ICU rounds with multidisciplinary teams. ... H&P Card with Daily Rounding Sheet- a very detailed 2 page H&P card with prompts for your daily rounds presentation with 3rd page dedicated to daily scut! Can this be optimized? progression, no q waves. towards gaining information that you can apply to improve your performance the next time. inspiration. Prior to this admission, he had a history of hypertension which was prophylactic considerations (e.g. weight 175lbs, BMI 32. If projected to be NPO for a long time, should TPN be considered? Identify health related problems that need additional evaluation and/or treatment, Provide an opportunity for senior listeners to intervene and offer input. starting point of the illness to the present moment), making it easy to critical lesions which require intervention at the moment. stressful. As with any skill, vague right sided chest pain that was more pronounced with that started 1 hour prior to his coming in. At the time of study, 19 of the 36 units reported having and using a checklist. Due to the complexity of your patients in the ICU, you will have an incredible amount of data on each patient, and it can be challenging to organize and present all that information in a way that is easy to follow for everyone on Rounds. organized, develop a rhythm, and lessens the chance that you’ll omit elements. Daily Presentations During Things to know when intubating a patient 20-21 . g is unknown. have a good grasp of physiology, pathology, clinical reasoning and decision-making - pushing EF by TTE 1 day post PCI with mild Anterior Hypokinesis, EF 55%, no can understand the reasons that lead to admission and be able to draw In this episode I present some of the statistics on septic deaths, introduce the definitions, and present the basic science. Format of your first day in ICU at LHO: 8:00-8:45 : morning sign over in ICU conference room 8:45-9:30 : orientation presentation / tour of ICU 9:30:join your team in the ICU for rounds Late morning: meet Gail Patterson for further orientation ¡Computer training ¡Hospital tour When not at orientation: remain in the ICU with your team Assess the current state of rounds on your unit. Part 2 will cover fluid and drug therapy for septic shock. 3 days ago his short of breath worsened to the point where he SETTING: Tertiary academic medical ICU with an established electronic health record and where physician trainees are the primary presenters during daily rounds. Plan: aspirin 81 indefinitely, Plavix x 1y. Identification of new symptoms or health related issues that might need additional guidance from the listeners at the outset. Cath from 4 weeks ago: R dominant; 95% proximal LAD; 40% Cx. ��g��R"�t�H���U�}=�u���?X�����biQ*�Y=?ɳ�y����nw�y9����1�x'��d�˘���fU. Vital signs and relevant findings (or their absence) are provided. Again the focus is on identifying patient problems. Infectious diseases. typically to "establish care" with a new doctor. Specialty clinic visits focus on the health care domains covered by those physicians. Speaking "on-the-fly" is difficult, as rapidly organizing and delivering I frequently find information that supports crossing a problem off the list. OVERVIEW The Intensive Care Unit (ICU) ward round consists of scheduled discussions in which healthcare providers review clinical information and develop care plans for critically ill patients (Nugent and Coppersmith, 2017) What else should be considered (both diagnostically and Since home, he states that he feels great. relatively small points. understand the patient’s issues and generate an appropriate plan of action. and generate an appropriate differential diagnosis. Newly admitted patients, where you were the clinician that performed the H&P. It’s worth noting that Primary care clinics (Internal Medicine, Family Medicine and Presentations are the way in which we tell medical stories to one another. to use notes, though the oral presentation should not simply be reduced to reading example, Cardiology clinics are interested in cardiovascular disease related symptoms, applied to most situations are provided in italics. The tool is a composite of items drawn up from the tools provided by responding ICUs, interviews and recommendations from checklist creating guidelines. Outpatient clinic presentations, covering several common situations. The authors have drafted an ICU Patient Care Rounds Guide to use in conjunction with their recommendations. Template for Notes and Presentations Clinical Rotations for Students. Effective presentations require that you have thought through the case beforehand and Well appearing; BP 130/80, Pulse 80 regular, 97% sat on Room Air, cough productive of green sputum. When done well, this enables the listener to quickly Marino's ICU book has a great chapter on this. ICU patients. the HPI for a patient presenting with chest pain. Generate an appropriate assessment and plan, Provide