All patients admitted to the SICU are examined and treated by the critical care team. All admissions to the SICU are to be approved by the SICU fellow or SICU attending physician. If you are contacted by a surgical service for an admission, refer them to the SICU triage fellow (314-305-4626). Patients are to be examined and evaluated immediately upon arrival. The Primary Surgical Service that the patient is admitted under should be made aware of all admissions upon their arrival.

        The SICU admission team writes or reviews all orders on patients excluding transplant immunosuppression, epidurals, chest tube, and drain orders. In general, the admitting surgical service will also write some admission orders in EPIC. Under the orders tab, these held orders can be found under the “Signed & Held” tab. The residents and fellows on the critical care team are responsible for knowing about all admission orders written by the admitting surgical team and should review them and discuss them prior to releasing them. Examine the orders thoroughly and make changes where necessary. If a plan discussed with the surgical service is changed by the SICU service, this should be discussed with the fellow and/or attending, and the surgical service should be notified of the change.THE CRITICAL CARE TEAM MUST REVIEW AND RELEASE ORDERS BEFORE THE NURSING STAFF WILL ACT ON THEM (DO NOT LEAVE ORDERS ON HOLD STATUS).

44ICU releasing orders

Sign and Held Orders

        If admission orders are not present for the patient, the order set “CC SUR ICU Admission” should be utilized, DO NOT use a service-specific order set. 

        After initial evaluation, residents/interns are to discuss the plan of care for the patient with their fellow. The SICU fellow will then discuss the plan with the SICU attending physician in a timely manner to allow further refinement of the management plan.

        Every patient admitted with drains or tubes will need to have those labeled with stickers provided by the unit and associated care orders. The surgeons will make an effort to place these in the operating room, but it is the responsibility of the SICU team to make sure the drains and tubes are accurately labeled and numbered. When a patient is dropped off from the OR, it is a good idea to have the surgical resident review the drains and tubes with the team and the nurse responsible for the patient to ensure that they are all accounted for and labeled.

        Medical Overflow Patients – Because of the relative size of the SICU compared to other ICUs at BJH, receipt of patients who would normally go to other (full) ICUs is commonplace. Most often this is seen with Medical ICU patients. These patients are treated exactly the same as any other patient coming through the 4400 ICU, but there are a few minor points to remember. When placing Epic admission orders, these patients should be admitted to SICU- Medicine to designate them as MICU overflow. When placing the “assign patient status” order, the patient should be assigned to the SICU attending at admission. When the patient is ready to move out to the floor, the patient is to be automatically accepted for transfer-out per the agreement with Medicine. A bed request should be placed through the 44SICU charge nurse and Patient Placement. After receiving a notification from our charge nurse with a bed number, a call needs to be placed to patient placement to find out to which team the patient will be assigned (747-7977). A Provider Event Note should then be placed in Epic about to whom signout is provided. Once the bed is assigned, the resident/NP is responsible for calling the medical team to give sign-out, and the transfer then resembles any other transfer out of the SICU (see below). MD handoff should be updated. If there are any questions or concerns with this type of patient, ask your fellow or attending for help.