Responsibility after dropping off in ICU
Started by painquestions8989
My place you signed out to the ICU attending. Document it, particularly for this type of cases.
painquestions8989
Full Member
Of course, I definitely did that
I always make a habit of documenting what drips are running at handoff specifically in a note. Also document major events that happened in the case if any. There are constant arguments about this especially in unstable patients, do not assume anyone is looking at your record - the vast majority of critical care docs and RNs have no clue where to find it or how to read it.
There is nothing worse than a crashing patient on rocket fuel with a canned “stable, no issues” anesthesia post procedure note. It’s lazy and reflects poorly on your department.
If you are handing off to an ICU doc, put their name in your handoff note.
There is nothing worse than a crashing patient on rocket fuel with a canned “stable, no issues” anesthesia post procedure note. It’s lazy and reflects poorly on your department.
If you are handing off to an ICU doc, put their name in your handoff note.
I didn’t see the original post, but if they’re coming in hot, I call the
Attending directly before leaving the OR and I use epic chat to give an abbreviated version of the same heads up to the team. That gives them at least a 20-30 min heads up to order different drips they want, request labs from us, etc.
Attending directly before leaving the OR and I use epic chat to give an abbreviated version of the same heads up to the team. That gives them at least a 20-30 min heads up to order different drips they want, request labs from us, etc.
Medico legally I don't think stable should ever appear on an icu note until day of discharge. Certainly not on admission.
In terms of handover, I just dont really trust a non anesthesiologist to resus anything so unless theyre "stable" on whatever drips i decide on, ie no phenyl pushes in a while, im just not leaving them there... I dont trust non cardiac anesthesiologists either so theres my bias. I trust my gut, tee everyone sick so I know the plan that needs to be followed for the next 24 hours @ least, so that can be a wide variety from just leave em on the levo/vaso for sepsis, to ecmo bridge to transplant etc etc.my plan is the one they better follow but I have to demonstrate its working myself before I leave
In terms of handover, I just dont really trust a non anesthesiologist to resus anything so unless theyre "stable" on whatever drips i decide on, ie no phenyl pushes in a while, im just not leaving them there... I dont trust non cardiac anesthesiologists either so theres my bias. I trust my gut, tee everyone sick so I know the plan that needs to be followed for the next 24 hours @ least, so that can be a wide variety from just leave em on the levo/vaso for sepsis, to ecmo bridge to transplant etc etc.my plan is the one they better follow but I have to demonstrate its working myself before I leave
Cardiac intensivists don’t exist at your shop?
Not at mine, which can sometimes be an issue
Same story here. Our surgeons, the cardiologists, and their teams manage all post-op hearts.
We bring flaps to the icu because the ent doc wants them to have hourly flap checks post op which can Only be done in icu. They are not on any drips and breathing on their own. I always mark them as stable in my drop off note.
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A horror story in eleven words
Nope only tee trained cardiac anesthesiologists mostly dual trained actually intensivists too although we have no interest in the med surg icu
Granted I'm at a huge academic place, but I virtually always find the ICU attending and sign out to them in person (or at least call them on the phone), even for relatively stable patients. I document in my postop note drips, stability, and who I signed out to (RC +/- fellow + attending).
My last "stable" post-op heart who came up on basically no drips PEA arrested overnight and ended up in the cath lab. They may be stable but that can change in a hurry. Also I can't even count the number of times I've dropped off a liver on no drips and then they were suddenly on 30 of norepi because they're bleeding and unless someone goes and assesses the patient the nurses just keep uptitrating the drips (not their fault, it's what they have the power to do)...
FWIW, I don't do this from a medicolegal standpoint but just because it's good medicine. Our APPs, residents, and fellows are (mostly) fantastic - but nothing beats an attending-to-attending conversation.
My last "stable" post-op heart who came up on basically no drips PEA arrested overnight and ended up in the cath lab. They may be stable but that can change in a hurry. Also I can't even count the number of times I've dropped off a liver on no drips and then they were suddenly on 30 of norepi because they're bleeding and unless someone goes and assesses the patient the nurses just keep uptitrating the drips (not their fault, it's what they have the power to do)...
FWIW, I don't do this from a medicolegal standpoint but just because it's good medicine. Our APPs, residents, and fellows are (mostly) fantastic - but nothing beats an attending-to-attending conversation.