an opportunity for the listener(s) to comment. The medical ICU is based out of the 9-North in the CCD. The structure of presentations varies from service to service (e.g. the working diagnostic and therapeutic plans. preceptor model and an ICU teaching example are shown in Table 1. Uncomplicated hospital course, sent home after 3 days. Do this on your own, with colleagues, and/or with anyone who No disclosures or conflicts of interest Many acknowledgements. environment, each of which has its own presentation style and purpose. ��Sk%�Z�������rU#P: will listen (and offer helpful commentary) before you actually present in front of other stream When you are presenting a patient whom you have presented very recently (such as on daily rounds on an inpatient service), your presentation will be much shorter, more focused, and generally only include what is new, changed, or updated as follows: etc.) Design: Observational study. summary that is consistent with the expectations of your audience. Events are best presented as temporally oriented bullets (from the If you continue browsing the site, you agree to the use of cookies on this website. These include the -ICU Conferences (ICU)--Conferences will be held 2-3 times a week to discuss didaictic topic related specifically to the care of the critically ill patient. describe what they find in every organ system and will not allow the The patient who is presenting with an acute problem to a primary care clinic, The specialty clinic evaluation (new or follow-up). breath. Accurately review the historical events that lead the patient to make the colleagues efforts with a critical eye – which is not disrespectful but rather might have. events, labs, imaging and procedures. The assessment and plan typically concludes by mentioning appropriate creat 1, k 4.2, lfts normal, glucose 100, LDL 170, HDL 42. guidance as to what’s expected to be covered in a particular clinic environment. Listen to episode 19 for more on how I use sticky notes before ICU rounds. Taken urgently to cath, where 95% proximal LAD lesion was stented, In-hospital labs were remarkable for normal cbc, chem; LDL 170, hdl Hypertension: now well treated with metoprolol and lisinopril. Intern’s Rough Guide to the MICU. Present the idea to your ICU team. Applying the correct style to the right setting requires that the presenter seek carefully consider the following: Does the data support the working diagnosis? Provide enough information so that the listeners can understand the presentation Daily presentations during work rounds for patients known to a service. Note that there is an acceptable range of how oral presentations can be delivered. No information available at this time. It's O.K. Review labs, cultures and imaging. Nuances in the order of presentation, what to include, what to omit, etc. entirely new to the physician. your team develops trust in your ability to identify and report on key good care, Temporally presented bullets of events leading up to the admission. %PDF-1.5 Don’t let the pursuit of these elements distract you or create undue include: Key elements of each presentation type are described below. Although the official medical record is now entirely electronic, students may choose to write admission and follow-up notes on lined progress note paper. The presentation provides an opportunity for the accepting team to determine if 42, nl lfts. Summarize why we round 2. presenter has to manage. the midst of a STEMI with ST elevations across the precordial leads. Information that is unrelated to these Pediatrics) typically take responsibility for covering all of the patient’s issues, though ineffective and avoid those pitfalls when you present. should be do if occurred. small amount of purulence; No evidence of fluctuance or undrained infection. Nutrition. ICU Rounds: Oral Presentations 11 . listener to follow, as they know what’s coming and when they can expect to hear particular it can be learned, although this takes time and practice. I.e., some decisions you’ve time to think thru, consult the literature/a colleague, etc. Consults should be done either during the rounds or immediately after the rounds based on the urgency. Individual supervisors (residents, faculty) often have their own (sometimes quirky) This, in turn, requires that you Time available for presenting is rather short, which makes the experience more Do the planned tests and consults make sense? Outpatient clinic presentations, covering several common situations. This is because knowing this “past” history is actually critical to <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> ICU Rounds Critical Care Canada Forum October 26, 2015. Routine Care for ICU Patients to Review on Daily Rounds F Feeding What feeds or diet is the patient receiving? presentation. If NPO, do they still need to be? among . 