CV-CCU/Cardiovascular Medicine Inpatient Service
The Sulpizio Family Cardiovascular Center – CV-CCU/Cardiovascular Medicine Inpatient Service is responsible for care of patients with cardiovascular diseases that are admitted to the Sulpizio Cardiovascular Center (CVC).
The team assigned to the CV-CCU/Cardiovascular Medicine Inpatient Service will consist of the following:
- An Internal Medicine Residency team
- A General Cardiology Fellow
- Several Physician’s Assistants
- A General Cardiology Attending Physician
- An Advanced Heart Failure/Heart Transplant Attending Physician (until late 2014)
The Cardiovascular Intensive Care Unit is located on the 3rd floor of the (CVC). It is a combined cardiovascular intensive care unit with Cardiology and Cardiothoracic (CT) Surgery. The CCU portion of the unit is directed by Dr. Lori Daniels. The CT Surgery portion of the unit is directed by Dr. Anthony Perricone. The CCU/cardiology team is responsible for the care of patients on the general cardiology and congestive heart failure services, and assists with patients who are recovering from CT surgery (CABG and valve replacement).
Progressive Care Unit-3B-CVC: Patients on the Cardiovascular Medicine service being managed outside of the Cardiovascular Intensive Care Unit will be primarily managed on 3B-CVC which is a progressive care unit. Overflow of cardiac patients will be managed on the 4th floor CVC progressive care beds.
Educational purpose and learning objectives
The educational purpose of this rotation is to train fellows in the treatment of inpatients with cardiac and vascular disease, particularly those who are critically ill and hemodynamically unstable. Learning objectives include competence in the optimal treatment of inpatients with CAD, acute MI, acute coronary syndromes, shock, congestive heart failure, critical limb ischemia, recent CT surgery, and valvular heart disease.
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Teaching methods include patient-specific instruction during CCU/cardiology rounds as well as didactic lectures during post-rounds teaching sessions. Fellows also attend cardiovascular catheterization conference and present cases at this conference during the rotation.
The patient population on this service is quite varied. Both men and women are well- represented. The majority of patients are >60 years of age, but there is a significant minority of younger patients with CAD, nonischemic cardiomyopathy, endocarditis, valvular heart disease, and peripheral arterial disease.
The fellow, in combination with the Internal Medicine Residents, is involved in Emergency Department evaluations of patients with cardiovascular complaints, and is responsible (with attending supervision) for decisions regarding admission to the CCU/Cardiology service. The fellow is also responsible for daily supervision of patients on the service and helps to facilitate their care. Fellows are encouraged to participate whenever their patients undergo catheterization laboratory procedures.
Under attending supervision, the fellow manages the CCU/cardiology service. Although attending supervision is constant, fellows are granted a good deal of leeway in clinical decision-making. Attending physician input is required for major changes in management or referral for invasive testing.
- Braunwald’s “Heart Disease”
- Hurst’s “The Heart”
Teaching files of interesting echocardiograms, angiograms, and stress tests are available on-line on the hospital's digital cardiac imaging system.
ACGME core competencies are evaluated monthly by the attending faculty. These evaluations are discussed with the fellows and forwarded to the program director. First-year fellows are expected to have a mean evaluation score of 5 or greater on the standard 1-9 scale of the 6 ACGME core competencies. Second-year fellows are expected to have a mean score of 6 or above; third-year fellows do not rotate on the CCU/cardiology service. Expectations of fellow performance vary by year of training.
First-year fellows are expected to have a basic understanding of cardiac pathophysiology, treatment of acute coronary syndromes, treatment of valvular heart disease, treatment of heart failure, and treatment of peripheral vascular disease and critical limb ischemia. Specifically, first-year fellows are expected to:
- Master transthoracic echo imaging in acute coronary syndromes, valvular disease, and possible cardiac tamponade
- Perform right-heart catheterization independently and left-heart catheterization under attending supervision
- Provide cardiology consultations in the acute setting with substantial attending input and supervision
- Manage acute heart failure with substantial attending input and supervision
Second-year fellows are expected to be fully competent in the treatment of acute coronary syndromes, congestive heart failure, endocarditis, valvular heart disease, peripheral vascular disease, critical limb ischemia, and shock. Specifically, second-year fellows are expected to:
- Master both transthoracic and transesophageal imaging techniques in acute coronary syndromes, valvular disease and possible cardiac tamponade
- Perform both right and left heart catheterization with minimal supervision
- Provide cardiology consultations in acute settings with minimal attending supervision
- Manage acute heart failure with minimal attending input
Specific activities during this rotation that will enhance the fellows’ skills in the 6 core competencies:
- Patient Care: Fellows will encounter a large group of patients a wide variety of acute cardiovascular illnesses. They will direct the care of these patients and assist in procedures performed.
- Medical Knowledge: Fellows will learn from the attending faculty during patient rounds and teaching rounds, and also from self-directed review of the literature.
- Interpersonal and Communication Skills: Fellows will interact with medical staff, nurses, pharmacists, and other ancillary personnel. They will communicate with patients’ families and cardiac surgery faculty. Fellows are expected to keep accurate, timely-signed medical records.
- Professionalism: Fellows will gain experience in the respectful treatment of all the above-mentioned groups, and will also maintain accurate procedure logs and hospital privileges.
- Practice-Based Learning: Fellows is expected to gain knowledge from self-directed literature review, and facilitate the education of internal medicine residents. Fellows will present cases from the CCU during weekly catheterization conference and discuss pertinent literature.
- Systems-Based Practice: Fellows will work within a team of health care professionals and participate in inpatient management, transfer facilitation (from UCSD Hillcrest campus and other referring facilities), and discharge planning. They will be exposed to patient concerns such as cost of medication, ambulatory follow-up, and end-of-life issues.