Supervision of Residents in MICU/SICU

[VentJockey]

I'm curious about what institutions other than my own do for supervision of residents in the MICU/SICU, especially at night. At my program, the attending comes for rounds in the morning, and is available during the day in house prn though most contact is via telephone, then is available via telephone at night (not in house) and can come in if necessary (though this rarely happens).

Is this similar to an arrangement at other places? There have been a lot of times, especially at night, where I've really wished I could have an attending take a look at the patient, just for my peace of mind to know I'm not missing something. But to call them in just because I'd like them to double check me without any specific concern is a bit much, and honestly if I asked for that I think they'd consider me weak.

So anyway, I'm curious about what other institutions do. Do you have attendings in house at night? How frequently are they there on the floor vs just available via telephone? How much autonomy is appropriate for a PGY2/3 in a MICU/SICU setting? I'm very curious about the way other places do this. Thanks.

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[namethatsmell]

I'm a pgy-2 and in my MICU and SICU months this year I've had a good number of nights where I was the most senior person in the hospital for the respective service. Spooky at at times though a fantastic learning experience. I did call my attending with questions (especially when it was something like an LVAD pt taking a nose dive, I wanted to put a pt on APRV, let then know a pt was coding etc) and they were always cool with it/thanked me for calling. The one time the attending came in was to push lytics on a pt with a massive valve thrombus.

I think it's not uncommon and am glad it was part of my training. Accelerates the process of having you stand on your own two feet.

 

[deleted547339]

We have fellows in house and attending stay until the late evening.

 

[timbuktu]

This is just for MICU (SICU operates very differently):

DAY: Formal academic rounds during the day. Attending, 1 or 2 upper levels, two interns. Attending leaves for clinic or whatever around noon and is available PRN. One upper level leaves after rounds, the other stays with the interns until evening sign out.

NIGHT: Only interns; no upper levels. Some nights it's two interns, some nights just one. Rounding (or lack thereof) depends on the nocturnal intensivist. About half of them will do very abbreviated (10-15min) table or bedside rounds, then go off to sleep in their office. The other half will only call you when they have an admission for you. All nocturnists are physically on campus all night, though. All of them will formally staff a patient with you, but it might not be until late in the evening/morning; just depends on the intensivist and how sick the pt is.

We're given a lot of autonomy if we want it except when it comes to admitting/discharging from the unit. The intensivists make those calls.