SICU Rotation: PGY-1 / PGY-2 Levels
Surgical Intensive Care Unit (SICU)
Rotation
PGY-1 / PGY-2 Levels
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SICU Rotation: PGY-1 / PGY-2 Levels
Patrick J. O’Neill, PhD, MD, FACS
Medical Director, Surgical Intensive Care Unit
Program Director, Surgical Critical Care Residency
Office: (602) 344-5637
Pager: (602) 608-0067
Tammy Kopelman, MD, FACS
Vice Chair, Department of Surgery
Associate Program Director, Surgical Critical Care Residency
Office: (602) 344-5637
Pager: (602) 608-0071
Sydney Vail, MD, FACS
Medical Director, Trauma Services
Medical Director, Tactical Medicine Program
Office: (602) 344-5637
Pager: (602) 608-0070
Paola Pieri, MD, FACS
Associate Medical Director, Trauma Services
Office: (602) 344-5637
Pager: (602) 608-0073
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SICU Rotation: PGY-1 / PGY-2 Levels
Noelle Rosenkrans, PA-C
Office: (602) 344-5637
Pager: (602) 608-0069
Stacey Lawrence, PA-C
Office: (602) 344-5637
Pager: (602) 608-0060
Michael Deeter, PA-C
Office: (602) 344-5637
Pager: (602) 608-0049
Introduction
One’s first encounter with the ICU may be overwhelming. For many of you, it is the first time you are
dealing with critically-ill patients, complex life support systems, potent medications, and complex
ethical issues. It is no surprise that many find the ICU a confusing, intimidating and challenging
place.
Comprehensive ICU management is a 24-hour a day process. The ultimate goal is to identify signs of
physiologic deterioration early such that appropriate interventions may be instituted before
progression to multisystem organ failure and death. In other words, it is our goal to make you into
“fire preventers” rather than “fire fighters”.
ICU care is best practiced with a multidisciplinary approach. Our critical care team consists of boardcertified surgical intensivists, general surgery and Ob/Gyn residents, physician assistants, and often
PA students or medical students. Non-physician members of the team include ICU nurses, respiratory
therapists, pharmacists, physical therapists, occupational therapists, nutritional support team members,
and caseworkers. It cannot be stressed strongly enough that it is vital to work constructively and
amicably with all team members. Good rapport with the staff will lead to better patient care. The
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SICU Rotation: PGY-1 / PGY-2 Levels
majority of nursing and respiratory staff are highly trained and experienced possessing sound
judgment which should not be discounted. You will depend on them for accurate information, early
warning of potential problems, execution of complex orders, and set up and use of multiple, complex
monitoring devices.
The surgical intensive care unit (SICU) is a 13-bed unit located on the fourth floor of the hospital. The
SICU provides comprehensive critical care services for surgical patients. The majority of the patients
are typically trauma and neurosurgery patients, but general surgical, Obstetric / Gynecologic
(Ob/Gyn), and surgical subspecialty patients are also cared for in the SICU. Patrick J O’Neill, PhD,
MD, FACS, is the Medical Director of the SICU.
Organization of the Service
There are primarily four attending/teaching surgeons who provide daytime coverage in the SICU: Drs.
O’Neill, Kopelman, Pieri, and Vail. Typically, the SICU attending is on service for one week at a
time. Daytime coverage for this attending is from 0900 until 1700, Monday through Friday.
There are four attending/teaching surgeons who take most of the nighttime, weekend, and holiday call
on the SICU service: Drs. O’Neill, Kopelman, Vail, and Pieri. Five additional attending surgeons,
Drs. Caruso, Matthews, Foster, Dixon, and Miller, also take call, but less frequently. The
attending/teaching surgeons take in-house call and are available from 1700 until 0900 the next
morning weekdays. Weekend call (Saturday, Sunday, and holidays) is from 0800 to 0800 (24-hour
shifts).
The SICU service is composed of at least two surgery residents: a PGY-2 resident and a PGY-1
resident. PGY-1’s from the Ob/Gyn Residency program join the team most of the year. Further, MSIV medical students occasionally rotate on the service. Nighttime coverage of the SICU is provided
by the PGY-2 resident.
Most of the time a mid-level provider (Physician Assistant; PA) will be present on the service. These
allied health professionals are experienced, team-oriented members of the SICU service. They are a
wealth of information and should be treated with respect.
