VA MICU/CCU Guide

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VA MICU and CCU Guide - Updated 2017

Location:

MICU is located on 8C. Take a right when you come out of the elevators, through the double doors.
There are 20 beds and the ICU is shared w/ SICU and CCU
MICU max census is 8 patients at a time
CCU patients are spread out between 8B (Tele) and 8C (ICU)

Numbers and Paging:

Nursing Break Room: 6715#
- can leave your food in fridge
MICU Call Room: 2318#
- door on the left when you enter is MICU call room
MICU Call Room Phone Number: x6617
ICU Numbers:
- Green Side: x5068
- Blue Side: x6718

Paging: call operator | 0 and ask them to page to a 4-digit number

Getting Set Up:

Go to Indra x6757 on 7B (next to the chief's office) in GME your first day
- She will set you up with CPRS (can take time)
- She will print a paper with codes for you. Go to the 9th floor; straight ahead of hallway (between 9B and 9C) to ask someone for help activating your Windows and Vista code
You may also have to go to the security office (1st floor by elevators) in order to get ID access.
Sinai Chief's office is on 7C (stop by if you need anything from them!)

Transport:

Shuttle at 8:15AM gets you there just in time for rounds at 9 AM everyday (large bus)
Post call shuttle at 10:30 AM (small van) or Subway
Pick up stop: Same location for drop off and pick up at the VA
Weekends: Subway, Taxi, Uber etc.
Subway: Take 4 Train to Kingsbridge Station
More details: https://inpatient.careteamapp.com/BronxVATransport

Call Rooms:

MICU Call Room:

MICU call room is on the left side when you enter
Put your stuff in any open locker or in the room if you are on long call
You have your own bathroom
To sleep: grab a pillowcase, sheets, and a blanket from any linen closet of an empty patient room (linen closets face the hallway outside of the room).
Strip your own bed in the morning before rounds
Nurses call the room, as the VA pager occasionally loses signal inside; when out of range, a loud beeping noise goes off
There is an overhead announcement in the call room for codes, etc.
Depending on how busy it is, you can sleep several hours a night (weekends tend to be slower)
Take this time to study (if you have boards coming up), watch TV, etc..
The VA Hospital has no WiFi so bring work that does not require internet/The main computers in the ICU have full access internet

CCU Call Room:

Located on 4B (sign out a key from the VA Police Office in the Lobby)
Bring a computer on wheels with you so you can place orders and return pages from the room

Food:

Breakfast, lunch, and dinner are provided at 8am, noon, and 5pm respectively
Nutrition room next to bed 20/bed 1 where you grab your tray and return it
The trays for us are labeled as Dr. Kosh, Dr. Reg, or Dr. Veg.
Usually we eat with the fellows and VA residents in the conference room at the end of the hallway
There is a small 30-45 minute window to grab your food before they take all the trays away
You can alternatively bring your meals and put it in the nursing fridge (make sure you label)

Schedule/Rounds:

Morning Rounds: start at 9am everyday, usually last 1.5 to 2 hours
Evening Rounds (only MICU): 8:30pm w/ the overnight attending for MICU. These rounds are typically very quick 1-liners w/ overnight plans. Present any new admissions from the afternoon during these rounds.

Organization: MICU - 2 VA Residents and 1 Sinai Resident; CCU - 2 Sinai residents and 1 VA

Long call Resident (27 hour call): put in orders on rounds, does procedures, writes all notes, admits new patients, no MICU or CCU consults

Post call resident: presents all patients on rounds; leaves by 11 AM; for CCU, some residents post-call will write the morning notes as they know the patient best and there are fewer patients than MICU

Short call resident (9 AM to ~11AM/12 PM): transfer any patients from the unit and put in orders

Sinai Critical Care Fellow: available 9 AM to 4 PM; will stay later if there is a late admission or procedure

Sinai Cardiology Fellow: attends morning rounds and has afternoon clinic; comes on weekends

Attending: changes almost daily vs weekly depending on the service.

