The ICU on 5 South is a combined coronary care (CCU), medical (MICU) and surgical (SICU) intensive care units. The CCU and MICU services are combined, with care delivered by a single medical team of housestaff and students, supervised by two attendings: the Cardiology CCU Attending and Pulmonary Critical Care Attending (each with their own fellow).
Each patient is designated for admission to either the CCU or MICU team. The Cardiology Fellow is responsible only for CCU patients, and will follow them until they are discharged from the hospital, including after transfer to the medicine service. The fellow may be asked to consult on MICU or SICU patients, which are discussed with the CCU attending. In addition to the ICU, patients may be admitted to the CCU-Cardiology service in the Direct Observation Unit (DOU), a step down unit with beds shared between Medicine and Surgery services on 5 South adjacent to the ICU, and to the Telemetry wards on 5 East and 3 North.
Patients are admitted to the CCU service from the Emergency Department (ED) or Urgent Care Centers (UCC), hospital wards, Cardiac Catheterization Laboratory, Electrophysiology Service, or transferred from outside medical centers. The ED or ward will call the ICU resident for a “unit evaluation.” The ICU resident assesses whether the patient requires CCU level care, then calls the Cardiology Fellow to discuss whether or not to admit the patient to the CCU (or MICU).
It is important for the Fellow to ensure that patients in the ED receive timely consultations and appropriate recommendations. If the ED or ward attending disagree with the recommendations of the MICU resident and/or CCU fellow, the fellow should discuss the case with the CCU attending in a timely manner before making a final decision on the disposition. Fellows should inform the CCU Attending of all admissions, particularly over the weekend.
The Cardiology Fellow is required to write a note on all patients who have been admitted to the CCU. The CCU attending will write an admission note, which may be an addendum to the ICU Resident admission note. Cardiology fellow notes should document major decisions and treatment plans, even when deciding not to admit or transfer the patient to the CCU. It is not sufficient to have a resident’s note state “case discussed with fellow” without a separate note documenting the decisions by the Cardiology Fellow.
Prior to discharge or transfer, it is often helpful for the Cardiology Fellow to summarize the events in the CCU and document the plans to ensure appropriate follow-up and management discussed daily with the CCU Attending and team. Many patients are scheduled for post-discharge visits with the Cardiology fellow in the Fellows’ Tuesday afternoon clinic. The fellows should be aware of how far out they are booked in their own Fellows’ clinics to make commitments for follow-up realistic.
Morning work rounds
Work rounds primarily focus on management decisions. The housestaff must be allowed sufficient time to complete their notes, arrange transfers or discharges, and go home post-call.
- CCU rounds: 7:30 – 9:00 a.m.
- Pulmonary-Critical Care team rounds: 9:30 – 11:00 a.m.
All rounds by the CCU and Pulmonary- Critical Care teams should end by 11:00 a.m.
Fellows cross-cover the VA and Sulpizio Cardiovascular Center (CVC) over the weekends. Arrive promptly at 7:30 a.m. on Saturday and Sunday in order to become familiar with the patients and management plans.
After fellows complete VA CCU rounds, they go to the Sulpizio CVC for rounds. The Cardiology Fellow should always discuss any new admissions with the CCU Attending, as well as the status of each patient on the service. The CCU Attending should see all new patients within 24 hours after admission and have this documented in the Computerized Patient Record System (CPRS).