ADULT CRITICAL CARE MEDICINE
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PART II - 2008
THE ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA
PART II
PRE-SURVEY QUESTIONNAIRE
ADULT CRITICAL CARE MEDICINE
University:
Name of Program Director:
Date of Review:
Sites Participating in this Program:
Program Website / URL:
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IV. RESOURCES
Standard B.4
"There must be sufficient resources including teaching faculty, the number and variety of patients, physical
and technical resources, as well as the supporting facilities and services necessary to provide the opportunity
for all residents in the program to achieve the educational objectives and receive full training as defined by the
specialty training requirements in the specialty or subspecialty."
Where the resources to provide "full training" are not available at the sponsoring university, several different types of
inter-university affiliations may be negotiated, as stated in the grey book "General Information Concerning
Accreditation of Residency Programs." It should be noted that the exchange of residents between two fully
accredited programs does not require an inter-university affiliation.
Coordination of Adult and Pediatric Subspecialty Programs
a)
Is this university accredited for (check one only):
adult critical care medicine only
pediatric critical care medicine only
b)
If the university is accredited for both programs, describe the extent to which the two programs are integrated in the
following areas:
1)
Program administration
2)
Academic program
3)
Clinical program
4)
Technical and/or laboratory skills
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1. Teaching Faculty
List by teaching site the members of the teaching faculty who have a major role in this program, including members from other departments. In indicating a
subspecialty, use as a criterion whether he or she is considered by colleagues as a subspecialist and functions academically and professionally as one.
Teaching Site
Name
University Rank
Specialty
Qualifications
What percentage of faculty listed above (#2.) have been practising in the specialty/subspecialty:
< 15 years
%
> 25 years
%
Subspecialty
(If any)
Nature of Interaction with Resident
(e.g. clinical, teaching, research)
ADULT CRITICAL CARE MEDICINE
2.
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Financing of the program
a) Describe the source of funding for residency positions in this program.
b) How is the program funding the following?
i.
Resident travel to conferences?
ii. The Society of Critical Care Medicine Multiple Choice Exam?
iii. Computers for the residents?
iv. Courses such as ACLS, ATLS, and PALS?
c) How is the Program Director supported to run the program? Comment on resources available, money available, and if
the Director has protected time to devote to the program.
ADULT CRITICAL CARE MEDICINE
3.
a.
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General Critical Care Data
Demographic Data for each ICU where residents rotate
Complete the following table for a 12-month period. Specify the 12-month period used, the source of data, and which ICU
acuity scoring system was used (APACHE score, MPM, SAPS etc) in the comments section. Add rows as needed to
include all units where residents rotate for primary ICU experience. Standard deviations can be included in the table if the
data is available. Only full ICU beds should be counted. If there are lower acuity beds (stepdown unit) attached to the
ICU these should be described in the comments section. Open or closed refers to the management functioning of the unit.
In a closed unit the ICU team is responsible for all orders and all admission and discharge decisions. Open units allow
non ICU services to write orders and make admission/discharge decisions.
Unit Name
Number of
ICU beds
Open or
Closed unit
Number of
admissions
Average
LOS
Average
acuity
score
ICU
mortality
(%)
TOTAL
Comments:
b.
Narrative description of units where residents train
Provide a written description of the purpose of each unit in the training program and the case mix of the admissions to the
unit. Indicate if one type of patient (ie post op cardiac, trauma etc) dominates the population of the unit. Comment on the
capabilities available for support of critically ill patients in each unit. Comment on the frequency of out of unit
consultations, and if the residents are responsible for responding to cardiac arrests or trauma victims outside of the ICU.
Describe the clinical responsibility of Critical Care residents in each unit. Use a separate paragraph or section for each
unit.
c.
Specific ICU activities important for training residents
Complete the table below by recording the number of admissions during a 12-month period where the primary admission
diagnosis is one of the four listed in the table. Specify the 12-month period used and the source of data in the comments
section. Add rows as needed to include all units and hospitals that receive ICU program residents.
Diagnostic information
HOSPITAL/Unit
TOTAL
Cardiogenic shock
ARDS
Post Cardiac
Surgery
Head injury
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Comments:
Interventions used in ICU over a 12 month period
Complete the table below by recording the actual or approximate number of the listed interventions for a 12 month period.
Specify the period used and the source of data in the comments section. Use the comments section to outline the
involvement of critical care residents in these interventions.
