admitting to the micu

The resident will be paged to evaluate patients for possible admissions/transfers to the MICU team. A patient should be seen within 15 minutes of a request. EVERY patient must be discussed with the Pulmonary fellow to determine whether or not to admit the patient to the MICU. The resident must write one of the following notes on patients evaluated:
- “CRITICAL CARE ADMISSION NOTE” if the patient is accepted from the ER
- "MICU EVALUATION NOTE" if the patient is NOT accepted from the ER
- “MICU TRANSFER EVALUATION Note” if the patient is NOT accepted from the floors
- “MED: Transfer/Receiving Note” if the patient is accepted from the floors
All evaluations/admissions, whether or not they come to the MICU or PCU, MUST BE STAFFED BY THE FELLOW AND/OR ATTENDING. This means that the resident may not reject an admission by themselves.
While the team is rounding in the morning, the Short-Call resident admits alone. At all other times, the Resident/Intern pair works together.
All patients newly on BiPAP, or High Flow Nasal Cannula (HFNC) for respiratory distress are to be under the MICU team, whether in the PCU or MICU.

The CLC is a nursing home that is located in the VA near Building 6 and employee parking. You may get called to evaluate a patient there.
If you think the patient needs to be admitted, call the geriatrics fellow/attending AND the MICU/CCU fellow. You will need to write a "CRITICAL CARE ADMISSION NOTE" for these patients.
If you do not think the patient needs to be admitted, you must call the geriatric fellow to discuss your assessment and plan. You must also write an evaluation note as above.
If there is controversy over the admission (i.e. should the patient go to the MICU vs. CCU vs. floor), discuss the case with your fellow, and if your fellow also feels that the patient should not come to the MICU, the MICU attending and nursing home attending need to discuss the case and come to a resolution.

All transfers from an outside hospital (Martinsburg VA, etc.) must be accepted by an attending, and the attending should write the admission referral note in CPRS that you will be able to see.
If you get called by an attending at another hospital for a transfer, direct them to the pulmonary attending for appropriateness of transfer.
Residents or fellows CANNOT accept/deny a transfer.

TRansfers to WHC for stroke

Walter Reed is NOT currently accepting transfer for neurosurgery

Brief outline of steps for transfer to OSH after acceptance from outside physician:

If there is need for emergency transfers, first call the Procare Communications Center.

Then call the ED to assist if needed.