PCCU Rounds: Physician Roles and Expectations

Morning Rounds

  • Begin at 07:45 Monday to Friday and 08:30 on weekends/holidays at the PACS station to review any relevant radiographic investigations
  • Residents and fellows should assign their name to patients on the PICU census board prior to starting bedside rounds. Assigned trainees are to write their name and pager on the beside nurse’s worksheet in the designated area as handover progresses through the unit
  • The I-PASS handover document should be updated on SharePoint by the outgoing night team prior to rounds. Copies should be provided to the incoming medical team
  • Bedside rounds are attended by incoming and outgoing staff physicians, fellows, residents, unit RTs bedside RNs, pharmacist, dietician, and PACE Fellow
  • These rounds will be led by the overnight fellow and resident where patients should be divided equitably based on the patient acuity and resident level of training. Ultimately the fellow has a supervisory responsibility to the resident and will be expected to act as a mentor and share accountability for handover provided by the residents
  • The night team will suggest a plan to the day team and address the patient’s major active issues. It is the responsibility of the day staff physician to confirm and/or provide any amendments to the plan of care
  • The PACE Fellow will carry the PICU Fellow Vocera and /or pager and will trouble-shoot emergent issues in the unit to avoid interruptions to handover

Post Rounds (TTC) Huddle

  • Should occur immediately after bedside handover roundsfor no longer than 10min
  • The daytime staff physician will huddle with the day medical team and charge nurse to ensure that there is clarity about patient discharges, investigations and subspecialty consultationsso that these occur in a timely fashion with appropriate communication

PACE Handover

  • The overnight team will meet with the PACE fellow and PACE RN immediately after handover in the PICU report room to review any PACE activations from the previous night

Daily Educational Rounds

  • Will occur every weekday from 10-11am in the PICU conference room
  • The schedule of educational events will be published weekly
  • All PICU fellows not on vacation or away on elective are expected to attend these rounds

Systems Rounds

  • Start at 14:00 and expected to end at approximately 15:30
  • The staff physician must be in attendance and can only defer to a fellow if assessed by the fellowship program to be capable of running rounds independently
  • During this rounds the RNs, RTs and multi-D team will provide a systems review of the patient
  • The residents and fellows are expected to address all medical issues prior to these rounds and not have a “wait until rounds” philosophy. Residents should ask fellows for guidance and fellows should provide appropriate supervision so that issues are not left until the afternoon. Staff physicians should be accessible to provide advice and input prior to afternoon rounds
  • The medical team, bedside RNs and allied health team are expected to collaborate in ensuring the daily goals checklist is completed prior to afternoon rounds. The daily goals checklist is embedded within the RN worksheet and replaces the FASTHUG checklist and so should be reviewed for outstanding issues during these rounds
  • ** On weekends these rounds begin 30-60 min after handover where the medical team is expected only to have addressed any major issues prior to starting rounds

Afternoon Medical Handover

  • These will occur in the PICU conference room and will be attended by both incoming and outgoing staff physicians, fellows and residents
  • The sign-out will be led by the daytime fellow and resident where patients should be presented equitably based on the patient acuity and resident level of training; once again the fellow has a supervisory responsibility for the resident’s handover (ideally addressed by pre-handover discussion/mentoring)
  • The I-PASS handover tool must be updated so that the up-to-date version can be provided the on-call team.
  • The PACE Fellow will carry the PICU Fellow Vocera and /or pager and will trouble-shoot emergent issues in the unit to avoid interruptions to handover
  • After handover of the PICU, the PACE Fellow should handover active PACE patients that require follow-up or for whom they may expect a PACE activation

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