Orientation

Each day you should review the following care categories. Connect with the primary team to ensure they are aware of — and acting on — new results.

Medications

Review all medications in the Active Medications list.

• Pay special attention to sedation and analgesics. Are there any drugs that can be discontinued?
• ICU has a primary role in management of sedation and analgesia since it is intimately related to ventilator synchrony.
• Discuss your plan to change medications with the ICU attending.
• Goal: use as little as needed to accomplish adequate pain control.
• Are there other medications that can be discontinued?
• For any meds that are not analgesia or sedation, confer with the primary service prior to discontinuing.

Polypharmacy is one of the key areas for potential harm in hospitalized patients. Strive for adequate, not excessive pharmacotherapy.

Radiologic Studies

As surgeons, you should constantly increase your diagnostic acumen by examining radiologic images yourself.

• Workflow:*

1. Personally review films first
2. Then read the radiologist's interpretation
3. If something does not seem to fit, discuss with a senior resident or attending

Microbiology Cultures

The SICU milieu is one where infections can flourish if not actively kept in check. Fevers and leukocytosis should be investigated and responded to in a timely fashion.

• Daily review of cultures is the responsibility of both the ICU team and the primary service
• Use of empiric antibiotic therapy should be limited and should only proceed after discussion with the attending of record

• Adapted from SurgCritCare. org for structured display and mobile use. Verify against current institutional policies and attending guidance.*

The Surgical ICU

The surgical intensive care unit is an environment where the team approach is used to care for critically ill and injured patients.

The ICU is a twenty-four bed, mixed medical/surgical intensive care unit. It operates as an open ICU, meaning the Surgical Critical Care team functions as a consulting service for all surgical patients in the ICU.

Open ICU Model

Because this is an open ICU format, you must take primary directives from the admitting team of record. This is typically:

• The Trauma service
• The Acute Care Surgery (ACS) service
• Occasionally: E1/2 services or Vascular

• Important rule:* The primary service is in charge of all clinical decisions except for:
• Management of the ventilator
• Management of sedation

These two domains remain under Surgical Critical Care direction.

Rounds

During weekdays (except Thursday), the ICU team and Trauma Team round at 8:15 AM.

• Thursdays:* Grand Rounds, teaching conferences, and pre-op conference occur. Rounds may be scheduled at an alternate time. The on-call attending on Wednesday night is typically the attending covering Thursday morning. The covering chief resident is responsible for arranging round time on Thursdays.

Resident Expectations

In addition to reporting patient data, residents are expected to synthesize a treatment plan that is evidence-based for each of the patient's active problems.

"Go-To" Person for ICU Issues

In addition to presenting on morning rounds, you will be the first "go-to" person for issues in the ICU. Your role:

• Keep the primary team apprised of new issues
• Help manage patients while the primary team is in clinic or the operating room
• You are not expected to manage patients on your own — ICU patients are complex and require a team approach
• All clinical decisions should be ones that the chief resident and/or attending agree with

Stay Connected, Ask for Help

Your ICU rotation will be what you make it. The ICU is a place where you can further your understanding of disease pathophysiology. At times, this rotation will challenge you both intellectually and emotionally.

Know that even when things feel hard, there are always Chief residents and Attendings who have your back. Keep lines of communication open and never, ever hesitate to ask for help.

• Adapted from SurgCritCare. org for display clarity. Clinical meaning preserved. Verify against current institutional policy and attending guidance.*

Day-to-Day Responsibilities

The HGH ICU is a twenty-four bed, mixed medical and surgical intensive care unit.

• Rounds timing:* During weekdays, ICU + Trauma rounds are typically at 8:15 AM unless otherwise determined by the ICU or Trauma attending.

• Who presents:* ICU residents are expected to present each patient on rounds. They present after the ICU bedside nurse reports updates from a nursing perspective.

Presentation Expectations

In addition to reporting patient data, residents are expected to:

• Synthesize a treatment plan that is evidence-based for each of the patient's active problems
• Use the recommended presentation format to organize reporting in a system-based fashion

Systems-Based Presentation Format

A systems-based presentation covers:

1. Overnight events — What happened since last rounds?
2. Vital signs — 24-hour trends (temp, HR, BP, O₂ sats, I/O)
3. Lines / Tubes / Drains — Type, location, date placed
4. Drips / Infusions — Active medications and rates
5. Ventilator settings (if applicable) — Mode, FiO₂, PEEP, volumes
6. Labs — Key values and trends
7. Imaging — CXR and relevant results
8. Systems assessment and plan — Neuro, Cardiovascular, Pulmonary, GI/Nutrition, Renal, Heme, ID, Endocrine, Lines/Wounds
9. Disposition and goals of care

ICU Progress Notes

In addition to presenting on daily ICU rounds, you will be expected to write an ICU progress note for each patient.

• Critical documentation expectations:*

• Do NOT cut and paste from previous notes
• Notes should be synthesized new each day based on:
• Overnight events
• Daily progression of the patient's clinical findings
• Radiology: Include only the key findings of imaging studies — NOT the entire radiologist's dictation

Family Connect Notes

In addition to progress notes, each patient should also receive "family connect notes" twice a week:

• First note: covers the first half of the week, completed by Tuesday
• Second note: covers the second half of the week, completed by Friday

What Family Connect Notes Should Include

These notes should:

• Document conversations with available family members regarding the patient's status
• Cover the key components of the discussion
• Do not need to be long unless the patient's bio-psycho-social situation demands it
• Function as a log of communications with the family regarding the patient's course in the ICU

Related Templates

• ICU Progress Note Template
• Daily Rounds Presentation Template
• Family Update Note Template

• Adapted from SurgCritCare. org orientation materials for structured display and mobile use. Clinical meaning and expectations preserved. Verify against current institutional policies and attending guidance.*