ICU Rounding Template/Scutsheet

[agranulocytosis]

I was wondering if any of you all had any good templates for rounding. I'm starting my attending career in Pulm/CC with critical care in the next couple of weeks, and was looking for some good templates which have been lacking online. All I seem to find are neuro scut sheets, which don't really do the job for MICU/SICU. I also found the SCCM sheet with the ABCDEF bundle for ICU liberation to be more useful for nursing.

Any help would be appreciated!

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[jdh71]

I assume you have an EMR?

I mean I know the first attending job can be nerve wracking but don’t make it more complicated than it needs to be. Everything you need should be in the EMR. Just write a list of things (generally) you want to check on your patient and just follow the check list the same way each time for every patient and you’ll begin to develop an efficiency and won’t even need a rounding sheet or checklist.

 

[deleted547339]

Yea. You’re WAY overthinking this. I don’t have mine in front of me, but this is what comes to mind quickly:

Antibiotics
Vent
Nutrition
lines/tubes
Glucose control
Foley
Pt/ot
GI ppx
Dvt ppx
Code status
Contact/family update

I’m sure I’m missing a couple, but you can start there. Depend on your patient population and specific icu you may want to add or subtract things like surgeries, consultants, daily labs, anticoagulation, SW, etc.

The first time you round you’re going to feel like an imposter, then you’ll quickly realize that it’s the same as when you were a fellow. Some questions have answers and a good fellowship should have taught you all of that, but a lot of what we do is just expert opinion - and guess what - now, you’re the expert.

 

[BigRedBeta]

No matter where your new job is, PP or academics, as the attending, you will likely find that someone else will unburden you with all those things - either trainees or nursing/pharmacy/ancillary staff. It will be unnerving, particularly if your fellowship was one of those places that demanded fellows "own" the entire unit and know everything about every patient (the norm in PICU fellowships, but my Pulm/CCM friends at other locations gave varying reports). You may also find ways in the EMR to optimize your workflow to cover all this stuff. Over the course of the last 4 years being an attending, my scut sheet has gotten significantly shorter, to the point now where I'm basically down to check boxes for the note, DNR status when applicable, and IV->PO conversions to serve as a reminder to do it. The rest of those things from TimesNewRoman are either built into my note, were added as a column on my patient list (e.g. on TPN), or nursing, or diet, or pharmacy take care of on their own and call with questions.

If you're going to have residents and fellows...make them track those things

 

[Merely]

No matter where your new job is, PP or academics, as the attending, you will likely find that someone else will unburden you with all those things - either trainees or nursing/pharmacy/ancillary staff. It will be unnerving, particularly if your fellowship was one of those places that demanded fellows "own" the entire unit and know everything about every patient (the norm in PICU fellowships, but my Pulm/CCM friends at other locations gave varying reports). You may also find ways in the EMR to optimize your workflow to cover all this stuff. Over the course of the last 4 years being an attending, my scut sheet has gotten significantly shorter, to the point now where I'm basically down to check boxes for the note, DNR status when applicable, and IV->PO conversions to serve as a reminder to do it. The rest of those things from TimesNewRoman are either built into my note, were added as a column on my patient list (e.g. on TPN), or nursing, or diet, or pharmacy take care of on their own and call with questions.

If you're going to have residents and fellows...make them track those things

what if the residents suck and don’t track them correctly, don’t you always have to be on top of it all

 

[BigRedBeta]

what if the residents suck and don’t track them correctly, don’t you always have to be on top of it all

Sure, potentially.

The bigger point is that some of the things that might go on a scut sheet aren't things you need to know immediately were someone to ask you or they are one time per day decisions to be made once you're the attending. Like a GI prophylaxis. Put it in your note template as a prompt to remind you to think about it and be done. But I can't think of any situation in which either an extra dose or a missed dose is high risk to cause significant complications (this is different than your acute GI bleeds in which it's a treatment and considerable part of the plan).

To me, the real point of a scut sheet is when you are a trainee and you don't always know what your attending is going to ask you. Having the "usual" info at your fingertips saves you time and embarrassment. But when you're the attending? Who cares if you know something now or take 3 minutes to look up whether or not the patient is getting X, Y or Z therapy? If you need prompts to keep these little details from being missed, of course do what you need to do, but there are other ways within the structures of notes or patient lists (or even better tracked by other staff or services) that can likely be more efficient.