For MICU: there is an AM attending 9am to 4 pm, afternoon attending coverage (4 pm to 8 pm) and a PM attending (8 pm to 8 am); styles are variable and plans change
For CCU: usually AM attending and fellow; an overnight cardiology fellow on call for emergencies

Sinai Med Student: teach them! They are typically 4th years and have done their sub-internship and want to help out. You should dismiss them by 3:30 PM (the shuttle is at 4pm)

Procedures:

Procedures include: A-line, Central Line, Diagnostic Paracentesis, Shiley placement, Bronchoscopy
Supervision provided by fellows and attendings

Admissions:

Usually the attending or fellow will notify you directly of any admissions and you will be called by the Book resident
Most of the admissions are transfers from the floor or from outside hospitals

Overnight ADMISSIONS:

MICU: the attending will inform you of admission and you often do the admit together (for MICU)
CCU: you typically admit alone and the fellow will come in emergencies. you are notified by the Book resident

Discharges:

MICU

For transfers to the floor: (1) Page book resident (2) If patient accepted, place an Interservice Transfer Note and provide verbal signout to floor resident

CCU:

Fill out green sheet ASAP for appointments and tape to counter on 8B, then write discharge instructions (notes -> instructions), place discharge order (orders -> discharge orders), write discharge summary (d/c summary -> new note)

Notes:

Advise making your own template
- Click on the “Notes” Tab --> My Templates --> New Template --> From here you can type and insert "Vitals" "Labs" from the left column (drag and drop or copy/paste). Click Apply

Daily Labs and CXRs:

Morning labs:

Order labs for 5AM - they print in either label maker on blue or green side (across from room 13 or 8)
VBG or ABGs need two labels each (ask the nurses how to print an extra label)
Physically hand the labels to the patient's nurse the night before AM labs are drawn
You can add on labs easily by putting in a consult Lab Add On
Labs Cumulative is the best viewing tab

CXRs:

Order Daily Portable STAT CXRs for intubated patients +/- those requiring CXR
Order for 7am and STAT
Radiology is x6557

How to See Imaging:

On rounds, go to Tools --> PACS and imaging for each patient can be seen through in an internet explorer window
Procedures Tab: has EKGs and Echo reports
Tools VistaImaging has actual EKGs to view

Consents:

Use one of the Computer COWS with the Signature Pad
Tools iMED CONSENT in the Search Bar, type the Procedure or Imaging Study
When you double click, it will enter a signature/consent document, follow the prompts
Scroll down and click the right button “Sign”
You sign on the signature pad
The patient +/- NOK signs on the signature pad after you
Click “Save” and CPRS documents the consent
Phone Consent: call Susan, x6880; the VA requires a witness via a 3-way call with the family member/NOK, you and Susan to confirm telephone consent

"The List"/Sign Out:

Long call resident is responsible for updating the list twice a day [MICU], once a day [CCU]
Update the list: prior to 9 AM rounds [MICU: prior to 8:30 PM rounds as well]

To find the list: 1. Go to MICU: My Computer: S:\Medicine\MICU 2017 --> Specific Month --> Open up recent date CCU: My Computer: S:\Medicine\Cardiology Files\CCU2 --> Specific Month --> Open up recent date

Fill the left column with: Lines, BMs, Is/Os, DVT ppx, Code status and NOK on the sheet
Essentris: to obtain Vital Signs and Is/Os
You can find the Essentris icon on the desktop/Windows and login using your CPRS login
Fill the middle column with Assessment/Interval History/And Labs (copied from CPRS/cumulative)
Fill the right column with Your Plan by System (copy your plan from your progress note in CPRS)
“Save As” your sign out by Date under the Shared Folder
Make 5-6 copies during the weekday and 3-4 on weekends
Copy Machine: 5071/code: 14888 on Green Side

Lectures:

Occasional critical care lectures, usually on Thursdays Dr. Siegel, the program director will stop by an inform the group on rounds

Nurses:

Nurses are great! Friendly, efficient, and make you feel welcome
Communicate with them when orders are placed and labs are ordered
Remember to print out labels and hand it to them!
If you want to order food, you can order with them at nighttime