PCCU Rounds: Physician Roles and Expectations
Morning Rounds
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Begin at 07:45 Monday to Friday and 08:30 on weekends/holidays at the PACS
station to review any relevant radiographic investigations
Residents and fellows should assign their name to patients on the PICU census
board prior to starting bedside rounds. Assigned trainees are to write their name
and pager on the beside nurse’s worksheet in the designated area as handover
progresses through the unit
The I-PASS handover document should be updated on SharePoint by the outgoing
night team prior to rounds. Copies should be provided to the incoming medical
team
Bedside rounds are attended by incoming and outgoing staff physicians, fellows,
residents, unit RTs bedside RNs, pharmacist, dietician, and PACE Fellow
These rounds will be led by the overnight fellow and resident where patients should
be divided equitably based on the patient acuity and resident level of training.
Ultimately the fellow has a supervisory responsibility to the resident and will be
expected to act as a mentor and share accountability for handover provided by the
residents
The night team will suggest a plan to the day team and address the patient’s major
active issues. It is the responsibility of the day staff physician to confirm and/or
provide any amendments to the plan of care
The PACE Fellow will carry the PICU Fellow Vocera and /or pager and will troubleshoot emergent issues in the unit to avoid interruptions to handover
Post Rounds (TTC) Huddle
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Should occur immediately after bedside handover rounds for no longer than 10 min
The daytime staff physician will huddle with the day medical team and charge nurse
to ensure that there is clarity about patient discharges, investigations and
subspecialty consultations so that these occur in a timely fashion with appropriate
communication
PACE Handover
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The overnight team will meet with the PACE fellow and PACE RN immediately after
handover in the PICU report room to review any PACE activations from the previous
night
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Daily Educational Rounds
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Will occur every weekday from 10-11am in the PICU conference room
The schedule of educational events will be published weekly
All PICU fellows not on vacation or away on elective are expected to attend these
rounds
Systems Rounds
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Start at 14:00 and expected to end at approximately 15:30
The staff physician must be in attendance and can only defer to a fellow if
assessed by the fellowship program to be capable of running rounds
independently
During this rounds the RNs, RTs and multi-D team will provide a systems review
of the patient
The residents and fellows are expected to address all medical issues prior to
these rounds and not have a “wait until rounds” philosophy. Residents should
ask fellows for guidance and fellows should provide appropriate supervision so
that issues are not left until the afternoon. Staff physicians should be accessible
to provide advice and input prior to afternoon rounds
The medical team, bedside RNs and allied health team are expected to
collaborate in ensuring the daily goals checklist is completed prior to afternoon
rounds. The daily goals checklist is embedded within the RN worksheet and
replaces the FASTHUG checklist and so should be reviewed for outstanding
issues during these rounds
** On weekends these rounds begin 30-60 min after handover where the
medical team is expected only to have addressed any major issues prior to
starting rounds
Afternoon Medical Handover
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These will occur in the PICU conference room and will be attended by both
incoming and outgoing staff physicians, fellows and residents
The sign-out will be led by the daytime fellow and resident where patients
should be presented equitably based on the patient acuity and resident level of
training; once again the fellow has a supervisory responsibility for the resident’s
handover (ideally addressed by pre-handover discussion/mentoring)
The I-PASS handover tool must be updated so that the up-to-date version can
be provided the on-call team.
The PACE Fellow will carry the PICU Fellow Vocera and /or pager and will
trouble-shoot emergent issues in the unit to avoid interruptions to handover
After handover of the PICU, the PACE Fellow should handover active PACE
patients that require follow-up or for whom they may expect a PACE activation
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