MMC has an ACGME-accredited Surgical Critical Care Residency. When the position is filled, there
will be a Surgical Critical Care Resident (Fellow) present in the SICU for the majority of the year.
Their role is to earn an advanced surgical critical care training experience leading to boardcertification. They will act as a resource to the SICU team but will not replace the members.
A simple organization chart is shown below:
SICU
Attending
PGY II
Chief
Surgical Critical
Care Resident
(Fellow)
Physician
Assistant
PGY-I
Resident
MS -IV
Med. Student
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SICU Rotation: PGY-1 / PGY-2 Levels
Schedule
A schematic schedule for the SICU service schedule is shown below.
 SICU rounds should start promptly at 0900 every day except Wednesday (1000) due to
conferences.
 PGY-1 residents: On-duty from 0600 – 1700 (Monday through Friday).
 PGY-2 residents alternate Schedule 1 and 2 each week:
o Schedule 1:
Monday 0600 – 0600
Wednesday 0600 – 0600
Sunday 1700 – 0600
o Schedule 2:
Tuesday 0600 – 0600
Thursday 0600 – 0600
Saturday 0600 - 1700
o Remaining shifts are filled by off-service PGY-2 and PGY-3 residents
 There are check out rounds at 0600 and 1700 (1800 on Wednesday).
 The SICU team is expected to attend Wednesday morning conferences, as well as noon
conferences on Wednesday.
 There is a Multidisciplinary SICU Conference every Thursday at 0900 in the Surgery
Conference Room. Bedside rounds will follow the conclusion of the conference.
 There is a SICU Fellows conference scheduled for Thursday afternoon at 1400 (when we have
a Fellow).
0600
0630
0700
0730
0800
0830
0900
0930
1000
1030
1100
1130
1200
1230
1300
1330
1400
1430
1500
1530
1600
1630
1700
1730
1800
Monday
Checkout
Tuesday
Checkout
Wednesday
Basic Science
Thursday
Checkout
Friday
Checkout
Conference
Morbidity &
Mortality
Grand
Rounds
ROUNDS
ROUNDS
Multidisciplinary
Conference
ROUNDS
ROUNDS
ROUNDS
Jr Clinical
Review Conf
SICU Fellow
Conference
Sr Clinical
Review Conf
Checkout
Checkout
Checkout
Checkout
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Checkout
SICU Rotation: PGY-1 / PGY-2 Levels
Expectations
Division of Labor and Specific Duties: There will be at least two residents on the SICU service
(typically a PGY-1 and a PGY-2). In general, both residents will be responsible for the entire service
(i.e. they will not follow individual patients). Division of labor will occur immediately after checkout
rounds in the AM. The PGY-2 resident will have the right of first refusal for all procedures in the
SICU. However, it is expected that the PGY-1 resident will perform at least half of the procedures
with the PGY-2 resident supervising.
The SICU team will co-manage the patient in conjunction with the primary service. The SICU team
will be responsible for the detailed clinical management of the patient including sedation and
analgesia, ventilator management, cardiovascular support, fluid and electrolytes, nutrition, antibiotic
administration, et cetera.
Specific duties of the SICU resident includes (but are not limited to):
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Be present and available in the SICU (the SICU is your only clinical responsibility)
during work hours (with the exception of lunch and restroom breaks)
Gather information and discuss patient issues with the SICU team
o Patients with significant past medical histories will require extra effort to find
outside medical records and medication lists
Perform a COMPLETE examination on each assigned patient prior to rounds
including, but not limited to:
o Standard physical exam including all wounds and back/buttocks skin
o Assessing the stability of the patients airway
 If intubated, determine the position and security of the tube / trach
o Assess the position and security of all enteral tubes (NG, OG, DHT, etc.)
o Examination of all invasive catheters to assess for signs of infection
o Check extremities for signs/symptoms of phlebitis or septic thrombophlebitis
o Reviewing any new radiographs and obtaining the official interpretation
o Review and confirm any and all culture results including speciation and
antibiotic susceptibilities and log such results in the SICU Culture Book
o Review all currently prescribed medications and discontinue those that are no
longer needed to keep the Medication Reconciliation accurate and safe
Present at morning rounds to the Attending (and Fellow)
Write comprehensive patient notes with the above data
Perform bedside procedures under the guidance of the Attending (or Fellow) and write
procedure notes immediately following the procedure.
