I can't imagine why you would give a s**t if the patient in bed 2 in "your ICU" was a SICU or Trauma ICU patient as long as you didn't have to manage them.
Because these patients code too, and even when they don't it's frustrating and demoralizing for the nurses when they don't have an easily available intensivist to address the many issues that come up in the course of an ICU day. It weakens any sense of unit cohesiveness and accountability.
I'm certain we don't need to lecture each other on the definition of a closed ICU--I'm sure you've read the same definitions in which it's defined as every patient in the unit being managed by or having a mandatory consult from an intensivist. Fact of the matter is, you don't get a free pass from this simply by calling a patient a "boarder."
And this is why in various initiatives like Leapfrog a closed ICU isn't enough and has to be combined with multidisciplinary rounds, 24-hour availabilty, etc. The model ICU isn't defined by a bunch of patients who happen to make their way to the unit, get followed mostly but not-all-the-time by intensivists, and then make their way out without direct physician-to-physician signout.
But since we're talking about USC, let's redirect to that. I'll again emphasize that I'm giving my take on what goes on here. If this is a ra-ra-USC-is-the-best-residency-in-the-world thread, please let me know so I can bow out. It's a great place but it has its flaws.
The hospital course of a typical County ICU patient:
1. Patient comes to the ED
2. Patient is managed (unusually effectively, usually) by the ED
3. ED decides to send patient to the ICU--calls the medical consult
4. Medical consult will listen to a bit about the patient, occasionally try to redirect the patient to the floor, and sometimes assist in some of the medical management. This is largely consult dependent. Some are excellent, some not.
5. Patient arrives on the unit
6. ICU team hears about the patient after the patient arrives on the floor. The patient is not even assigned a team, in fact, until after they've physically arrived in the unit. This often means that a patient who presumably is by definition critically ill has not physician caring for them for the time it takes this team to get assigned, often 15-30 minutes.
7. Patient is managed. Signout on the patient is obtained from either an overwhelmed medical consult who knows only the basic details about the patient and very often has not seen them, or from the ED's note. To speak to the ED directly about a patient's course requires at least two calls by an accepting team: One to the medical consult, who will give the ED's number, and then to the ED. We have variable luck getting in touch with the treating ED MD in a timely fashion. Again for patients who are presumably critically ill.
8. Patient gets managed and stabilized for floor.
9. Upon transfer to the floor, a transfer note is written and the patient is sent to the floor. There is no standard for resident-to-resident communication upon transfer. ICU patients are transferred out with a note in the electronic record.
This is how it happens. Is it adequate? Probably. Is it ideal? Absolutely not. If you're considering USC as a residency there will be many positives. I'll emphasize again, I believe the ICU is one of them or I wouldn't have chosen to come here. But the system, like many large hospitals, has major transfer and accountability issues.
If you're used to a model in which you receive report about a patient before they arrive so that you can immediately provide them adequate care, and in which you give report to an accepting physician before they leave so you can ensure they continue to receive adequate care, you will be disappointed. Nurses have figured this out. We have not. It's a flaw, and can be improved. USC isn't perfect--it's a great place to train and I'm looking forward to continuing to meet residents who are enthusiastic about making it even better.
Did you apply to Scripps?
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