Surgical Intensive Care Unit (SICU) Curriculum
The Surgical ICU at BMC is an integral part of overall ICU services which function on a multidisciplinary level. Adult patients are housed in a closed surgical unit comprised of sixteen beds. Although census varies weekly over the course of a year, about 20% of the patients on the surgical service are postoperative complications. A further 20% are emergent trauma patients. The bulk of the patient load consists of elective postoperative monitoring of patients with projected or known hemodynamic instability (60%).
In terms of time, the patients who remain the longest are neurotrauma patients and those with hypoproteinemic related muscle strength/respiratory impairment. Overall length of stay figures are thus highest for these two groups, although in terms of proportion to overall admissions their numbers are low.
The basic goal of this ICU is to prevent or minimize perturbation of basic homeostatic mechanisms via monitoring and prophylactic therapy, and in those cases where such instability has occurred to correct the physiology. This is achieved through the use of mechanical and medicinal life support.
The SICU is organized around the team concept. For practical purposes the core team consists of:
- Two or three surgical residents at the PGY1, 2 or 3 level
- An Anesthesia resident
- An Emergency Medicine resident
- A bedside nurse
The overall team leader is the most senior surgical resident. The team is facilitated by an intensivist.
The SICU team is responsible for coordinating and optimizing patient care. This is done by assuring in-depth discussion of diagnostic and therapeutic intervention with appropriate team members or consultants; reviewing these ideas with a senior member and other involved parties; verbalizing a care plan on rounds and then carrying out the plan. Due to the vast changes in the critically ill over short time spans, this process is shortened to immediate individual response as required; followed by rapid discussion with the intensivist.