Updated 6.17.24
PICU Response Team
1) Replacing Rapid Response Team (RRT)
2) 15 MINUTE Response Time
3) Call a Code White if you need help/assessment/interventions earlier
4) OK to transfer a patient directly to PICU for known needs ie. drips
5) Starting July 9th
Doc of the Day
1) Now 24/7!
2) PICU transfers may go to residents for call back
Senior Reminders
1) Make sure day attending name is updated on the list
2) Keep an eye on the list. If approaching 20 patients, notify Admitting Hospitalist aka Doc of the Day for redistribution to Platinum. Identify a few patients with your day attendings which patients may be good candidates for off loading.
3) Triage your patients for rounds, round on new ones/sick patients first
4) Update attendings in AM which patients can be seen early prior to rounds for discharge. Can be on the same group text with case management and SW so everyone is aware
5) Weekend residents holding phone should keep attendings notified of new admits to prevent delayed staffing (and overflow into night shift)
6) Keep ED Covering MD boards updated
9) Admissions - Use order sets - IPR vs OPO
Additional Tips:
1) Consult BOTH Infectious Disease AND Cardiology (even if ECHO normal)
Medication Shortages/Lab Updates
1) IV Ativan Shortage
2) BNP changing to NT-proBNP (starting July 1st 2024). Cerner order is NBNP or N-Terminal proBNP
Communication
1) Ensure logged into Voalte at start of shift. Incorporate this into your verbal sign out
2) Notify ED MD and RN for any major changes to plan of care and/or orders
3) Huddle with nursing at bedside upon arrival to floors, discuss patient plan of care using 5P's, document in Cerner Checklist
4) Discussions regarding non urgent orders with floor charge nurses
5) Use consult templates!
Codes/RRT/Watchers
1) 7/9 - PICU Response Team now live!
2) Be mindful of crowding around and conversations being held during event
3) Please clear out if not actively involved in the code/RRT event
4) ED Watchers soon to start
5) Use role stickers for Code Whites
1) Replacing Rapid Response Team (RRT)
2) 15 MINUTE Response Time
3) Call a Code White if you need help/assessment/interventions earlier
4) OK to transfer a patient directly to PICU for known needs ie. drips
5) Starting July 9th
Doc of the Day
1) Now 24/7!
2) PICU transfers may go to residents for call back
Senior Reminders
1) Make sure day attending name is updated on the list
2) Keep an eye on the list. If approaching 20 patients, notify Admitting Hospitalist aka Doc of the Day for redistribution to Platinum. Identify a few patients with your day attendings which patients may be good candidates for off loading.
3) Triage your patients for rounds, round on new ones/sick patients first
4) Update attendings in AM which patients can be seen early prior to rounds for discharge. Can be on the same group text with case management and SW so everyone is aware
5) Weekend residents holding phone should keep attendings notified of new admits to prevent delayed staffing (and overflow into night shift)
6) Keep ED Covering MD boards updated
9) Admissions - Use order sets - IPR vs OPO
Additional Tips:
- For early AM admits - Seniors to eyeball/ put in orders, have a med student do admit. Ok if not totally ready to present new admit at the end of rounds
- For weekends – post call senior should sign out and leave, but expectation is that the intern can stay a few hours longer to continue to tie up loose ends. Intern to message covering senior with updates and that they are leaving. Attending also around to help support intern wherever needed.
- For weekend rounds – in an effort to improve efficiency, the expectation is that whole team will not round bedside on every patient if high census. Can “table round” on most patients and go to bedside of acute and actively changing patients. Make sure to update RNs on all plans and that attending will be by later for those not rounded at bedside.
1) Consult BOTH Infectious Disease AND Cardiology (even if ECHO normal)
Medication Shortages/Lab Updates
1) IV Ativan Shortage
2) BNP changing to NT-proBNP (starting July 1st 2024). Cerner order is NBNP or N-Terminal proBNP
Communication
1) Ensure logged into Voalte at start of shift. Incorporate this into your verbal sign out
2) Notify ED MD and RN for any major changes to plan of care and/or orders
3) Huddle with nursing at bedside upon arrival to floors, discuss patient plan of care using 5P's, document in Cerner Checklist
4) Discussions regarding non urgent orders with floor charge nurses
5) Use consult templates!
Codes/RRT/Watchers
1) 7/9 - PICU Response Team now live!
2) Be mindful of crowding around and conversations being held during event
3) Please clear out if not actively involved in the code/RRT event
4) ED Watchers soon to start
5) Use role stickers for Code Whites
Coming Soon...
1) Improving feedback for night residents. Any suggestions welcome!
2) Watchers in ED
3) Blood culture algorithm
1) Improving feedback for night residents. Any suggestions welcome!
2) Watchers in ED
3) Blood culture algorithm