A Typical Day in the ICU

I get there at 6 and get sign out from the resident on call overnight. I pre-round on anywhere from 4 to 10 patients, seeing them, checking their vitals, reviewing their labs and studies, updating medication lists, and entering any important orders. We round at 8 as an enormous caravan. The team consists of the attending, two ICU fellows, four to five residents, a gaggle of medical students, a pharmacy resident and student, and occasionally a palliative care fellow or dietician. We also wheel around two to three computers. Seeing each patient and determining the plan usually takes two to three hours. Then we try to get procedures done, call consults, and write our notes.

X-ray rounds are at 11:30 so we tromp down to radiology and review films with a chief resident. After that, we grab some food for a didactic lecture at noon covering basic topics like sepsis, ventilators, and antibiotics. From 1-3, we continue doing "work," finishing up odds and ends, touching base with consultants, updating families, etc. During afternoon rounds at 3, we review the day's activities on all the patients and revise the ongoing plan.

The resident on call stays while everyone else tries to go home; although it sounds as though we can leave early, for the most part, we stay pretty late helping out. During the day, everyone chips in to take new admissions who can come from the emergency department, outside hospital, floor, or operating room. After afternoon rounds, the resident on call is on his own. There are usually two fellows around until midnight when one of them goes home. On call, we cover all the patients and new admissions, which can be quite busy.