Please present in a "Systems" format

1. Start with patient one line summary

2. Discuss overnight events and your exam/current medications by organ system

3. Summarize your patient and give an assessment on how they are doing that day. 

4. Go through your plan, again by organ system 

• Orders should be completed on rounds. Designate a person to complete orders.

• Order readback after each patient on rounds - there is a "checklist" on each WOW for you to refer to.

• Designate one person to update the HOTs on rounds as much as possible.

• We do family-centered rounds in the PICU - ask families if they would like to join rounds. Precautions and extenuating social circumstances may prohibit this, please talk to Fellow or Attending if you have questions. 

Admissions

• Admissions are truly a team effort!

• Two residents should go to each admission - one person should be examining the patient and obtaining the history (including PMH, FH, SH), while the other person is placing orders. 

• After you gather the history, come up with a plan with the Fellow and the Bedside RN. 

• PICU residents are responsible for placing the "Admit to Inpatient" Order for patients coming from the ER or the Inpatient floor

  • PLEASE SELECT INTENSIVE CARE for the level of care (see below)

• Please use the PICU Admission orderset for ALL of your admissions!

• Order medications, labs, imaging as STAT (when we need things in the PICU, we actually need them, like, NOW!)

• Call consults ASAP

• Call consults with a SPECIFIC QUESTION IN MIND. If you are not sure about the exact question, please ask the Fellow/Attending

• Please update your Fellow/Attending with consultant recommendations. We do not necessarily follow all the recommendations from consultants so this is vital to patient care. 

• Follow up to see how your patient responded to a medication/intervention IN REAL TIME. 

• Walk over and TALK to your patient’s nurse in person instead of calling. If you put in a new order or change an order, make sure to tell the RN. PICU RNs are often busy taking care of the patient and aren't aware of new orders on the computer!

• Keep your Fellow updated! 

If you have a question, never be afraid to ask! And if you’re confused about why we’re doing something, definitely ask! You’re here to learn and as long as the Fellow/Attending isn’t actively in the middle of managing a patient we are happy to teach.