In this episode, I discuss our process for rounding on critically ill patients in our ED Critical Care Unit. This is similar, but still different from how I would round on pts in an ICU.
Rounding Sheet
The Literature
- Systemic Review of ICU Rounds Practices (Crit Care Med 2013;41:2015)
#HollywoodWeingart
Updates
- Mabasa V, Malyuk D, Weatherby E, et al. A Standardized, Structured Approach to Identifying Drug-Related Problems in the Intensive Care Unit: FASTHUG-MAIDENS. Can J Hosp Pharm. 2011 Sep;64(5):366-9.
Additional New Information
More on EMCrit
Additional Resources
- EMCrit 373 – Mike Weinstock with another Critical Care Bounceback: “Asymptomatic Hypertension” - April 18, 2024
- EMCrit Wee – Ross Prager on 10 Heuristics for the New ICU Attending - April 13, 2024
- EMCrit 372 – FoundStab Intubation SOP - April 5, 2024
As allways. Thank you for your posts. Great stuff.
I used to go by FAST HUG FAITH where FAITH is fluid ballance (first F is feeding), aperients, investigations and results, therapies, hydration.
http://inc.sagepub.com/content/11/1/69.full.pdf+html
But this is better.
Scott: is it true that you will be attending SFAI (annual meeting in Sweden for anaesthesia and intensive care) next year?
Regards Petter
Fast gugs in beds please! Amazing thank you scott. Emcrit rocks 🙂
Thanks for sharing this with those of us who have wondered how life works in an ED-ICU. I had a couple questions that were left rattling my brain after finishing: 1. Do you guys try to formally round on the entire unit twice a day? Once with the morning shift and once with the evening shift? (Assuming you’re doing 12 hours shifts like many of us). I’m trying to wrap my head around this coming from a background of EM/IM/CCM and currently working in a traditional ICU structure where we round in the morning with everyone (attending, fellows, residents, students,… Read more »
Currently we do it on afternoon turnover and evening turnover
In the morning, we generally do the rounds with just incoming attending and residents and it is more informal as many of the pts have been there for >24 hrs and have transitioned care
as to documentation, we scribe our notes freeing the residents and attendings from most of the pain. I do my own crit care billing note–systems based; problem additions after system
First I’ve heard of an ICU scribe system (obviously aware of it’s prevalence among EDs which is likely why you have the service available). I’m sure it’s invaluable given your high turnover. Seems like a dream situation where you are relatively freed from the documentation demon and can focus on actual patient care and interaction.
Hi Scott, I already downloaded the form and I like it very much.Sure, very helpful.We are using FAST HUGS BID in Jo’burg TICU- where I am doing my training- as modified by Vincent (himself) and Hatton . The Chris Nickson’s version you suggested in the form/& podcast is more comprehensive (&honestly easier to remember). I have one thing only to add :nurse concern? Usually after each patient encounter I ask the nurse do you have any concern? I think it helps. Critical care Nurses have always contributed to my decision -Most of the time .Shared mental model is really important.(… Read more »
nurses are intimately involved in all systems discussions and have no problem speaking up–otherwise we we would have designated ? just as you say
Hey Scott Great podcast. I wanted to pick your brains on the TFT question in the acutely unwell patient. In our cost-conscious hospital, I routinely have my request for TFTs/T4/TSH declined because of the interpretation of TFTs in the acutely unwell patient/sick euthyroid. I then, if I’m keen to push it, have to lock horns with the biochemistry Consultant where we’ll discuss the merits, or lack thereof, of the utility of TFTs in the critically ill and the difficulty with interpretation. Is there a podcast in this? It might be a bit niche but I’d be interested to hear your… Read more »
I can understand full TFTs, but TSH really needs to be available as a screen for the critically ill. We are not talkiing subtle changes, we want to know myxedema/storm
Hi!
Great to hear about hospital and unit functionality and not only about clinical topics.
Could you explain the structure of emergency department and ICUs in your hospital and how you think it should ideally be?
Thank you.
coming up soon
As a medical student, one of my favorite ICU attendings advocated the step of running the “untamable beast” that is the medication administration record and med list — making sure that ordered meds were given, that every med that is ordered has a corresponding problem, that everything you think is ordered actually is, etc. I like this practice for several reasons, but they all revolve around the idea that everything else is “plan” whereas orders that actually are written and carried out (or not!) are *reality*. If your plan and your reality are not concordant, it doesn’t matter how good… Read more »
yep, definitely more of an issue in the ICU where pts have standing meds as opposed to EDICU where the problem is usually lack of standing meds
This is a really important topic that we as clinicians should spend much more time considering. I have used a A4 laminated structured rounding tool that I developed for a few years in ICU. Have a look and see what you think. I use a ABCDEGHI approach instead of systems and divide taks into “think” and “do”.
Checklist found here https://www.dropbox.com/s/ud1l87qr6i4twcl/icu%20checklist.pdf?dl=0