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Rushing to the ICU?

June 2011

“Oh, wow, I’d better see the ICU patients first ‘cuz they’re so sick.”

Wait a minute. What’s the rush?

If you’re the only doctor caring for these patients, maybe you should see them early. But if there are consultants on the case–and there nearly always are–those guys will be there as early as 6 a.m. checking labs, replacing potassium and adjusting ventilator settings. And writing notes.

On top of that, these patients have ICU nurses taking care of them. Day shift ICU nurses. Unless you have grave doubts about the nurses’ competence, odds are you’ll be called about any and all changes in patients’ conditions.

But after lunch it’s different. The pulmonary guy and the nephrologist are seeing office patients and the cardiologist is in the cath lab; none of them is going to address the increasing doses of pressors the patient needs or see the family members who come in after they drop the kids off at school. If you make your visit in the afternoon, you can read everybody’s note, call them if you need to talk,and evaluate the patient one more time before nightfall.

On top of that, you have those floor patients, who are tucked away in their rooms with 4-5 other patients making demands on the nurse. Wouldn’t it make sense to see them first and see how things went through the night?

If you’re really anxious to know what’s going on with everybody, most hospital computer systems will give you vital signs and lab results, maybe even some nursing details like “tube feeds on hold.” Check your ICU patients remotely first, ask the intensivist about them if you see him in the hallway and give them the benefit of your presence later on.

And try to relax a little bit.