A Day in the CVICU

The CVICU team is made up of four senior residents, cardiac anesthesia fellows, or critical care fellows. We also have a team of nurse practitioners who help out a great deal. The residents or fellows usually arrive before 5; sometimes, we even get to the hospital at 4 if the service is large. It's a bit brutal, but when we are on our week of night shifts, it's nice to get company at around 4:30 in the morning. There are anywhere from 15 to 25 patients, and because most are quite ill, there's a lot of information to gather before rounds at 6. We usually start rounds by examining all the morning films, then go from bedside to bedside with the cardiothoracic surgery patients. We start with the sickest patients or anyone who might be going to the operating room. After covering the general CV surgery service, we meet the VAD/ECMO team followed by the transplant services to round on those patients. The good thing about rounding with surgeons and rounding early in the morning is that we are usually finished by 10. The first post-operative patients usually come out around noon so we have a gap of time to put in orders, write notes, and complete procedures. There are usually two residents or fellows on during the day, and we try to get one of them home earlier as otherwise the month gets exhausting. Each weekday, we get about 2-4 postoperative patients and 1-4 patients transferred from outside hospitals or the ED. The night shift resident or fellow arrives at 6, and the second day resident or fellow leaves after evening signout. Usually the attending will round again on all the patients once the night person arrives. It's a very fatiguing schedule, partly because of the hours in the hospital and partly because of the complexity of patients and acuity of care.