STICU

Most Recently updated June 2025 by Sean Stevens MD

Anesthesia Attendings: Jason Brainard, MD; Naveen Kukreja, MD; Ben Scott, MD; Josh Douin, MD; Jacob Basak, MD

EM/Critical Care Attendings: Julie Winkle, MD

Surgical ICU Attendings: Clay Burlew, MD; Mitch Cohen, MD; Michael Cripps, MD; Joanna Etra, MD; Kristy Hawley, MD; Juan Pablo Idrovo, MD; Whitney Jenson, MD; Aaron Marshall, MD; Robert McIntyre, MD: Lauren Steward, MD; Catherine Velopulos, MD; Frank Wright, MD;

STICU APPs: Zach Asher PA, Marcus Barlow PA, Kimberly Berry NP, Lauren Fukuhara PA, Gregory Gleckler PA, Madison Hexter PA, Drea Horne PA, Frankie Macri PA, Caroline Kirby PA, Heather Stuart PA, Annabelle Thomas NP, Stephanie Victoria PA

Schedule and Call

The schedule loosely follows a standard rotating schedule of “rounding, rounding, late, call, post-call.”

If the call shift lands during a weekday, it’s an overnight shift, see details below.

If the call shift lands on a weekend, it’s a 24-hour shift, see details below.

If rounding lands on a weekday, it’s a day shift, see details below.

If rounding lands on a weekend, it’s a day off (no clinical duties)

Rounding – Weekdays. Come in prepared by 6 am and receive sign-out from the overnight team. Round and be primary for your patients until sign-out begin at 4pm.

Late – On weekdays, come in at 6 am like a rounding provider. No change to daytime schedule except you will receive sign out on your team from the other residents/APPs at 3pm and will stay until 7 pm and sign out to the moonlighter. This was implemented to reduce handoffs and the number of patients the call overnight person had in the late afternoon. Late days typically happen 1x/resident/week and often are the day before your call shift.

Call- Weekdays you come in at 3pm. You will receive sign out or do a brief walk/work rounds to find out what happened during the day.  Drs. Scott & Brainard, in particular, prefer walk rounds. Once sign-out is complete, the other resident and APP(s) will leave for the day.  At that point, you will manage the team overnight. Usually, a fellow will be available (from home) throughout the night and will be your point of contact. If a fellow is not scheduled to work that night, you will contact your attending. Some attendings will want you to call around 7-8pm to run the list. A moonlighter will come in at 6:30 pm, who takes half of the patients and will split admissions. After everything has settled, you will do brief walking rounds with the Moonlighter + Charge nurse at 10pm to see if the bedside RN needs anything or has any questions.

TIP

PRO-TIP – if you do these night rounds well, your overnight calls/messages will be drastically reduced.

Weekends/Holiday - come in and round like a normal day at 6am, stay all day and overnight (24 hours + 4 hours as needed to finish patient care tasks). Round with the charge RN around 10pm. Sign-out to team coming on at 6am.

Post call- You will sign-out patients to the day team in the morning and head home.

You don’t come in on the weekends except the days you are scheduled to be on call.

Daily Workflow

Pre-Rounds: Sign out occurs at 6am sharp. You should plan to be there 5 minutes before to print your list and get settled. At 6 am, you will receive sign-out from the post-call resident to see what happened to your patients overnight (they bled, they coded, etc.), and see if there were any overnight admissions that need to be seen.  Patients are divided between the residents / APPs. You will sign-in to each of your patients as their “Primary contact” in EPIC (if unsure of how to do this ask a senior resident to APP). Please remember to also sign in to the STICU Admit team, as well. Then go around and see your patients, talk to their RN, and perform a quick and focused exam. Pre-rounding physical exam should include surgical wound exam and knowledge of color, consistency, and volume of all surgical drains. Next, review patient data (labs, I/Os, cultures) in EPIC, start the daily progress note (see EPIC instructions below) and write any urgent orders (transfuse, replace electrolytes, etc…).

If time permits, write/review orders for the next day’s labs, films, etc. The STICU is a single order entry unit.  We (the STICU team) put in most of the orders (the exception being that all immunosuppression orders are entered by the transplant team).  However, the co-managing surgical team (TACS, Green, Transplant, ENT, etc.) places the initial admission orders.

Make sure everyone is seen by the time rounds start.

Rounds

STICU rounds start at 8 AM on weekdays and weekends. Rounds are variable and attending dependent but expect to go from room to room starting with co-rounding on transplant patients (often starting with the post-call resident’s patients) and each resident will present their patients.  The other resident (who is not presenting) should grab a “workstation on wheels” to round with and write any orders that might come up and make sure there are orders for the next AM.  If you are not presenting or writing orders, you are expected to update sign-out. These tasks are often divided between the rounding APPs and residents; good communication is key!

