Surgical Critical Care

The HGH ICU is a twenty-four bed, mixed medical and surgical intensive care unit. During weekdays ICU + Trauma rounds are typically at 8:15 a.m. unless otherwise determined by the ICU or Trauma attending. The ICU residents are expected to present each trauma patient on rounds. They present after the ICU bedside nurse reports updates from an nursing perspective. In addition to reporting patient data, residents are expected to synthesize a treatment plan that is evidence based for each of the patient's active problems.

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In addition to presenting on morning rounds, you will be the first ”go to” person for issues in the ICU. Your role will be not only to keep the primary team apprised of new issues with patients, it will be to help manage patients while the primary team is in clinic or the operating room.

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The open unit format requires you to take primary directives from the admitting team of record. This often will be the trauma service or the Acute Care Surgery service. (occasionally the E1/2 services or Vascular) may have patients in the ICU. Regardless of primary, the rule still holds: the primary service is in charge of all decisions except for management of the ventilator and sedation.

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In addition to presenting on daily ICU rounds, you will be expected to write an ICU progress note for each patient. These notes should not be cut and pasted from previous notes. They should be synthesized new each day based on overnight events and the daily progression of the patient’s clinical findings. Only the key findings of radiology studies should be relayed in daily progress notes, NOT the entire dictation from the radiologist.

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Family Connect Notes

 

In addition to progress notes, the patient should also get ”family connect notes” twice a week. One note for the first half of the week ending on Tuesday.  The second should cover the second half of the week ending on Friday.

 

These notes should refer to conversations with available family members regarding the patient’s status and cover the key components of the discussion. These notes do not not need to be long unless the patient's bio-psycho-social situation demands it. The goal is for them to be a log of communications with the family regarding the patient's course in the ICU.