HOSPITAL/Unit
Mechanical
Ventilation
Conventional
Hemodialysis
Continuous Renal
Replacement
Therapy
Intraaortic
balloon pump
Intracranial
pressure
monitoring
TOTAL
Comments:
Nutritional
Describe the training that residents in critical care receive to evaluate the nutritional status of patients, to determine
current deficiencies, and how to provide the appropriate nutrition in the most effective manner, be it enteral or parenteral,
to sustain the patient throughout the period of critical illness.
Does a dietician attend daily rounds in the unit?
Do residents receive exposure to metabolic charts during their ICU rotations?
What percentage of patients admitted to each ICU receives total parenteral nutrition during their ICU stay?
Trauma
Complete the following table for all hospitals. Include the 12-month period used and the source of data in the comments
section. Add rows as needed to account for all units and hospitals that admit trauma patients. Use the comment section to
outline the involvement of critical care residents in trauma care in your primary trauma unit.
HOSPITAL/Unit
Type of Trauma centre
Number of trauma victims
managed at Hospital with
Number of
trauma victims
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Injury Severity Score
greater than 16
admitted to
ICU
TOTAL
Comments:
Describe the team and organization responsible for the care of multiple injuries. Please indicate the hospital(s) involved,
the general plan of management from initial care to definitive treatment, and the role played by the critical care residents
in this process. Does the hospital have a designated trauma team? How is the critical care resident involved in the early
phase of trauma resuscitation?
Describe the specific trauma training provided to critical care residents.
Sepsis
Complete the table below for a 12-month period. Use the comments section to indicate the 12-month period used and the
source of data. Add rows as needed to include all units where residents rotate for primary ICU experience.
INTENSIVE CARE UNIT
Number of septic shock admissions
TOTAL
Comments:
Describe the role of the critical care residents in managing patients with septic shock. Is there an Infectious Disease
service available for consultation? Are there any antimicrobial agents or other medical therapies that CANNOT be
ordered by the critical care team?
What training do critical care residents receive in infection control procedures?
Toxicology
Complete the table below by recording the number of toxicologic emergencies responsible for ICU admission in each of
your units. Specify the 12-month period used and the source of data.
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INTENSIVE CARE UNIT
PART II - 2008
Toxicologic Emergency Admissions
TOTAL
Is there a liaison with a poison control centre?
Describe any additional toxicology training available and the opportunities available for critical care residents to receive
toxicology training.
Burns and Electrical Injuries
Complete the following table for a 12 month period. Use the comments section to indicate the time period used, the
specific acuity score reported, and the source of the data. Add more rows as needed if several intensive care units admit
burn patients. Use the comments section to describe the involvement of critical care residents in the unit where most of the
burn care is delivered.
Hospital/Unit
Number of Burn
admissions to ICU
Average Acuity score
of burned ICU
admissions
Average LOS of
burned ICU
admissions
ICU mortality of
Burn admissions
(%)
TOTAL
Comments:
Describe the facilities to provide training to residents in fluid resuscitation, early grafting, prevention and management of
burn wound sepsis and the minimization of metabolic complications of burns.
Transplantation
Which of the following types of transplantation programs are operating in your centre?
Cardiac Transplant
Bone Marrow Transplant
Lung Transplant
Hepatic Transplant
Other (specify)
No Transplant programs in operation
Renal Transplant
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Which type of transplant patients are admitted to ICU in the immediate post transplant period?
Cardiac Transplant
Lung Transplant
Bone Marrow Transplant
Hepatic Transplant
Renal Transplant
Other (specify)
None routinely admitted to ICU
If you admit recently transplanted patients to ICU complete the following table. In the comments section indicate what 12
month period you are using, what the source of the data is, and what units are admitting the patients. Use the comments
section to describe any additional training related to transplant care.
Type of transplant
Number of
admissions per year
Average Length of stay in
ICU
Total
Comments:
Complete the following table including all Intensive care units that routinely receive residents from your program.
Provide data over a 12 month period. Use the comments section to specify the 12 month period used and the source of
data. Add rows as needed to include all units.
Unit/Hospital
Number of patients who were
declared brain dead
Number of patients who were organ
donors
TOTAL
Comments:
Pediatric ICU Experience
Is Pediatric ICU experience mandatory for residents in your program?
Yes
No
Is there a pediatric component to your adult ICU?
Yes
No
If yes, outline how pediatric patients are integrated into the adult ICU. Is there a pediatric intensivist?
