MEDICAL ICU SERVICE TEAM: STRUCTURE AND EXPECTATIONS

STRUCTURE:
The ICU team is divided into 2 teams (except on weekends and holidays). Each team typically
consists of the following:
 One attending intensivist per team
 +/- critical care fellow
 2 teachers: medicine- R3s or R2s (second half of year), med/peds- R4s
 2 learners: R1s or R2s (first half of year)

EXPECTATIONS:
Expectations for the ICU Rounder (may be any level resident):
Patients will be split among the rounding residents. Ideally, the senior resident will follow patients
that they admitted. Generally, the admitting resident should have the fewest patients to cover as
they will likely be pulled away from the floor for consults and admits.
1. Pre-round on patient. Collect all appropriate data, discuss events with NF and bedside
nurse, prepare for rounds, which is to include completing a “purple sheet”, i.e., “ICU Daily
Communication Checklist and Plan of Care”, prior to rounds on each patient.
2. Write/review orders on patients. If other residents enter orders on your patient during
rounds, you are to check that they are accurate.
3. Update nurse, ancillary staff and family as necessary.
4. Write daily progress notes, transfer/discharge notes, accept notes, admission
5. H&P.
6. Take admissions as necessary.

Expectations for the Day Senior Resident:

1. Each R1 should be paired with an R2/R3/R4.
2. Review data, current orders, and plan with R1 before rounds as needed.
3. Provide guidance to the R1 in their patients’ management.
4. Go over all discharge summaries for the R1s.

Expectations for Day Admit Resident:

1. Arrive 9am to 9pm shift
2. Sign into ICU admit pager 90707
3. Gets calls from the triage attending on admissions for the ICU and does admissions or
assigns to other residents as appropriate.
4. Available for Floor ICU consults and RRT critical care back up.
5. Act as Code Blue leader for all the wards with the exception of the surgical ICU.
Expectations for Night Team Senior:
1. Arrive 8:30pm for sign-out from day team. Signout should be at table and should finish at
9pm
2. Signout is done in IPASS Format
3. Supervises and helps the R1 in cross-cover issues.
4. Gets calls from the triage attending on admissions for the ICU and does admissions or
assigns to other residents as appropriate.
5. Available for Floor ICU consults and RRT critical care back up.
6. Act as Code Blue leader for all the wards with the exception of the surgical ICU.
7. Helps the intern split patients for the upcoming day team
8. Leave by 9am

DISCHARGES AND TRANSFERS:

1. The senior resident is responsible for all discharges in the first 6 months. Additionally, senior
resident responsible for ALL discharge summaries from off-service residents for the duration
of the year. Every patient must have a discharge summary written prior to transfer to the floor
ward team.
 When a patient is anticipated for transfer to the floor, an order will be placed in CIS, patient
placement (x42337) will be called, and the ICU Charge RN will be informed.
 Patient placement will arrange for a “3 way call” with the gridholder to whom the ICU
transferring resident will give report.
 The ICU resident will place an MD to RN order as follows: “Once the patient is on the floor
please page the medical admit resident on pager # 93076.”
 When the patient is physically ready to leave the ICU, the resident will clean up the ICU
orders (if not already done) and send an FYI page to the gridholder that the patient is leaving
the ICU.
 Once patients are identified for transfer, the process must be initiated without delay. Do NOT
wait until after rounds.
 If there are any concerns re: the patient’s smooth transfer to the floor, please notify RRT
(x40436) so that the RRT Resource RN can facilitate transfer of care.
DAILY ALLOCATION OF PATIENTS FOR THE ROUNDERS:
 For allocation of patients by the post-call team to the incoming rounders, please make sure
you look at the block schedule for all residents on a daily basis. This is important to note who
to expect each day.
 The admitter comes in at 9am and therefore should not be assigned patients
 Patients will be split among the rounding residents. Ideally, the senior resident will follow
patients that they admitted.

Expectations for Fellow:

1. The ICU fellow should be aware of all unstable patients.
2. Assist the residents with developing and completing plans of care as needed.
3. Cover patients beyond ICU resident cap of 18 (usually in SICU, may be in HVCC).

MORE SPECIFICS for DAY-DAY from PRIOR ICU TEAMS

MICU patients in the SICU or HVCC
 If there are a reasonable number of patients in the SICU (or HVCC), only one resident should
be assigned to cover them.
 The resident covering patients in the SICU (or HVCC) should join regular rounds as possible.
 This resident should NOT be one of the on-call residents, as on-call residents are required to
participate in formal MICU rounds.
 MICU patients in the SICU (or HVCC) are precepted with the "triage" attending.

ROUNDS
 Arrive 6-7am to receive signout from overnight team (note senior residents may come in a
little later before 8 as long as they can be ready for 8:30 rounds)
 Someone should bring a "workplace on wheels" and place orders as you go.
 If the attending is not completing the “purple sheet”, i.e., “ICU Daily Communication Checklist
and Plan of Care”, then the fellow or 1 of the residents (NOT an R1) should be doing so by
verifying/annotating the checklist while the resident presents and creating the “To Do” list for
the day. This sheet needs to be initialed by the rounding attending before it is left at the
patient’s door.
 Daytime rounds usually occur around 9 am and 4 pm. On the weekends and holidays,
afternoon rounds are sometimes not done.
DIDACTICS
 There are daily didactics that take place while on the rotation. These consist of lectures and
simulation sessions. The schedule is posted on the new ICU website and is also on the door
of the workroom. One resident should take charge of ensuring lectures happen on a
daily basis. This is mandatory for all residents.
 Please make sure you are on time for the SIM session as an ICU attending and simulation
coordinator will be expecting you.