Update patients and their families as appropriate (at least daily)
Be an active participant in checkout rounds each evening to the PGY-2 SICU resident
REMEMBER: If you always practice medicine with the thought in mind of “I want to provide the
same level of care I would want for my loved ones”, you will likely be doing the right thing.
Operating Experience: The SICU residents are not expected to participate in any surgeries unless
there is a critical need for their presence in the operating room. Their primary responsibilities
must have been fulfilled, and they must have permission from the SICU attending to
participate in surgeries. Surgeries on patients in the SICU will be the responsibility of the
primary service.
Clinic: There is no specific clinic responsibility while on the SICU service.
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SICU Rotation: PGY-1 / PGY-2 Levels
Conferences: Mandatory conferences include Basic Science, M&M, and Grand Rounds on
Wednesday morning, as well as Junior Clinical Review conference on Wednesday. The SICUspecific conferences are the Multidisciplinary Conference on Thursday mornings and the SICU Fellow
Conference on Thursday afternoons (when a Fellow is rotating in the SICU).
Procedures: Maricopa residents have competency requirements that must be met prior to performing
procedures (such as central venous access, arterial lines, tube thoracostomy) independently. All
rotating residents must demonstrate proficiency at procedures to the satisfaction of the chief resident,
mid-level, or attending prior to performing procedures independently. All procedures must be
accompanied by a written procedure note placed in the chart immediately following the procedure.
The attending surgeon must be notified prior to performance of bedside procedures. A word of
advice: Read and understand the technical aspects and potential complications of a procedure
BEFORE attempting it. Beginning a procedure without adequate preparation will result in
FORFEITURE of the procedure.
PGY-2: The PGY-2 resident is considered the “Chief” for the SICU service. It is their additional
responsibility to oversee the entire service and make sure all members are performing at the expected
level. The PGY-2 resident must take “ownership” of the service. A successful PGY-2 SICU Chief
will lead by example and encourage the members of the team to perform.
Research: We have numerous clinical and basic science research trials ongoing at any point in time.
Residents will be made aware of these trials for educational purposes. Resident participation in
research is strongly encouraged and vigorously supported.
Textbook: The textbook for the SICU rotation is The ICU Book by Marino. There is a posted reading
list that if followed will allow the resident to complete the book in time for the end-of-rotation SICU
examination.
Examination: At the completion of the SICU rotation, each resident will be expected to take and pass
a written examination. A score of 70 or higher is a pass. A score of less than 60 is a failure and will
result in failure of the rotation. A score of 60-69 is a marginal pass; passing the rotation will then
depend on an above average clinical evaluation.
Each resident is expected to contact the Trauma Administrative Assistant, Sydney Zordani
(Sydney_Zordani@dmgaz.org; 602.344.5637) to schedule the exam AT THE COMPLETION OF
THE ROTATION. Taking the exam after the rotation has concluded will be approved on a case-bycase basis only and must be pre-approved. FAILURE TO TAKE THE EXAM AT THE END OF
THE ROTATION WILL RESULT IN A FAILURE OF THE ROTATION.
Call: The SICU team is on for the hours listed above.
Reasons to Contact Attending/Teaching Surgeon: (an extensive list is posted in the SICU)
 Death
 New admission
 Increase in level of care (e.g. transfer to ICU)
 Need for procedural intervention (e.g. chest tube, central venous catheter)
 Respiratory failure requiring intubation
 Unexpected extubation
 Diagnosis of shock (e.g. vasopressor need or sustained hypotension)
 Unexpected cardiac dysrhythmia (e.g. new onset atrial fibrillation, ventricular tachycardia,
ventricular fibrillation)
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SICU Rotation: PGY-1 / PGY-2 Levels
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Diagnosis of sepsis, or severe sepsis
Unexpected critical laboratory values
End of life issues (e.g. change in code status)
Patient or family complaints
Uncertainty regarding the plan of care
Any situation exceeding the resident’s comfort level
Evaluation: The evaluation criteria that will be used by the the mid-levels and the attending/teaching
surgeons to evaluate you are listed in the objectives in the Curriculum. Additionally, each evaluator is
asked to submit a subjective narrative of overall impression, areas of strength and improvement, and
overall performance.
You will also be asked to evaluate the SICU rotation and your
attending/teaching surgeons. On or before your last day of SICU rotation, you are required to take the
SICU exam. This must be scheduled in advance with Sydney Zordani via phone 344-5637 or email
Sydney_Zordani@dmgaz.org
Objectives: The specific objectives for this rotation are listed in the Curriculum.
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