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CTICU at UCH ​

Important People ​

CTICU Attendings Sarah Alber, MD Sam Gilliland, MD Kenji Tanabe MD Hans Tregear MD Jenna Cottral MD Andrew Hennigan MD Marianne Wallis MD

CTICU APPs: Caitlin Blaine, PA (lead), Lisa Bauers NP, Terra Busse PA, Kelly Dever NP, Phil Logan PA, Sean Meehan PA, Nora Metz NP, Stephanie Schneider PA

Overview ​

The CTICU is split up between two provider teams (Red/Blue) each with their own attending. Attendings rotate on a weekly basis changing over each Monday. The attendings alternate days for admissions. You will bounce between teams (sometimes split between teams) based on which patients you are assigned. Typically, the APPs will send out a text the night before with the next day’s patient assignments. Generally, the CTICU is well staffed. You will typically be assigned 3-4 patients during the day.

Daily Workflow ​

Most days follow the same pattern, first thing in the morning is fellow rounds with the CT Surgery fellow, followed by pre-rounding, ICU/Attending rounds, then everything else before signout at 4p.

Fellow rounds ​

Arrive around 5:45 – 6:00 AM depending on the census. I overnight resident will have printed off a sign out list for you and filled in many of the numbers (Vitals, Swan numbers, I/Os) The overnight residents/APP will then present all the cardiac patients on fellow rounds. The night resident will briefly present cardiac patients ONLY to the cardiac fellow. – There you will hear a brief daily plan from the fellow/night resident. Thereafter, the night resident will give sign out on the rest of the unit patients (Thoracic and Vascular patients) and answer any questions.

Fellow rounds presentation tips

  • Goal of 2-3 mins per patient
  • One liner with notable 24H events
  • Remains in the ICU for the following
  • Resp status (how much NC or vent settings)
  • Review of vasoactives
  • Overall I/O total and did we hit our goal; what's our diuresis plan, is CRRT something like we need to consider?
  • Drains in place with outputs and how we will manage them
  • Pacing wires present? How will we manage them?
  • Pertinent labs: CBC, coags, SCr, ABG
  • AC plans?
  • Finally, high-priority, patient specific items if needed

Pre-rounds ​

You then have time between fellow rounds and attending rounds to completely lookup and familiarize yourself with your patients. Including: talking to their RN, performing a quick and focused exam, reviewing patient data (labs, I/Os) in EPIC, starting the daily progress note and write any urgent orders (transfuse, electrolytes replacement, etc.); always try to glance at the daily CXR before rounds. Make sure everyone is seen by the time rounds start. There are rare days where you will be assigned more or less.

Attending rounds ​

CTICU attending rounds start around 8 AM and the length is quite variable depending on the attending, ranging from brief to comprehensive (surgical attendings prefer brevity).

TIP

Attending rounds presentations:

  • Start with Name, POD# s/p surgery. Note any significant intraoperative events.
  • Then significant 24hr events.
  • Then jump to Assessment/Plan by system (Neuro-including sedation/pain, CV, Pulm, Renal, ID, Endo, FEN.
  • Finish with review of invasive lines, meds and dispo.

Shifts ​

There are essentially 4 types of shifts: Weekday rounding (6AM-4PM), Admitting M-F (10AM-10PM), Weekday night call (4PM-7AM), Weekend 24h call (7AM-7AM)

Weekday Rounding ​

6AM-4PM, you should plan on arriving shortly before fellow rounds. The overnight resident/APP will present the cardiac patients, so you don’t need to worry about fully looking up your patients prior to fellow rounds. Fellow rounds will begin at 6 AM T/W and 6:30 AM M/Th/F. Fellow rounds are BRIEF and typically take 2- 5 minutes per patient. The presentation should be concise and focus on drips (inotropes, vasopressors), drains, line, and wire management. The fellows will make decisions on which drains to pull based on your I/O info. Pay close attention to the location of the drains, typically mediastinal or pleural (sided R or L).

Admitting ​

Weekdays 10AM-10PM: When you are assigned an admitting shift (generally a few times per month), you arrive at 10AM, check the OR board or that days cardiac/thoracic cases destined for the CTICU. Check in with some of the APPs they usually know the latest info about the cases. You will then prep the handoff, put in ICU admission orders and await the new admits arrival. You will admit the days post-op patients, stabilize and cross-cover them until signout around 10PM. If it is slow and no other patient on the unit is crashing, you may be able to sign out early.

Weekday Night Call ​

Shift begins at 4PM, you split the list with an APP or surgery moonlighter and get signout. At approx. 10PM or earlier if it is slow, the admitting provider will sign out the days admits for you to cross-cover overnight. If any admits come in after the admitter goes home, you are responsible for admitting (alternating with APP/moonlighter) and staffing with the attending overnight.

Weekend 24h Call ​

Shift is 7AM- ~8AM the following day. Arrive shortly before 7AM for fellow rounds with the overnight team. You will split the unit with 1-2 APPs. You will round and carry out duties as normal. You will split daytime and overnight admissions with the other provider on the unit. At 4PM the day APP signs out and you will split the list with either another APP or a general surgery moonlighter. Fellow rounds begin the next day at 7AM on Sunday and 6:30 AM on Monday. You are responsible for pulling drains/tubes/wires as discussed on fellow rounds prior to going home.

Call Schedule ​

It isQ4 call in the CTICU. Weekday call shifts start @ 4 pm. You will get sign-out from the day team and then cross-cover those patients until the morning. The weekday admitter will sign out the days new admits to you around 10 PM (potentially earlier if it is slow). You will present the cardiac patients at fellow rounds in the morning and sign out thoracic patients directly to the day resident/APP covering those patients. For weekend 24h call you arrive on Sat/Sun at 7AM with fellow rounds shortly to follow. The overnight resident is then allowed to go home, and the day resident and one or more APP split up the unit. The APP will typically stay until around 4pm on weekends when a general surgery moonlighter arrives, at that point you re-distribute the unit for overnight coverage.