UIH Intensive Care Unit Orientation
Fellows
Welcome to the Intensive Care Unit Rotation!
DESCRIPTION
The intensive care unit at the University of Illinois Hospital offers a wide variety of patient diagnoses
that afford the opportunity to sharpen diagnostic, technical and organizational skills. Diagnoses
encountered include respiratory failure, shock, sepsis, severe acid-base and electrolyte disturbances,
gastrointestinal hemorrhage, liver failure, drug overdose, post-operative patients, and many others.
Fellows will learn to strike a balance between primary hands-on management of patients and
supervision of residents and students caring for the patients. There is a focus on a multidisciplinary
approach to patient care involving the attending, fellow, residents, nurses, pharmacists, respiratory
therapists, nutrition and social services. All members of the team work together, enabling a
comprehensive and stimulating discussion of all aspects of patient care.
EDUCATIONAL OBJECTIVES
Patient Care
Fellows are expected to provide patient care that is appropriate, effective, and compassionate in an
intensive care setting, and to provide care that promotes health, prevents illness and is supportive at the
end of life.
Specific objectives for this rotation include:
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Gather essential and accurate information about patients
Develop and carry out patient management plans based upon scientific evidence, sound clinical
judgment and patient preferences
Use information technology to support medical decisions and learning
Competently perform essential medical procedures
Medical Knowledge
Fellows are expected to demonstrate knowledge of established and evolving biomedical, clinical and
social sciences related to critical care medicine, and demonstrate the application of their knowledge to
patient care and the education of others.
Specific objectives for this rotation include:
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Demonstrate an investigatory and analytic approach to clinical situations
Know and apply basic and clinical science to patient care
Practice-Based Learning and Improvement
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Fellows are expected to be able to use scientific evidence and methods to investigate, evaluate and
improve patient care practices, particularly as they relate to critical care.
Specific objectives for this rotation include:
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Analyze their own knowledge gaps and perform improvement activities
Locate, appraise, and assimilate evidence from scientific studies related to patient problems
Use information technology to obtain and manage patient data
Facilitate the learning of students, colleagues and other health care professionals
Interpersonal and Communication Skills
Fellows are expected to demonstrate interpersonal and communication skills that enable them to
establish and maintain professional relationships with patients, families and other members of health
care teams.
Specific objectives for this rotation include:
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Communicate effectively and demonstrate caring and respectful behaviors when interacting with
patients and their families
Counsel and educate patients and families
Work in harmony with other health care professionals
Communicate clearly and succinctly in the medical record
Professionalism
Fellows are expected to demonstrate behaviors that reflect a commitment to continuous professional
development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude
toward their patients, their profession and society.
Specific objectives for this rotation include:
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Demonstrate respect, compassion, integrity, and responsiveness to the needs of patients and
society. These characteristics should supersede self-interest
Show accountability to patients, peers and colleagues
Demonstrate a commitment to excellence
Demonstrate a commitment to ethical principles pertaining to the provision or withholding of
clinical care, confidentiality of patient information and informed consent
Demonstrate sensitivity to patients’ culture, age, gender, sexual preference and disabilities
Systems-Based Practice
Fellows are expected to demonstrate both an understanding of the contexts, and systems in which
health care is provided, particularly to patients in the critical care setting, and the ability to apply this
knowledge to improve and optimize health care.
Specific objectives for this rotation include:
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Practice cost-effective health care and resource allocation that does not compromise quality of care
Know how to work with health care managers and other providers to access, coordinate and
improve health care
Collaborate with other members of the health care team, including nurses and social workers to
ensure the optimal care of patient
Attend and participate in monthly multidisciplinary administrative meetings to gain an appreciation
of ICU management problems, issues and standing administrative structures required for
maintenance of the ICU environment and supported tasks
PRINCIPAL TEACHING METHODS
Fellows work as part of a team that includes a critical care attending and fellow, residents, students and
nurses that provide care to patients. Team-attending rounds, didactic sessions and informal discussions
are the fundamental teaching activities on this rotation. Formal attending rounds occur daily in the
morning and the attending reconvenes with the team towards the end of the day to re-review all the
patients. All radiographic, laboratory, hemodynamic, and pathologic studies are evaluated both for
patient care and educational purposes. Fellows should give additional didactic lectures on topics
relevant to critical care. There should be at least 4 of them over the course of the month. They should
include topics such as mechanical ventilation, acid-base evaluation, sepsis and vasopressors, sedation,
end-of-life care, pleural space management, massive pulmonary embolism, and hemodynamics.
Templates for these talks are available on the orientation CD.
Self-instruction is highly emphasized and fellows are expected to read primary Critical Care texts, such as
Hall’s Principles of Critical Care. A list of articles in Pulmonary and Critical Care Medicine can be found
online at the American Thoracic Society’s website http://www.thoracic.org/go/atsreadinglist/.