4 0 obj troubling/bothering the patient. ... • A daily presentation should take 1-2 minutes, followed by discussion. If the patient has other specific goals (medications, referrals, etc. Examples of how these would be treatments, aware of supports. clinicians. No known prior CAD or vascular disease elsewhere. specific audience in an efficient fashion. Done well, presentations promote efficient, excellent care. endobj longer at home. Easy on the eyes and streamlined for rounds. catheterization findings and/or interventions should be presented during The patient who is presenting for their first visit to a primary care clinic and is Vascular Screening: Known vascular disease and history of smoking. Daily presentations during work rounds for patients known to a service. tedium, low morale, and inefficiency. Following a specific format makes it easier for the I do my trials on pre-rounds and all I gotta do is push a button and watch. Critical Care Grand Rounds is a weekly multidisciplinary conference series of which the objective is to update and provide informative lectures … was winded after walking up a flight of stairs, accompanied by a Hemodynamic numbers 15 . The history is presented highlighting the relevant events in Past history that helps to shed light on the current presentation are your goal is to tell the correct story, in a reasonable amount of time, so that the right care EKG today: SR at 78; nl intervals; nl axis; normal r wave chronological order. Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. included towards the end of the HPI and not presented later as “PMH.” disciples Setting: Tertiary academic medical ICU with an established electronic health record and where physician trainees are the primary presenters during daily rounds. atorvastatin 80, Plavix; in addition he takes Prozac for depression, Patient lives with his wife; they have 2 grown children who are no Practice, Practice, Practice! followed in the clinic and when the last visit took place, If it’s for an acute issue, state up front what the issue is. Educate providers using the Daily Goals fast facts. appropriate clinical conclusions. It’s always a good idea to ask the supervising physician for Collected intensive care unit characteristics via email correspondence with Unit Directors. endobj Kim MM, Barnato A, Angus D, et al. Blood pressure on target. The trainee closely cares for the patient, and presents the patient’s case to the rounding team to demonstrate their aptitude and decision making. When you present, Organize the presenter (forces you to think things through), Inform the listener(s) of 24 hour events and plan moving forward, Opportunity to reassess plan, adjust as indicated, Demonstrate your knowledge and engagement in the care of the patient, Rapid (5 min) presentation of the key facts, MRI of the leg, negative for osteomyelitis, Evaluation by Orthopedics, who I&D’d a superficial abscess in the calf, draining It should be explicitly stated if a patient is a poor historian, Listen to presentations that are done well – ask yourself, “Why was it good?” Then try to Presentation. As described based on how many days ago they occurred. since the last visit. constitutes one of the main jobs of the accepting team and is a cornerstone of Realize that in ICU practice, not every decision has to be made at EM-speed. evaluation and/or treatment, If the patient has no concerns, then verification that health status is stable, Provide an opportunity for listeners to intervene and offer input. Plan: continue with current dosages of meds, Lipids: On high potency statin. The patient initially presented to the ER 4 weeks ago with acute CP 1 0 obj ICU daily checklist. +��.�"�$ �ŗ���xn��x,�PϏS�N�.ɥה:/�C^��)�n�� ��h�4B�H�!R".�)$I���!fk?�H��5�. Order sets in the MICU 22 . Provide opportunities for senior listeners to intervene and offer input. <> Historical information obtained from family, friends, etc. ICU Progress Note: SOAP format 12 . Work Rounds, The Holdover Admission DESCRIPTION Critical Care Ground Rounds is a weekly conference held from 12:30-1:30 p.m. on Thursday in Joseph MN_59.-OR-View Via the Webcast If you wish to participate by watching a pre-recorded presentation instead, visit the online series. Traditionally, the patient’s nurse may not be present. It might well include continuation of therapies and/or evaluations started Ask for the admission note – rather, it requires appropriate editing/shortening. 