What is the workload for your ICU like ?

[CaliforniaAppli]

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current resident here , wanted to get a sense of how reasonable or unreasonable my program is for our icu month:

30 call q4hr. No cap!! We could admit 10 in the day if shlt hits the fan. No overnight attending either. Fellows leave at 5. One resident one intern teams.
There is a night float resident also.

 

[whoknows2012]

current resident here , wanted to get a sense of how reasonable or unreasonable my program is for our icu month:

30 call q4hr. No cap!! We could admit 10 in the day if shlt hits the fan. No overnight attending either. Fellows leave at 5. One resident one intern teams.
There is a night float resident also.

Q4 24-27 hr call. No cap on admissions one intern one resident overnight for 12-16 beds. Overnight fellow and attending in house. Average night was 1-2 admissions never seen more than 5 in one day/night.

 

[epicandprivate]

Night float system. Everyone works 6A to 6P or 6P to 6A. Generally 6 days on and one off. Usually we have 2 residents on service at night (3rd and 2nd year). Admit typically 2-4 pts a night and cross cover for up to 20.

ICU at night is home call for fellows, no attending in house either. Fellows usually came in for admissions and came in if residents were uncomfortable putting in lines/procedures, etc. Attendings are almost never seen at night. I felt this system was way to cush for fellows. I never understood how a fellow could be at home for call for the ICU but looking back now I appreciate the autonomy I got. I feel more comfortable going forward into fellowship training.

 

[IMreshopeful]

My residency program had pretty busy quarternary care ICU. 30 beds, two icu teams, q4 24-30 hour call for residents and interns. At night residents and interns cross covered and admitted to both teams for the whole unit. In house fellow and attending at night.

Some programs have it as sort of a badge of honor that they had no in house attending. Ours typically only got involved if there was truly an issue where the fellow needed help or if multiple codes were going on etc, but I liked having them available for backup.

 

[Psai]

Sounds about right.

 

[DoubleBogey]

8p-6a - no in house attending or fellow, one reseident and one intern, covering 16 beds at a quarternary center. Days had 3 residents and 3-4 interns. Admits/upgrades overnight 0-5, responding to rapids 0-5 night and days. One resident and intern stayed from 5p-8p to cover until night float team came in. Nocturnist overnight helped with any lines that were difficult. Fellow was called in if someone was difficult to vent, all admissions ran by fellow overnight. Certain attendings liked to be notified of any admits overnight as well with the attending called in if still difficult to vent.

Probably a little more kush than some of the other experiences in here, but I didn’t mind.

 

[NewYorkDoctors]

Where I did residency at a large tertiary care center

7PM to 7AM
One resident one intern one NP
In house night intensivist attending
No In house fellows at all (the fellow on pulmonary has night pager call for RCU admissions)

Intern and NP take care of the unit and lines while the resident is off at consults, rapid responses , code blues and floor line consult requests (usually an USG PIV placement)

Admissions vary . Up to 10 admissions.

Very Cush for the fellows . The mantra was septic shock at 3am is the same at 3pm it seems

 

[alternatecharacter]

Academic hospital: NF system. 12 hour night shift. 1 resident, half an intern (they have other responsibilities), in house fellow. Cross cover 14-30+ patients, admit anywhere from none to the worst I've heard is 16. Average is 8 consistently. Attending is at home. When it's overwhelming, which for me is 5 in a couple of hours or 12+ total for the night, the fellow helps with notes and orders on some. Other people have different thresholds and ask for help earlier. Most of the time it's the resident doing the orders/notes on all the patients with supervision for procedures if needed, and we check out the plans on most patients. If stuff starts to melt down, the attending will come but that is only a once every couple of weeks type of thing. It is busy, but I feel less stress because I know I have backup.

We of course cover all blues for an enormous hospital as well.

Our VA: Home call fellow. 1 resident for ICU who also supervises all floor admissions by an intern who also cross-covers floor. Relatively few admissions. Icu tends to have 1-14 patients, luck of the draw whether your whole week is covering 3 patients and admitting none or covering 10-14 and admitting 2-3 each night. On average I'd say 5-6 patients and 2-3 admissions in a whole week. The VA is not an enjoyable place to work. You have to babysit everyone or they won't do their jobs (properly or otherwise).

Cover all blues and rapids at VA.

 

[Psai]

Academic hospital: NF system. 12 hour night shift. 1 resident, half an intern (they have other responsibilities), in house fellow. Cross cover 14-30+ patients, admit anywhere from none to the worst I've heard is 16. Average is 8 consistently. Attending is at home. When it's overwhelming, which for me is 5 in a couple of hours or 12+ total for the night, the fellow helps with notes and orders on some. Other people have different thresholds and ask for help earlier. Most of the time it's the resident doing the orders/notes on all the patients with supervision for procedures if needed, and we check out the plans on most patients. If stuff starts to melt down, the attending will come but that is only a once every couple of weeks type of thing. It is busy, but I feel less stress because I know I have backup.

