That's the opposite of what we see. Hell even being on the vent isn't enough to get you into our SICU sometimes, they will sometimes have us ride it out in PACU for a few hours to see if they extubate because they don't have the bed space. You gotta be deathly ill to get into SICU. We will have patients in stepdown units on the vent via a trach at times.
Fem-pop patients in the ICU? Really? They are practically floor patients.
I wish the SICU at my residency and fellowship hospitals were like that. At both places, university settings, anyone s/p a vascular bypass surgery came to the unit for 24 hours for neurovascular checks. It was purely a nursing indication. They were hardly ever on pressors, more than NC oxygen, or really required the ICU for medical reasons. In all honesty, it was annoying. The VA is like this, too. But the again, transferring to the floors at a VA is like discharging to the streets. Same level of care.
As far as PACU goes, I think my residency hospital was like that; we could have vented patients. The question then becomes who manages them? Anesthesiology because they're post-anesthesia in PACU or are they automatically turfed to the SICU team (like at my fellowship hospital), who then had to leave sicu and come see the patients in pacu. What about if they are still in pacu on POD 1 but waiting for an ICU bed?
We could send trach patients to step down (very few beds in hospital) or floors as long as they were trach collared. If they required a vent, automatic ICU. We need more step down units in general.
I've rotated through both MICUs and SICUs (managed together or separately by Anesthesiology and Surgery) and for interns, I still stand by my opinion that the MICU is a better place for them. Interns get to do more in a MICU. As an intern, I had first crack at lines and was more involved in making some decisions under the oversight of my senior. Rounds were full teaching rounds and there were education sessions by attendings or fellows targeted at residents. In the SICU where I did residency (purely trauma run) we were glorified order-writers and everything was run by either the ICU attending or the primary surgeon. In my fellowship I experienced ICUs run by anesthesiologists and it struck me as a hybrid model, in the sense that we still taught the residents, had teaching rounds, discussed evidence, and also spoke about intraop events/management and its effect on how the patient presented to us postop. However, the residents still had to run basically everything by the fellow or attending, and occasionally the surgeon.
I may be generalizing my experience from 3 hospitals systems, but I still think an intern stands to learn the most about CCM and CCM procedures in a MICU, followed by an Anesthesiology-run SICU (less procedures as they usually come from OR rather than ER), and finally a purely surgery-run unit.
