The objective is to train housestaff in didactic and technical aspects of management of patients with high risk for surgery and those that are critically ill perioperatively. The NCICU team works closely with the adjacent PACU and with specialty Anesthesiology Services in the adjacent OR. The STAT lab is located next to the SICU in the PACU, and provides ABG, co-oximetry, STAT electrolytes (Na/K, glucose, lactate) and coagulation measurements.
The rounds start at 6:00 AM, and evening rounds follow MICU evening rounds. On Mondays, the rounds start at 6:00AM in order for the fellows to attend the Cardiothoracic and Neurosurgery Ground Rounds. The Critical Care team covers this unit on site 24/7. The average night call for fellows on this rotation is every fourth night. The fellows are expected to acquire basic knowledge of intraoperative surgical and anesthetic management through regular visits to the operating room during this rotation. This ICU is the focus of the recently approved liver transplant program.
The most frequent diagnoses at the time of admission to the NCICU are liver transplant surgery cases, major vascular surgery such as abdominal aneurysm resection, major bowel or liver surgery, subarachnoid hemorrhage requiring clipping, and major medical complications of surgery on anesthesia. The fellows are exposed to a large variety of post-operative patients undergoing major cardiovascular and neurosurgical procedures. Patients are admitted from all areas of Montefiore Medical Center.
Goals and Objectives
The educational purpose of this rotation is to develop full competence in evaluation, diagnosis and treatment of patients with surgical critical illness.
The principle teaching method is thorough case management of all patients including history, physical exam, and interpretation of laboratory tests and cardiorespiratory physiology data. Teaching rounds, unit based conferences for both clinical and administrative management, increased involvement in house staff instruction, and mastery of technical aspects of major required procedures are mandatory.
Fellows are required to prepare for teaching rounds by supplementing case based understanding with review of major textbooks and current peer reviewed literature.
Fellows are required to attend all curriculum conferences, and competently prepare their presentations under faculty supervision while on this rotation.
Fellows are required to attend the Surgery or Neurosurgery Grand Rounds held on Monday morning at 7:00 AM when on this rotation.
Faculty will provide supervision to fellows on site 24/7 every day.
To instruct the fellows in the basic skills to staff and direct a general surgical and neurosurgical intensive care unit in a university hospital setting.
To develop a clinical training program in liver transplant during the 2004-5 year.
- PATIENT CARE: competent management of a university hospital surgical and neurosurgical intensive care unit
- MEDICAL KNOWLEDGE: state-of-the-art diagnostic and therapeutic applied knowledge
- PROFESSIONALISM: ethical and compassionate care delivery in a collaborative practice model
- INTERPERSONAL SKILLS: highly effective interpersonal communication focused on best practice model under intensivist leadership
- PRACTICE BASED LEARNING AND IMPROVEMENT: data collection and analysis to allow for highly competitive quality improvement in established and developing areas of surgical practice
- SYSTEMS BASED PRACTICE: competitive and effective delivery of surgical intensive care with focus on global resource utilization and outcomes
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