General schedule

6:30-8:30am: Pre-rounding for residents/interns and med students:

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1)     Unforward the phones so that calls go directly to the team responsible. See directions on workroom whiteboards. 

2)     Review overnight events from on call night float resident and resolve overnight issues. 

3)     Identify any unstable patients and see them immediately.

4)     Collect and record as part of the MICU daily progress note the previous 24 hour data on all patients on the service. Review nursing             notes, consultant notes, and procedure/test results.

5)     Medical students will practice their presentations and run through assessment and plan with residents, NP, or fellow. 

6)     The MICU daily progress note consists of overnight events and a system-specific problem list that should be started prior to rounds.         Complete the note during or shortly after rounds.  Notes must be accurate and updated.  This is a medical-legal document.  Use               ICD-10 diagnostic language and appropriate medical terms (ex: not “low platelets” but “thrombocytopenia”).

7)     Identify all patients meeting criteria for transfer out of the ICU. The MICU transfer note may be written on these patients in lieu of               the daily progress note.

8)     Identify any patient ready for pressure support trials and communicate with RN and RT the goal of liberation from mechanical                     ventilation.

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8:30am-noon:

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1)     Daily work rounds with attending, pharmacist, nursing, NP and/or Fellow and, when available, respiratory therapy.

2)     Orders should be written during rounds. Rounds are most efficient if a resident uses a WOW (work station on wheels) and enters                 orders while discussing the patient’s plan.  The person presenting should not be the person entering orders.

3)     Transfers should be confirmed and executed during morning rounds. The hospitalist team will ideally be notified of transfers by                 11:00am. Call the hospitalist triage pager (available on Amion). 

4)     Extubations should take place during morning hours if possible, but are also to perform in the afternoon or evening if approved by           the attending on duty. 

5)     After placing consult orders in Epic, call appropriate consultant for direct communication and request of consultation. 

       

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12:00-1:30pm:

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1)     On Mon, and Thurs: Residents/Interns and medical students should attend the medicine noon conference.

2)     On Wed: Residents/Interns and medical students should attend Grand Rounds in the East Building Auditorium.

3)     On Tues and Fri, a critical care attending or fellow will give a core lecture in the S6 conference room. Lunch will be provided. 

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1:00-4:30 pm: 

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1)     Implement the patient plans formulated on morning rounds. 

2)     Perform any planned procedures.

3)     Complete daily notes. 

4)     Have discussions/follow ups with consultants. 

5)     Update families and family meetings.

6)     Sign-out as appropriate to the on-call team. 

7)     Forward the phones to the appropriate number when signing out for the day. See directions on workroom whiteboards. 

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4:30-7:00 pm (On-call MICU team):

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1)     Evening discussion or brief walk rounds with attending (day and/or evening attending).

2)     Formulate overnight management plans.

3)     Identify patients who are candidates for weaning protocols and initiate protocol for either evening attending or enter appropriate             orders for the morning (hold tube feeds in the AM and ensure sedation/analgesic medication have the Richmond Agitation and                 Sedation Scale (RASS) goal of -1 to +1).

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7:00 pm-6:30 am (Night Float): 

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Provide cross-coverage of all MICU patients. Leave a progress note in Epic on any significant cross cover issues.

1.   Carry night float phone.

2.   Implement overnight plans and complete sign-out tasks.  

3.   Admit new patients. Write a complete MICU H&P template note on new admissions. Call the fellow and/or attending with any                   questions, concerns, or challenging cases.  NEVER WORRY ALONE.  It is better to call than not call.

3.   Respond to rapid response calls.  Write an RRT note.

4.   Respond to all codes.  Write a code note.

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Weekends Rounds:

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1. On weekend rounds, there will not be any core teaching sessions. Pre-rounds will remain the same.

2. The post call team can sign out once their work is finished.

3. The night float resident day off will occur on Saturdays and will be covered by a resident from an elective service ("doodle shift").