Once rounds are finished, make sure all orders have been placed as discussed on rounds, any consults are placed, procedures are taken care of, and get your notes done. Patient care should take priority over documentation, so make sure that the patient care tasks take precedent.

Transplant patients will be presented by the transplant APPs. Many attendings will want to round on the patient again for thoroughness.

Presentations

All attendings prefer system-based presentations. Start with Name, POD# s/p ‘x’ surgery. Followed by significant 24hr events. The bedside RN will present pain, sedation, mobility, skin, and indwelling lines.  Then jump to Assessment/Plan by system: Neuro-including sedation/pain, CV, Pulm, Renal, GI, ID, Heme, Fluids/Electrolytes/Nutrition. Finish with review of invasive lines (plans on whether they need to remain or can be removed), big daily plan and disposition. Make sure to know urine and drain output – both quantity and character (i.e., 150cc of serosanguinous output overnight).

Rest of the day

Check the OR board for expected ICU admits.  If time permits, read about them briefly and add them to the list and update the sign-out with basic information from the chart (PMH, PSH, Medications, ect.).

All major changes in clinical status (intubation, pressors, etc.) should be communicated to the primary teams.

Monday, Tuesday, Wednesday, and Friday there is lecture from 12-12:30 about various critical care topics.  Please make every attempt to attend. It will rotate between the 2nd floor CTICU conference room and the 5th floor STICU conference room in AIP2 unless otherwise specified. Thursday there is noon critical care grand rounds, which you are expected to attend via Zoom.

New admits

When a patient is admitted to STICU, the primary team writes the initial admission orders. They also should talk to you either in person or over the phone to give you report (reason for admitting, OR events, plans).

TIP

PRO-TIP – Key items to clarify with primary team in admission include diet, anticoagulation / antibiotic plans, return to OR plans and any vital sign parameters (SBP, MAP, ICP, etc.) that will need to be closely monitored

Patients will usually come directly from the OR to ICU accompanied by an OR RN, anesthesia provider, and member of the surgical team. On occasion, they go to PACU because ICU was not initially intended or there are no ICU beds available. In these instances, make sure to speak with the anesthesia/surgical teams (they should reach out to you, but do not always do so) and go down to PACU and evaluate the patient to make sure they do not have any problems that require immediate attention.

Make sure you evaluate the patient, do a focused physical exam, & review EPIC for pertinent info (brief medical hx, meds, labs).  The OR Anesthesia team should also contact you to give you report (OR course, airway, I/O’s, drugs given, drips, IV access, invasive monitors, etc.).

You will write a STICU Accept Note (progress note) in EPIC. (note template is .sticuprog24) Then order/follow up on labs/CXRs and manage critical care issues that arise including placing any invasive monitors if needed.

INFO

Note: Some teams are VERY hands on (transplant), and some don’t care what you do (ENT, ortho).

In general, discuss all major management decisions with the primary surgical service (during the day); not for their permission, but just to maintain good communication among the team members.

For liver transplant patients, run just about every management decision (no matter how small) by the transplant fellow. You should also be expecting to communicate with them every hour (phone call or EPIC message depending on their preference) with new labs and drain output immediately after they come from the OR.  You will quickly get a feel for how hands-on vs. off they will be for each individual patient.

TIP

PRO-TIP – For all new patients, know and document the exact location of every drain and what portion of the body it is draining (i.e., Drain #2 liver bed, next to caval anastomosis), neuro exam for vascular or trauma patients, pulse exam, etc. Surgical attendings will want you to be very specific.

EPIC for STICU

How to modify your EPIC for ICU use:

Use the EPIC button on the top left to “change context” to “zz intensivist” from “zz anesthesia.” to “zz intensivist.”

From the “patient summary” button use the wrench function to add parameters to your toolbar. (Names may change slightly from year to year)

• Comprehensive flow sheet (or “adult comprehensive” or “comp”)
• Pain management (or “pain”)
• Microbiology (or “micro”)
• MAR (or “meds history”)
• Fever (or “fever”)
• Intake/Output
• LDA (or “lines/drains/airway”)
• Blood Transfusion (or “transfusion”)
• Anticoagulation
• Alcohol Withdrawal Monitoring (or “ETOH”)

Add order sets to your favorite list by right clicking on “order sets” Useful ones are:

