- Starts at 0700 EVERY Day in the ICU Conference Room
- Overnight Fellow and Residents sign out to day team Fellow and Residents
- ALL fellows, residents, and medical students attend
- Which team receives sign out first (Red or Blue) depends on which team gathers first.
- Should be primarily performed by Intern/Resident – Good Practice!
Residents Should Use Handoff to Sign Out
Example
ICU30 is 62 year old female with ESRD on dialysis through RUE fistula, HTN, HLD, DM, bilateral carotid artery stenosis s/p stenting, sacral decubitus ulcers, DVT previously on warfarin, CVA with right sided weakness, chronic foley, paraplegia 2/2 SC compression with AMS at nursing home intubated 3 days ago during a Rapid Response for respiratory failure with UCx with greater than 100K E Coli and Klebsiella and moderate Pseudomonas on Resp Cx in septic shock on Norepinephrine at 8.
Overnight Events: She had escalating doses of NE as high as 20. Bedside US was performed demonstrating hyperdynamic and underfilled LV. Given a total of 2L of crystalloid with good response.
Remember she is a difficult airway if she extubates!
After Sign Out and Before Rounds
- ALL patient’s should be seen!
- Intern and Resident should determine who is seeing what patients in consultation with Fellow.
- Fellow will do their own pre-rounding
- As house staff YOU ARE YOUR PATIENTS PRIMARY DOCTOR!
- You should use this time to:
- EXAMINE YOUR PATIENT
- Talk to the Nurse about concerns or overnight issues
- Review labs and results
- Work on daily progress notes