Harbor:VA MICU rotation

Background

• VA Coordinator is Christine Seydel. 310-268-3034. Email christine.seydel@va.gov. She works from Monday-Thursday.
• Call schedule at the website: www.amion.com. The login is cedarsim

Pre Day-1

1. Complete online training
   • www.ees-learning.net
   • select: VHA Mandatory Training for Trainees
   • Complete the course module (takes about 1-1.5 hrs to complete)
   • Print out 2 copies of your certificates and bring them with you.
2. Westwood VA is located just west of the 405 on Wilshire Blvd.
   • http://www1.va.gov/directory/guide/facility.asp?ID=78&dnum=ALL
3. Go to Human Resources which is on the north side of Wilshire near the Chapel looking building on the hill- opposite side of main hospital. Find Bldg 218, Rm 14 Human Resources at 310-478-3711 Extension 48395. Monday thru Friday from 7:00 AM to 3:00 PM.
   • They will make you pledge an oath to the USA and take your fingerprints. You do not need a new ID badge. You can use Harbor’s.
4. Next, go to main hospital.
   • No parking permit is needed if you park in lot 2 or 6. On weekends, do not use lot 6- they have motorcycle class. Lot 2 is near the ED and empty on weekends. You can take Sawtelle and it will lead you directly into Lot 2. Lot 6 is to the west of the hospital. DO NOT park in the front of the hospital.
5. Go to room 1605 for hospital codes. Bring your printed certificates for the CPRS lady. Tell CPRS to place your pager as VA pager 5582. (310) 478-3711 ext. 41289
6. Take the printed certificates also to the Residency Office which is in 3East.
   • At that time, ask Chris (coordinator) for your meal voucher = money for each night you are on call. $7 each weekday and $13 on the weekend calls. Make sure you log onto Amion and print out your call schedule, as the form for reimbursement requires it.

Basics

• MICU/CCU/SICU is in 5 West.
• pCU is in 5 South C
• Telemetry (cards) is in 5 South B

• The ICU is broken into 3 teams that consist of an intern and a resident. Call is usually q3. Call is from 8 AM-6AM. Any patient you admit before 6 AM the following day goes to your team. Similarly, the previous day's call team may give you an admission if it arrived to them after 6 AM on the morning you are starting call.
• You admit any medical patient who needs any sort of monitoring. Even neuro stroke patients watch overnight and rarely surgery patients as well.
• You transfer patients to and receive patients from the ward
• The nursing care at the wards at the VA is like our 6W ward. That is poorly monitored. So do not hastily transfer to ward to diurese your service. You will likely run a code in the ward- when someone has already been dead for a few hours.
• Rounds usually begin around 8:30. However, if you have any CCU patients on your service, the CCU fellow and attending round at 7:30 and you must be present. Also, if you are on call for the day and there are any CCU patients on the entire MICU service (even if they’re not yours), you must be present for the 7:30 rounds.
• The docs rely on you to assume care for admitted patients once they talk to you, so see your patients soon after getting the admission.
• Code pager always goes off at 9 am for test.
• You carry the code pager and the "rapid response" pager. Do not ignore these pages- but you will likely get many false alarms.
• To page people in the VA, VA pager dial 11 first. Cedars pager dial 19 first. UCLA pager 1-800-BEEP-231 first.

Admission

• You can get 2 types of admits: From the ED and transfers from other services and the general medicine floor. For the floor transfers, go see the patient before accepting the transfer. You are able to block the transfer if you think it is not acceptable, however, it can be easier just to take the patient. If you accept the transfer, the primary team needs to write a transfer summary note as well as delayed orders to your service. The intern caps officially at 10 patients and then you see the remainder of the admits on your own.
• At night, if you get an admit, ask the MICU if they have room for the patient prior to transfer, the nurses greatly appreciate this.
• To consult a service, you call the service as well as place a consult in the computer. Overnight, any surgical consult including neurosurgery is a general surgery intern.
• Procedures: it depends on the fellow but procedures on your own are ok if you feel comfortable. The fellow can also help.
• Intubations: if you are comfortable, you can intubate patients yourself without anesthesia. However, RSI drugs are not necessarily readily available and you may have to push the drugs yourself. If the fellow is around he can help you out. Anesthesia (usually a CRNA) will likely always steal your tube. Even if you are the one running a code. But you can always ask to do the intubation.
• Signout — the interns sign out to each other. Usually the residents would just heads-up each other if they felt a patient was unstable, etc.

Discharge/Transfer

• To transfer someone, you usually will call general medicine and transfer the patient to the medicine ward.
• At the beginning of the day, call Bed Control to inquire how many GMED beds are available/request GMED beds for transfers to a lower level of care for however many patients you anticipate to be transferring
• Call the gmed admit team BEFORE 2 PM/EARLY. Often you can initiate this process early, even before rounds if you had already made a plan yesterday to downgrade the patient if there were no acute changes overnight. Make sure to ask them who they are, the attending’s name, and the team number. You/your intern will need to then write DELAYED transfer orders and a transfer note. It will not allow you to finish your transfer orders unless you know the gmed attending.
• After calling for transfer, the patient remains officially your patient until they physically leave the monitor and go to ward.
• If you discharge somebody directly from the MICU, you must write a discharge summary in the computer. The same goes for death notes.

Call Room

• Call room is on 6th floor East, follow signs for resident quarters.
  • Door code is 5-2-3-1.
• Remember to bring food and drinks. Cafeteria closes at 3 pm. There is NO food in the hospital on the weekends. There is free lunch in the 3East conference room on Mondays, Wednesdays, Thursdays, and Fridays, usually sandwiches or pizzas. There is a fridge in the call room for you to store your food.

References

9/11/05 Dorcas Atkinson, Lisa Dabby, Chirag Shah
7/10/08 Rachelle Sohren's Guide to the VA Rotation
7/6/09 Jonie Hsiao
7/18/09 Tina Nguyen

Authors

Hemang Acharya, Ross Donaldson, Anand Narayan, Michael Holtz, Neil Young