How many pediatric admissions do you get per year? _________
What is the minimum age that can be accepted in your adult ICU by policy? _________
Over the last 2 academic years have ANY of your residents done a rotation in a pediatric ICU?
ADULT CRITICAL CARE MEDICINE
Yes
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How many? ______
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No
Describe the PICU where your residents might rotate.
Hospital
Number of ICU
Admissions Per Year
Number of Ventilated
Cases Per Year
TOTAL
4.
Skills
Who routinely performs the following procedures in your Critical Care Units? You may indicate the actual or
estimated number of procedures performed by Critical Care residents if you have the data, by placing the number of
procedures performed in the appropriate column. Indicate if the number is estimated or if you are tracking the
procedure as part of your program.
Skill/Procedure
Orotracheal intubation
Mechanical ventilation (invasive)
Non invasive ventilation
Liberation from prolonged mechanical
ventilation
Bronchoscopy (INTUBATED PATIENT)
Arterial line insertion
Central line insertion
Pulmonary artery catheterization
Dialysis catheter insertion
Neurologic declaration of death and organ
donor management
Defibrillation and cardioversion
Temporary pacemaker insertion
Lumbar puncture
Peritoneal tap
Resuscitation of patients with undefined
shock states
Thoracentesis
Thoracostomy tube insertion
Insertion of ICP monitor
Management of ICP monitor
Insertion of intra-aortic balloon pump
Management of intra-aortic balloon pump
Calculation of nutritional plan
End of life discussion with patient/family
Routinely performed by (check all that apply)
ICU
ICU Resident
Other (specify)
attending
CHECK skills that
residents will leave
program with BOTH
competence and
practical experience
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5.
Critical Patient Transport
a)
b)
c)
Is there a Critical Patient Transport Program for adult patients?
Is there a Critical Care Patient Transport Program for pediatric patients?
Do critical care residents physically leave the ICU to transport patients?
PART II - 2008
YES
YES
YES
NO
NO
NO
d) Describe the organization of patient transfers into the tertiary critical care units in your city. What is the role of the
critical care resident in this process? Are they involved in the decision to transfer to or from the tertiary unit? How
are they involved in organizing the transfer? How are they involved in the actual transfer?
e) Are residents involved in transfers between intensive care units in your city? How? What is their role?
f) What training do residents in your program receive regarding transport of critically ill patients?
6.
Epidemiology
a)
List staff with expertise in epidemiology and biostatistics and provide their qualifications.
b)
Describe the arrangements within the program to allow the resident to gain expertise in the use of epidemiological
techniques to relate environmental, socio-economic and life style factors to critical illness and the critical care milieu
and specifically in tabulation and evaluation of institutional and regional morbidity and mortality. Provide details
with respect to any didactic teaching.
c)
Describe any opportunities for residents to gain experience in high risk scoring systems (e.g. Injury Severity Scores),
and patient evaluation systems (e.g., APACHE, TISS, etc.)
d) Do your units have a dedicated ICU database? Describe how you obtain demographic and outcome data if you do
not. Describe the data collected and the data collection process if you use an ICU database.
7.
Biomedical Ethics
a)
Is there an ethicist available for consultations in the Intensive Care Unit?
Describe his/her role.
YES
NO
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b)
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Does the ethicist participate in:
Teaching conferences?
YES
NO
Case discussions?
YES
NO
b) If applicable, describe any opportunities provided for instruction in coping with the moral and ethical issues which
impact on patients, their families, and the critical care specialist.
c) What instruction and experience do residents get around end of life care and withdrawal of life support?
d) Describe any opportunities that provide residents with experience in the medico-legal considerations specific to the
critically ill patient.
8.
Supporting Diagnostic and Laboratory Services
Are there any limitations for the Critical Care training program in areas of pathology, biochemistry, microbiology, or
diagnostic imaging?
9.
Supporting Clinical Services
Are there any limitations for the Critical Care training program in any of the following: cardiology, endocrinology,
hematology, immunology, infectious diseases, neurology, nephrology, pharmacology, general surgery, neurosurgery,
anesthesiology, cardiovascular surgery, orthopedic surgery, plastic surgery, otolaryngology, urology, and
respirology?
10. Summary of Adequacy of Resources
Comment on the adequacy of the resources in the overall clinical program, with particular reference to the
relationship between such resources and the number of residents dependent upon them. Identify any areas where
deficiencies of staff, suitable patients, or essential facilities are affecting adversely the training of residents,
indicating measures under consideration to correct such deficiencies.