Harbor:VA MICU rotation

Background

• Badge/CPRS coordinator is Kerri Frasca Mapu: (310) 268-3002/Kerri.Frasca@va.gov/Office Main Hospital 3220
• Schedule contacts are Kelsey Anderson (Kelsey.Anderson2@va.gov), Ian Cowan (ICowan@mednet.ucla.edu), and UCLA chiefs (CurrentChiefs@mednet.ucla.edu)
• Call schedule at the website:to amion.com, use the login code “ucla im”

Pre Day-1

VA Check-In Process:

1. The VA check in process is in two phases, first you need to get fingerprinted, which can be done at the WLA VA or the Long Beach VA (see contact info below). Second, you need to get a photo taken for your ID. This must be done at the West LA VA location. You must contact Kerri Mapu ahead of time (1-2 months before the start of your rotation) and make your appointments for fingerprinting (WLAVA) and photo/ID badge. If it’s feasible time-wise, please make your appointments during your elective/jeopardy rotations.
2. For fingerprint at the WLAVA location, after obtaining appointment from Kerri, 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.
3. If you choose to have this done at the Long Beach VA rather than the West LA VA, call the VA in Long Beach and ask when you can come to get fingerprinted. You will need to give the SOI (VAP4) or SON (1625) number. I’ve heard from other residents that they accept walk-ins, but call to make sure, their phone number is 562-826-8000 ext. 5651
4. A badge is not required for identification purpose - you can use your Harbor badge. However you do need a badge to sign into a computer. Often for technical reasons many of us do not have a badge on our first day. You may call *14 (the IT department) from a VA phone to obtain a temporary log in username and password.
5. YOU WILL NEED CPRS (the VA EMR) on your first day. Make sure you have an appointment on your first day with Kerri to obtain CPRS access (it only takes 5 minutes).
6. 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.

Basics

Geographics, Team Structures, and Routines

• MICU resident working room is located in Pod B
• MICU/CCU/SICU is in 5 West (Pod A - D)
• PCU is in 5 South
• Telemetry (cards) is in 3 South
• The ICU is broken into 4 teams that consist of an intern and a R2/3 resident. 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.
• Signout — In the morning the interns sign out to each other. Usually the residents would just heads-up each other if they felt a patient was unstable, etc. In the afternoon usually you and your intern sign out together to the on call resident and intern. You need to update/print out the sign out sheet in CPRS.
• On a non-call day you and your intern can sign out to the call team at 3pm on weekdays and noon on weekends.
• It is the responsibility of the pre-call resident to supervise the post-call intern in a "sister team" model and assist him/her with patient management. So be familiar with the patients on your sister team!
• The MICU fellow is expected to be present until at least 5pm daily to both supervise house staff and to provide teaching in the afternoon.
• To sign out/cover a pager, call UCLA pager operator (310)206-6766. Your pager number is usually 93233.
• Phone directory is posted in the working room

FAQ's

1. Do I get reimbursement for meals?

• Yes. You get up to $25/day from CIR. Save your receipts!
• Lunch is provided M-F for medicine lectures which everyone goes to.

2. What to do if there is a disagreement about patient's level of care?

• Level of care questions should be discussed with your attending or MOD attending (pager 2200, CALL AFTER 4:30PM) prior to accepting the patient onto your service.

3. What procedures do I get?

• It depends on the fellow but procedures on your own are ok if you feel comfortable. The fellow can also help. The MICU is responsible for putting in Quinton catheters for dialysis.
• Intubations: You may ask to do elective/urgent intubations in the unit. RSI drugs are not necessarily readily available and you may have to push the drugs yourself. In a code situation, anesthesia usually does intubation.

Admission/Call Day

When You Are On Call

• Sign on to MICU admitting pager 89081 at 7am, and carry the code pager.
• Call is usually Q4days. Call is from 7am -11am (but admit until 6am). Any patient you admit before 6am 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 6am on the morning you are starting call. You carry the code pager when you are on call. On a call day your intern stays until 7pm. A night float intern arrives at 7pm (who does all the floor work and is not usually responsible for new admissions).
• You admit any medical patient (from ED or wards) who needs any sort of monitoring. Even neuro stroke patients watch overnight and rarely surgery patients as well. Cap: 10 new patients.
• The docs rely on you to assume care for admitted patients once they verbally signed out to you (they would ask your team information and place transfer order right away), so see your patients soon after getting the admission.
• Code/RRT pager always goes off at 8am, 2:30pm, and 8pm for test. You will need to sign in at 8am and 8pm at the main nurse station binder.
• For any code/RRT, an MOD (on call hospitalist), MICU resident/intern, and Telemetry (CCU equivalent) resident/intern are required to be present. For RRT, the note will be written by the resident from the accepting team if level of care is escalated, or if the patient remains on the original service (i.e. GMED), the the resident who ran the RRT will be expected to write the note. The MICU resident is responsible for leading the code with the MOD and write the code note. Make sure you record the vital signs as they are required for your note. For emergent intubations, anesthesia will be present. You are NOT responsible for emergent intubations.

Transfer/Discharger

• Place delayed transfer orders (with your own team info as the accepting team, but change the level of care).
• Call the Bed Control/Nursing Supervisor 53568 or page 2920 to find out if patient has been assigned a bed.
• Once the patient has been assigned a bed, page GMED admitting resident pager 89082 to sign out your patient. Remember to ask their team info to update the transfer order.
• The cap for ICU-->GMED transfers is 4 patients per receiving team. The ICU residents should discuss amongst themselves and prioritize the transfers with most ongoing hospital needs.
• Transfers from ICU to GMED occurring after 5pm should be discussed with the MOD to ensure appropriateness of transfer.
• In the circumstances where the ICU is in need of beds at any time, the patient can be transferred out of the unit overnight and still be cared for by ICU team, then transferred to GMED in the morning.

• 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 3251
• Remember to bring food/snacks and drinks. Cafeteria closes at 3 pm but re-opens at 12:30 am. 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 7/2017 Diane Hsu