The medical ICU at Henry Ford Hospital is the largest in the state of Michigan, with 68 dedicated beds (and the ability to overflow into other ICUs). These beds are divided into four “pods”- fellows will round in one of the 16-bed pods with a resident team or the 20-bed pod with advanced practice providers. The patient population is identical throughout all four pods, except that pulmonary hypertension patients on continuous IV prostacyclin analogues are specifically cohorted in one of the teaching team pods (Pod 4).
Fellows participate in rounds and lead the plan of care development as they progress through training, and are the primary proceduralists for common ICU procedures, including intubation, arterial and central lines, paracentesis and thoracentesis, and dialysis catheter placement. Once proficient, fellows can supervise residents in any procedures in lieu of performing them themselves (with attending signoff).
Fellows are responsible for triaging both internal admissions and accepting outside transfers to the ICU, rotating this on-call responsibility each afternoon between the four fellows rounding in the ICU. (Triaging in the morning is done by the PFT fellow so ICU fellows can round.) Each day, the on-call fellow stays until the night fellows arrive at 7:30 while off-call fellows are usually able to leave between 4-5 PM. Fellows have one day off each week (on a weekday, to allow for continuity in service management on weekends) and rotate weekend on-call duties among the 4 pods.
Any MICU patient cannulated for V-V ECMO remains on the ICU service and is cohorted in the cardiovascular ICU. Fellows remain the primary providers for these patients and round with ECMO staff after normal teaching rounds, to maximize their exposure to ECMO management.