For: Medical Critical Care and Emergency Medicine Critical Care Fellows
Goals, Expectations, Duties and Responsibilities.
During the rotation, the fellow will build on a pre-existing knowledge base and continue to develop an in depth understanding of physiology, pathophysiology, and diagnosis of critically ill surgical patients in order to formulate treatment plans. The fellow integrates knowledge to teach other members of the SICU team both at the bedside and in formal lectures. The fellow will develop critical analysis of surgical clinical problems, the ability to prioritize patient care needs and make appropriate patient care decisions.
The fellow rotates in a 40 bed Surgical Intensive Care Unit. A concentrated experience is provided in managing critically ill general, colon and rectal, acute care/trauma, vascular, and transplant surgery patients. Each team has a Senior Staff Critical Care faculty, a fellow and residents. Residents are HO1, HO2, and HO3 from the departments of Surgery, Otolaryngology, Neurosurgery, Orthopedic surgery, Urology, Obstetrics and Gynecology, Anesthesia and Emergency Medicine. Under the direct supervision of the faculty, the fellow will learn to lead the team and supervise the residents.
The Surgical Critical Care Unit is a semiclosed unit. The operating surgeon/chief resident retains responsibility for the patient. The SICU team provides minute to minute bedside care and updates the surgical team and family. Bedside procedures, emergency management and daily SICU patient care are provided by the SICU team. Management decisions are discussed in a collaborative fashion. Differences of opinion are bumped up to the senior staff as per the chain of communication.
The fellow is expected to round 3 weekend days a month and will cover both teams. During the week there is a Senior Staff present in the unit until 10pm after which time coverage is provided by the Senior Staff on trauma call. The fellow is expected to take home call to provide advice to the residents. There is an HO3 from the department of Surgery On-Call 24hours/day whose responsibility is to assist the unit residents.
Educational Goals and Objectives
Medical Knowledge:
Demonstrate the application of medical knowledge by formulating an evidenced based treatment plan
Contrast surgical resuscitations (trauma) with medical resuscitation
Discuss therapy and complications in trauma and head injury patients
Understand the pathophysiology of surgery and its influence on ICU course
Patient Care:
Use evidenced based and relevant plan to treat critically ill surgical patients
Recognize, evaluate and treat postoperative surgical complications
Use ultrasound to aid in bedside diagnosis
Use technical expertise in critical care procedures
Demonstrate ability to lead bedside rounds
Practice-Based Learning and Improvement:
Understand the importance of an open unit and its conflict
Demonstrate responsibility for teaching, monitoring and evaluating the performance of the residents
Assume responsibility for teaching both bedside care and procedures to residents
Participate in monitoring protocols of care to improve practice
Interpersonal and Communication Skills:
Demonstrate effective communication skills with nurses, technicians, surgeons, residents and consultants involved in the care of surgical patients
Demonstrate the ability to develop effective management plans in collaboration with surgeons
Professionalism:
Develop effective relationships with consultants, surgeons, nurses and other health care providers
Demonstrate compassionate and effective methods for communicating with patient and their families
Demonstrate sound ethics principles in the care of critically ill surgical
Demonstrate good hygiene and appropriate dress
Systems-Based Practice:
Understand the role of surgeons, respiratory therapists, nutritionists, consulting specialists
and other healthcare professionals in the management of surgical ICU patients
Demonstrate knowledge of the cost-effective utilization of laboratory, radiology and
diagnostic testing in the SICU setting
Display Proper coding, billing and timely completion of procedure notes
Duties During the month:
Prior to first day:
Obtain sign-out regarding existing patients on current service from outgoing fellow.
Discuss plans with colleagues and others regarding typical workings and running of the service.
Focus reading prior to arrival on peri-operative issues.
Arrange, as a professional, logistics for first day, start time and any issues related to delays, vacations, time-off needs, call for other services.
Arrange weekend coverage schedule for month in collaboration with other fellows.
Daily:
Arrive before rounds begin.
Pre-round on patients requiring additional needs and who are unstable or potentially extubatable.
Establish priorities for rounds.
Begin rounds at 8AM, regardless of presence of staff rounder.
Contact staff rounder if they are not present shortly thereafter.
Attend the orientation and the majority of 9:00 or 9:30 a.m. teaching conferences.
Complete rounds after teaching conference and then verify and prioritize work for the team.
Monitor and assist with procedures
Re-round continuously throughout the afternoon.
Give detailed sign-out on critical patients to evening ICU and night team.
Cover fellow phone to obtain sign-out on all new admissions
Monitor duty hour compliance of all team members.