We of course cover all blues for an enormous hospital as well.

Our VA: Home call fellow. 1 resident for ICU who also supervises all floor admissions by an intern who also cross-covers floor. Relatively few admissions. Icu tends to have 1-14 patients, luck of the draw whether your whole week is covering 3 patients and admitting none or covering 10-14 and admitting 2-3 each night. On average I'd say 5-6 patients and 2-3 admissions in a whole week. The VA is not an enjoyable place to work. You have to babysit everyone or they won't do their jobs (properly or otherwise).

Cover all blues and rapids at VA.

Oh my god, 8 ICU admissions a night on a regular basis? You probably don't need a fellowship to become an intensivist at that point.

 

[aafisahar]

Oh my god, 8 ICU admissions a night on a regular basis? You probably don't need a fellowship to become an intensivist at that point.

8 a day is a light service for us. 12-16 is the norm. q4h call

 

[epicandprivate]

8 a day is a light service for us. 12-16 is the norm. q4h call

12-16 new admissions a night? How many residents and/or fellows in house. I find that hard to fathom.

 

[aafisahar]

12-16 new admissions a night? How many residents and/or fellows in house. I find that hard to fathom.

fellow and attending overnight all the time

 

[IMreshopeful]

8 a day is a light service for us. 12-16 is the norm. q4h call

What is the acuity of those admits? We usually had 4-8 admits per night but our ICU patients were insanely ill.

 

[Psai]

8 a day is a light service for us. 12-16 is the norm. q4h call

1 resident 1 intern? How many patients are you covering? These are all icu level patients and not some boarders or step down? That sounds insane.

 

[epicandprivate]

8 a day is a light service for us. 12-16 is the norm. q4h call

There is no way one resident is admitting 12-16 true ICU level patients a night.
Physically impossible, even if your providing crappy care, still not possible.

 

[mochief2000]

Guys remember ICU is not ICU everywhere. Each hospital it depends on what your nurses, RT are comfortable managing on the floors. So in some institutes Bipap can be used on the floors while at others it can't. Same for drips etc. Some places have step down some don't. All this can add to the ICU census
With that being said admitting 12 ICU patient is not impossible, but if that is 12 septic shock type of patients, somebody is definitely dying....

 

[redpanda]

Academic quaternary care center. 50% or more admits via transfer from OSH, 30-40% or a little less via the ED, the rest transfer up from the floor. 13 hour night float. NF with 1 resident, 1 intern covering 24 beds. 1 in house fellow overnight for procedural supervision. 0-8 admits overnight. Very uncommon to have boarders/pts that don't have a strong ICU need by 7PM still in a bed.

 

[alternatecharacter]

Guys remember ICU is not ICU everywhere. Each hospital it depends on what your nurses, RT are comfortable managing on the floors. So in some institutes Bipap can be used on the floors while at others it can't. Same for drips etc. Some places have step down some don't. All this can add to the ICU census
With that being said admitting 12 ICU patient is not impossible, but if that is 12 septic shock type of patients, somebody is definitely dying....

Definitely true. Like anyone knows it's possible to have a 4 admit night that's insanely busy/stressful and a 10 patient night that is chill. The worst are the code blues from the floor that come back and need the CPR time (usually a couple of times), lines, a lot of chart review to figure out what went wrong, note and orders. That is a real time suck. Plus they usually die anyway so it's depressing.

For us usually only half or a third are septic shock patients. Usually get one dka every couple of days, we can't put those on the floor here. So that's a brainless 15 minute admit. Most of the non-septic shock patients are GI bleeds and neurological problems which both tend to be fairly quick. Our neuro ICU is under MICU. We can do continuous bipap on the floors thankfully otherwise we'd be in trouble. Most cardiac related gtt's like milrinone/dob/lasix can be done on our CCU floor, and we have a CVICU and CTICU so that diverts patients away. Our ED does a great job of resuscitating, working up, lining and tubing people so if the patient is from in house they are usually tied up in a bow. Outside transfers, which do represent a chunk of our admissions, are usually a gigantic mess.

Having a good EMR is also nice. We have great order sets, writing notes is streamlined. The expectations for our assessment and plans are not high overnight. Basically all the problems listed, and a basic sketch of what you are thinking and doing not the endless crap you write as an intern on days.

 

[Trogghunter]

Tertiary/quaternary referral center, catchment of 5,000,000 people, only major center for 100 miles in any direction, about 30 hospitals all referring to us. 40 bed MICU with room for overflow, highest I saw was about 50 between the 2 teams. Each day team had an attending and a fellow with 2 residents and 2-3 interns total. Night float was brutal, one fellow, 2 residents. For a while they pulled interns from the night system...attending not in house but always available. Had to get to work going through an avalanche, uphill both ways, and just before the door you got kicked in the teeth by a mule. The program stopped NF to do q4 call as part of that residency program study/experiment a couple years back, but we were getting 20 admits/consults in a shift as residents and it was becoming too much. Glad that's over.