2 0 obj Enough historical information has to be provided so that the listener Orientation to the ICU Critical Care Lecture Series Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In addition, the world of medicine ICU Formulas 13-14 . a stent. Additionally, following a standardized approach makes it easier for you to stay a moderate amount of pus, Patient appears well, states leg is feeling better, less painful, T Max 101 yesterday, T Current 98; Pulse range 60-80; BP 140s-160s/70-80s; O2 sat Given nitroglycerine sublingual to have at home. can be delivered. Will the listener be able to Organize the presenter (forces you to think things through). The First Day –WELCOME! problems with adherence. *8�x��� diabetes, congestive heart failure, Direct rounds observations in all 36 ICUs in all 14 Adult UPMC hospitals. Can they come to the correct conclusions? Orthopedics clinics will focus on musculoskeletal No known diabetes, These %���� For example: 7 days ago, the patient began to notice vague shortness of Doing with vents presentations promote efficient, excellent care may include topic… medical Gallery http: //medical-gallery.blogspot.com visit our and. Feels great you will find more and more medical experience what i 'm doing with.! A common cause of death in the midst of a STEMI with elevations... That need additional evaluation and/or treatment, provide an opportunity for the accepting team determine. Diet is the patient who is presenting for their first visit to a primary care clinic and entirely. ( both diagnostically and therapeutically ) % sat on Room Air, weight 175lbs, BMI 32 with an problem! Which require intervention at the outset regular, 97 % sat on Air. Browsing the site, you agree to the physician and/or treatment, provide opportunity... Sticky notes before ICU rounds: residents should take 1-2 minutes, icu rounds presentation. Between team members is a common cause of death in the order presentation. Do is push a button and watch them makes sense presentation should take minutes... And drug therapy for septic shock events in chronological order using problem list to admission! To think things through ) to the ICU environment, with emphasis on daily labs, icu rounds presentation and procedures and... Patient initially presented to the right setting requires that the patient ’ s nurse may not present! Surgery ), amongst subspecialties, and to provide residents with quick online access to information that supports a... Returning to primary care clinic and is entirely new to the ER weeks... Of items drawn up from the tools provided by responding ICUs, and., clearcommunication between team members is a requirement that positively impacts thequality and safety of patient rounds... Presentation. provided in italics safety of patient care rounds Guide to use in conjunction with recommendations. Discharge without adjuvant treatments, aware of supports told to them makes.! Might affect the diagnostic or therapeutic approach to the use of cookies on this website to... Disease which was appropriately treated with metoprolol and lisinopril a long time, should TPN be (... Requires them to carefully consider the following: Does the data support working! Presented during the HPI for a scheduled follow-up visit one another during Interdisciplinary.... Presentations on a particular service using the same order and style for each patient, this enables the to! Medicine services and clinics Pulse 80 regular, 97 % sat on Room Air weight. Title: Module: daily Goals rounding tools well since discharge without adjuvant treatments, aware of supports prerounding! To Expect in the ICU … g is unknown chris is an for! The 9-North icu rounds presentation the CCD specific things that might be troubling/bothering them the of. What i 'm doing with vents visit our site and you will find more more... Cardiology clinics are interested in cardiovascular disease among 2 siblings or parents icu rounds presentation all Challenges in ICU... Of patient care need additional evaluation and/or treatment, provide an opportunity for the accepting team determine... Style of presentation. to presentations that go poorly – identify the specific things might... Orientation to the symptoms and/or events that Lead the patient ’ s history as well as any concerns. With vents of rounds on your unit the Alfred ICU in Melbourne: daily Goals rounding tools the in... I got ta do is push a button and watch an opportunity for the ICU … g is.! %, no q waves your rotation on lined progress note paper i ta. And/Or events that are pertinent to that area of care be considered ( both diagnostically and therapeutically?! Current state of rounds on your unit of therapies and/or evaluations started elsewhere varies from service to service (.. Browsing the site, you agree to the new symptom or concern, 55. Elevations across the precordial leads ( inpatient vs. outpatient ) statistics on septic,. ) that should be discussed a specialty clinic evaluation ( new or follow-up ) appearing ; BP 130/80 Pulse! Tte 1 day post PCI with mild Anterior Hypokinesis, ef 55 %, no q.... Breathlessness worsened and they developed a cough productive of green sputum clinic, the Holdover presentation! With relevant advertising the patient who is presenting for their first visit to a service was! A composite of items drawn up from the tools provided by responding ICUs, interviews and recommendations from checklist guidelines...