In order to adhere to resident team caps of 18 and to distribute patients evenly when MICU is overflowing, please adhere to the following guidelines for MICU admits. Triage fellows please contact GAP staff for advice. GAP staff should be your resource for staff-to-staff discussions.
CICU Triage: During MICU high-census periods (>60 beds), patients with significant cardiac diagnoses (Heart failure, HTN emergency, cardiac arrest,arrhythmia) may be triaged to CICU Service (CICU Triage Fellow: 916-4484). If disputes arise concerning MICU vs. CICU triage, notify Unit Directors (Drs. Mendez, Hudson) so that admissions and workload are equitably shared.
61-66 beds: Admit to resident teams until cap of 18 is reached. Overflows into our own ICU pods don’t count towards cap
67-68 beds: Admit to Green Service
>69 beds: Please notify Drs. Mendez, DiGiovine, or Tatem to arrange for coverage. This may include 1) extra fellow moonlighter 2)creation of ad-hoc ICU team with F2 staff and fellow 3) arrangement of weekend coverage
Admit appropriate P4 overflows to SICU team. In these situations, please consider repatriating a stable existing MICU patient to the SICU team on P4 (or already overflow on p4) so that a new patient can be taken by the MICU. Triage fellow will notify the P4 charge nurse of the admission (16-0547) and discuss assignment to SICU team 2 or 3. The fellow will discuss patient with either the SICU fellow (313-614-2525) or the appropriate SICU team (team two-16-0854 or team three;16-0544) when bed is assigned.
In all situations above, triage fellow, charge nurse, and GAP staff should work together to assess for repatriation of high acuity overflow to home pod, including swaps with lower acuity patients to overflow ICU.
Specific situations:
In-house ICU to MICU transfer requests: During periods of MICU overflow, we will generally be unable to accommodate most HFH ICU (SICU, CICU, NICU) to MICU transfer requests. IPD consult fellow/Staff should preferentially consider “accepting” patients already in MICU beds or after bed available in an MICU pod. Please do not automatically accept a patient if we are overflowing. This will likely require staff to staff discussion to let the transfer request team know that we are available as consultants but that we are awaiting open beds. On weekends, Green Moonlighting Fellow will see new/pending patients and staff with Green Rounder. On a daily basis, IPD consult team should see/staff these patients everyday and assess for MICU bed availability and repatriation.
ED/GPU to MICU transfer requests: Any patient (ED or Floor) that is evaluated and not accepted to MICU must be staffed (GAP staff on weekdays, Green on weekends) and a brief note generated.
Outside transfers: All outside transfers should be accepted – ATMO will work on finding a bed. If we are full and overflowing, we can then work on our contingency plans as outlined above.
In order for these contingency plans to work most smoothly, we will need to communicate closely and consider direct MICU staff to staff communication with our CICU/SICU colleagues. Something along the lines of, “Our MICU pods are full and we are in a high overflow census situation, as previously agreed upon by our department leader ship, we will need your help…..”
Please, let me know if you have any questions or suggestions,
Mike Mendez, MD
Director, MICU
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