• UCH Adult IV insulin Infusion
• UCH Subcutaneous Insulin for TPN or Tube Feeding
• UCHS Subcutaneous Insulin: Basal/Bolus for PO, NPO, or bolus TF
• UCH Pain/Agitation Management for mechanically ventilated patient in the ICU
• UCH Blood Administration: Inpatient and Emergency Department
• UCH Heparin Continuous Infusion CTICU/STICU Anticoagulation
• UCH Intravenous Patient Controlled Analgesia (IV PCA)
• UCH Enteral Tube Feeding
• UCH ICU Electrolyte Replacement Guideline
• UCH End-of-Life Care for the Intensive Care Patient
• UCH Neuromuscular Blockade – Adult ICU

To get to the STICU Patient lists (this must be shared with you):

Patient lists at top → Shared Patient lists → STICU…

To add someone to your shared lists (SubIs or new Residents coming on service), Click on the list, click “Properties” the “Advanced” tab. Scroll to the bottom of the list and add the name and under Access Level—type “5” then accept.

Add & Remove Patients from the STICU list as they are admitted and discharged.

(Remember to also add the patient to the SICU Sign-Out Report)

TIP

PRO-TIP: Do not copy and paste from EPIC to the signout. This messes up the font. It is acceptable to copy and paste from the signout to EPIC.

To add templates for STICU notes:

EPIC → Tools → Smartphase Manager → Change USER to Anesthesia, Resident → click GO.  This will automatically import STICU progress note, STICU accept note, STICU CT progress note templates that have been created and have already been shared with you. Highlight all templates. Then click on “Share” then accept to share this with yourself.

Now to start a note---go to “New Note” then to add a template, click on the “list my phases” to the left of the green plus sign (little dude in purple shirt). Pick STICU progress note (or STICU accept note for new patients)

Finish notes by scrolling through dot phrases etc. using F2 button.

You can copy your progress note from the day prior by selecting the “Copy” button on the upper left corner of the note pane. This will automatically refresh any lab links. Be sure to edit all the info in that note, so that you aren’t still writing that the patient is intubated and sedated when they are not.

STICU Pearls:

It is helpful to come to the STICU ahead of your rotation as time/schedule permits to get orientated, access to the shared patient list, and tour the unit.

Never transfuse a transplant patient without talking to their team first (usually not team pager/first contact, but senior resident/fellow or attending).

Call your attending with any major issues, or with any questions, they would rather you call than not, and they only do 1 week at a time, so it’s not as bad for them.

Discuss all consults with primary team, especially ID and palliative care.

Sign out should be given to the primary team for all downgraded patients especially ortho and TACS. You don’t have to write a transfer summary as the primary team already knows the patient. TACS requests a handoff note if transferring to a lower level of care after 6pm

Talk to the nurses about what they might need BEFORE you lay down, if you get the chance (between 8pm and midnight is a good time). Walking around with the charge nurse and a “workstation on wheels” during these unofficial rounds helps ensure everyone is on the same page and allows you to rapidly add/change orders.  This will save you 2 am phone calls and build your rapport with the nursing staff.  This vastly improves your ICU experience!

There is ALWAYS an in-house TACSs attending and an in-house intensivist (MICU) to call if you need help with a line or if there are any questions. There is also a surgical R3 who may be available in the ER or OR.

When extubating, get ABG on PSV, weaning parameters (NIF, FVC, secretions, cuff leak test) - obtained by the RT, RSBI, and then call the attending with your plan.  Only write the order to extubate after confirming with you attending. The RT will usually do the physical extubation for you, but it is a good idea to be present.

Ask for help if you need it, from nurses, APPs, fellows, surgical and other anesthesia residents, or attendings. We are all here to take care of patients and work toward their best possible outcomes.

The STICU protocols that Dr. McIntyre and Dr. Brainard have put together is a helpful resource and is now online. Make sure to peruse it before you start your rotation! http://www.ucdenver.edu/academics/colleges/medicalschool/departments/surgery/divisions/Trauma/Trauma-at-UCH/Pages/STICU-Protocols.aspx

The STICU APPs are listed at the beginning of the section. They see about the same # of patients as you each day and are staffed on both weekend days. They are an extremely valuable source of information about how the STICU service works, critical care, and attending preferences so learn from them and treat them well! Please notify Zach Asher (Zachary.asher@cuanschutz.edu ) if there are any concerns about the APPs in the STICU.

There is always a STICU fellow (sometimes 2), who is also helpful. The Fellow may run rounds, do procedures with you, or act as first call or attending during certain times.

Door Codes

Call Room -- badge access

Store/Pyxis Room -- 3030#

Break room -- 9669#

Rooms that don’t have badge access -- 9669#