2.3 Surgical Critical Care Consultation Guideline
The Surgical Critical Care Service (SCCS) model assumes the following premises:

1.
The SCCS should provide consultation, input, and critical care procedures for
patients who are critically-ill as this patient populations utilizes the most
resources in the ICU setting.
2.
SCCS can improve throughput and decrease costs in the ICU as demonstrated
in the literature.
3.
SCCS does not assume primary responsibility for the major diagnosis that has
placed the patient in the ICU.
 SCCS guides the minute-to-minute changes (i.e., vasoactive drips,
ventilatory changes, antibiotics, continuous renal replacement therapy,
etc.) as it pertains to the patient’s critical care diagnoses.
4.
SCCS treatment recommendations that differ from the Primary Service should
result in direct communication with the involved Chief Resident and / or
Attending to ensure that a common understanding of the patient’s underlying
conditions and needs exists.
 When disagreement persists, the Primary Team maintains decisionmaking responsibility.
The SCCS will consult and then assume primary responsibility for all Trauma patients in
the Surgical Intensive Care Unit (SICU).
o It is imperative that upon the patient’s admission to the SICU, the Trauma Team
discusses the plan of care with the SICU resident (+ Attending) to ensure
continuity of care.
 “Dropping off patients” without a provider-to-provider hand-off is
discouraged.
o The SCCS team will discuss the patient care plan and active issues daily with the
Trauma Chief (+ Attending) in order to keep them informed.
o These patients will be rounded on daily by the SICU Attending.
o The SCCS team will be responsible for all orders and procedures on such
patients.
o The Trauma Team will be responsible for all operative interventions on such
patients.
o When disagreements arise, the SCCS and the Trauma Service must communicate
and make a plan congruent with optimal patient care.
 If disagreements cannot be resolved at the resident level, the involved
Attending physicians must discuss the issues and come to a resolution.

The SCCS will consult and provide critical care services for all General or Subspecialty
Surgical Service patients admitted to the SICU that:
o Require inotropic support and / or invasive monitoring.
o Require invasive, non-invasive, or specialty ventilatory management.
o Require Continuous Renal Replacement Therapy (CRRT) management.
o Are hemodynamically unstable or have active critical care issues.
 These patients will be rounded on by the SICU Attending of the Week.
 Each day the SCCS team will discuss the care and issues of the patients
that have arisen in order to keep the Primary Service informed.
 If the Primary Team wishes changes in management or additional
therapeutic interventions, these patient care concerns and / or additional
written orders must be discussed with the SCCS to ensure continuity and
completeness of care.
 The SCCS will be responsible for all ICU procedures on such patients.
 The Primary Service will be responsible for all operative interventions
on such patients.
o It is imperative that upon the patient’s admission to the SICU, that the General or
Subspecialty Service discuss the plan of care with the SICU resident and / or the
SICU Attending to ensure continuity of care
 “Dropping off patients” without a person-to-person hand-off is
discouraged.
o The SCCS team will discuss the patient care plan and active issues daily with the
General or Subspecialty Service to keep them informed of any and all critical care
issues / concerns.
o These patients will be rounded on by the SICU Attending of the Week.
o When disagreements arise, the SCCS and the General or Subspecialty Service
must communicate and make a plan congruent with optimal patient care.
 If disagreements cannot be resolved at the resident level, the involved
Attending physicians must discuss the issues and come to a resolution.

The SCCS will be available for consultation and management of all General or
Subspecialty Service patients admitted to other ICU’s (MICU, BICU) if requested to do
so.
o It is the responsibility of the General or Subspecialty Service to consult the SCCS.
o Consultation is encouraged in patients who:
 Require inotropic support and / or pulmonary artery catheter monitoring.
 Require invasive, non-invasive, or specialty ventilatory management.
 Require CRRT management.
 Are hemodynamically unstable or have active critical care issues.
o All efforts will be made to transfer these critically-ill patients to the SICU to keep
them in one central location to optimize patient contact and care.

Consultation at the time of admission for patients not included above is at the discretion
of the Primary Service, but critical care issues should be apparent
o Simple admission to the SICU for nursing care / wound care / pulse checks / etc.
does not require a SCCS consultation.



Consultation will be ongoing until critical care issues resolve.
In order to avoid confusion and divergent patient care plans, it is imperative that all
written orders by the Primary Service be discussed with the SCCS.
The SCCS will triage the most critically-ill patients to be physically located within the
SICU. This allows constant contact between the SCCS and the patient. If necessary, the
SICU Attending may need to triage out less critically-ill patients to provide space for
sicker patients. The ultimate authority on which patients will be cared for in the SICU is
the SICU Attending.