Additional study guides on Swan-Ganz catheterization, hemodynamic monitoring and other topics are
also available at that site in the clinical information critical care site. Fellows are expected to do
advanced literature searches on the diseases they encounter and share their findings with the team.
CONFERENCES
The principal teaching methods include fellow and attending rounds, teaching conferences, online
journal articles, and textbooks.
Didactic topics and journal reviews covering pertinent critical care topics can be voluntary or assigned.
All members of the ICU team are also encouraged to teach other team members. When the unit is less
busy, these topics can be discussed to make the most of the ICU experience.
FELLOW RESPONSIBILITES
Scheduling
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The Section of Pulmonary, Critical, Sleep and Allergy sets the schedules, which are listed in New
Innovations (www.new-innov.com). This schedule will be followed during the rotation at UIC
hospital. The schedule is set well in advance of starting the year. It is important to indicate your
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preference before the schedule is completed. Changes after the schedule has been established can
be done by switching with other fellows with the approval of the Chief Fellow.
Duty periods cannot last for more than 24 hours. Fellows must log in the time that they come in
during off-hours and they may take those hours off the following day. They may not work more than
80 hours per week.
Each UIC-ICU fellow will take 2 overnight calls per month. These calls will be counted toward the 80
hour per week rule.
All unscheduled days off for any reason should be avoided if possible during this rotation. If
unavoidable, the Attending and Chief Fellow need to be alerted as soon as possible.
All days off by students need to be approved by the Attending or Chief Fellow.
Daily Routine Overview
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The fellow should arrive at 7:00 AM. At this time the Fellow should find primary evidence regarding
the care of the patients, personally examine the patients, review radiographs, and audit the chart
prior to work rounds.
Work rounds with the fellow should start at 8:00 AM. This is an excellent time for pragmatic,
bedside teaching by the fellows.
Attending rounds are generally from 9:00 AM until 12:00 PM unless otherwise arranged. Some
attendings may round earlier.
The day ends when all work is completed.
ICU Fellow Specifics
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The fellow works closely with the senior residents, who are often the first team members contacted
about admissions. If possible, it is preferable for the fellow to see any admissions immediately with
the senior Residents as they are being considered for unit admission.
Any refusal of Intensive Care Unit admission must be seen and approved by the ICU attending.
Fellows are expected to know all pertinent patient information and to have audited the patient’s
electronic chart and examined the patient personally before attending rounds.
A senior resident must see and evaluate all ICU consultation requests and write a full consultation
history and physical including a plan of action to be place under Consultations in Gemini for those
patients with an Admission History and Physical. For those patients being admitted to the hospital,
the resident’s note should be placed in Gemini under the Admission History and Physical. Refusals
also need a Critical Care Consultation note.
Ventilator Management Consults. The ICU fellows will see and evaluate all Ventilator Management
patients in other ICUs (Neuro, Surgical), they will write a full consultation including a plan of action
to be place under Consultations in Gemini.
The senior resident and fellow should be notified of all surgical admissions. The senior resident must
coordinate the care of surgical patients with the surgical team. All substantive decisions regarding
patient care should be vetted by the surgical team, unless there is an emergency.
Once a patient is accepted, the team should work together to formulate a plan. The fellow should
supervise any procedures the resident is performing to ensure competency. The resident then may
supervise the intern and medical students in these procedures.
The fellow should review and oversee the content of the intern notes on a daily basis to assure that
the notes reflect the team discussions. The fellows should write a short concurrence note daily.
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Fellows, residents and interns should work together to communicate with patient’s family members
concerning day to day care and change in health status as appropriate.
Night pages from residents should be promptly answered. The threshold for evaluating patients in
person during the night should be low. If either the fellow or resident is uncomfortable with the
situation or resident’s ability to do procedures, the fellow should come in and provide direct care
and supervision.
Any major changes in a patient’s status, including DNR/DNI or withdrawal of care should be
communicated to the attending, regardless of time of day.
WEEKEND CONSULT RESPONSIBILITIES
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The fellow on call Friday evening should receive sign-out from the consult fellow regarding any
patients who need continued consultation over the weekend. They will then follow those patients
over the weekend, staffing them with their attending.
The fellow on call will then check the consult list each day to evaluate any new consults and their
urgency by chart audit and contact with the primary team.
Any bronchoscopies done at any time must be staffed by an attending.
TRANSFERS
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All transfers should be evaluated over the phone for propriety by the fellow. They should be written
in a log in the ICU and, if accepted, should be communicated with both the transfer coordinator and
the nursing supervisor.
Any transfer refusals must be approved by the attending.
EVALUATION
Fellows will be evaluated by the attending who supervises them during the rotation. Verbal feedback is
given as needed on an ongoing basis. The attending must complete an ABIM Competency-Based
Evaluation Form and must discuss the fellow’s performance with the fellow at the completion of the
rotation. If an attending judges that a fellow is performing poorly in any area, the attending should
provide constructive feedback as soon as the deficiency is apparent.
Fellows evaluate attending physicians and program performance using a standard departmental online
form that provides for comments.
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