GOALS AND OBJECTIVES OF ROTATION
Click Here For CCU Curriculum
Click Here For ICU Curriculum

Manage acutely ill medical and cardiology patients

Understand ventilator management

Understand hemodynamic monitoring using PA catheters

Understand and utilize vasoactive pressor medications.

Refine skills in history taking

Refine skills in physical examination

Refine skills in ordering and interpreting diagnostic skills

Refine procedural skills (thoracentesis, central catheter etc)

Refine skills in communication with patients

 

Team Compositions

ICU is composed of 2-3 R1s, one R2, and one R3

CCU is composed of 2-3 R1s, one R2, and one R3

Ectopic 1-2 FPR1s intermittently through the year

Ectopic SubIs intermittently through the year

 

Patient Volume per resident

R1 is responsible for up to 5 patients

R2 is responsible for a maximum of 2 patients, when R1’s are capped

SubI is responsible for a maximum of 2 patients under the supervision of the R2

 

Patient Location

ICU covers the ICU and medical patients in the STU

CCU covers the CCU and medical cardiac patients in the STU, if CSU is closed,

PACU is covered by the WICU daylighter or moonlighter

Coverage may vary depending on season and availability of moonlighter for CSU and PACU

 

R1 Responsibiities

AM system note and a PM update note

An intern H&P on every unit admission

Admission orders for new admits

An intern Accept note on patient transferred into the unit and a Transfer note on patients leaving the unit

There will be no longitudinal clinic office hours during Unit rotations

Management of patient PRN problems

Supervised procedures PRN

Doc-to Doc messages for on-call team

Post call interns will be expected to complete AM notes and signout by 11AM.

Morning progress notes are to be written after AM sign in rounds.

 

R2 Responsibilites

Distribution of patients at sign-in

Always available in the unit for intern prn problems

Procedures

Attend AM and PM rounds

Provide current literature for patient management

Teach R1’s

Supervise SubI

R2s will cosign all R1 notes

Notes, when interns are capped

All admissions with an intern

An upper year H&P on all admissions

Bed Clearance for all new admits and transfers

12) R2s will not have longitudinal office hours during unit rotations

 

R3 Responsibilites

Plan daily agenda prior to morning report

Supervise and teach R1’s and R2’s

Know all medical patients in the unit

Check R1’s progess notes and H&P’s

The CCU R3 is responsible for all CODE 30’s in AMH, with ICU R3 as back-up

Conduct AM Radiology and PM rounds

R3s will not have longitudinal office hours during Unit rotations.

Admissions with an intern, when R2 is not available

Cross-cover Chief R3 ( alternating CCU/ICU R3), when the Chief R3 is in office hours

On Call and Weekends

· 3B or surgical consults within 24 hrs if not done by the ambulatory R3

· Backup for 1W interventional unit and 2W

· Chiefs admissions and coverage of chiefs patients

 

Daily Schedule

1) Sign in at 7:00 am at unit board (R1 on-call, daytime R1’s, and one upper year must be present)

2) 7:00-8:30AM personal patient rounds

3) 8:30-9:30AM morning report

9:30 AM Radiology/Work Rounds with R2 and R3

AM system notes

Noon Lecture

Attending rounds 3-4x/week

PM work rounds and update notes

Doc to Doc messages for on-call team

4:30-5:00 PM sign out in Conference Room (All R1’s in the unit, one upper year from each unit, and the on-call team must be present.

 

Commnication Issues

The Admitting Officer(x13197) needs to be called about all transfers out of the unit to a teaching floor

Updated Doc to Doc Messages. See GMF Description packet

Interns are required to enter their name and beeper on the primary resident sceen.

The CCU team is responsible for all daytime CODE 30’s

All on-call unit persons are required to respond to nighttime CODE 30’s

Neurosurgery patients are covered by the Long-call moonlighter after 5 pm weekdays and the full weekend

Unit admissions are the responsibility of the daytime residents until 4:30 pm

Ectopic interns and residents on-call must be present at 4:30 prompt for sign-out. It’s the responsibility of the resident to make their outpatient/clinic preceptor aware that unit call begins at 4:30 pm

 

 

Weekends

Saturdays: Sign-in at 7:00 am. Patients seen and notes written. AM work /radiology rounds. Interns cross-cover for the intern on-call Sunday. At least two upper years, between both units, need to be present to supervise. . Sign-out at 11AM on Saturday.

Sundays: Sign-in at 7:00AM . Notes written by On-call Saturday and Sunday
teams. Sign-out in AM, after all patients are seen.