Policy:

All critically ill patients of Department of Medicine faculty admitted to either the 3100 – ICU or the 4100 (CCU) will be co-managed or primarily managed by physicians on one of the critical care teams.

 

3100 – ICU

All Medicine patients admitted to the 3100-ICU will be defined as critically ill unless as follows:

1.      The patient is admitted to the ICU primarily because of having Cardiac Surgery.

2.      The patient has orders written for transfer out of the ICU within 24 hours of ICU admission.

 

4100 – CCU

For the purposes of this policy, patients admitted to 4100 (CCU) are defined as critically ill if they meet one of the seven characteristics below.

 

Criteria for Definition of 4100 (CCU) patients who are Critically Ill

1.      Respiratory Failure (either…)

a.       Intubated

b.      BiPAP (excluding patients on home BiPAP for sleep apnea on stable setting)

c.       Severe hypoxemia (PaO2<60 mm Hg or O2 Sat < 90% on supplemental O2), or hypercapnia PaCO2 > 50 mm Hg

2.      Hemodynamic instability at significant risk for respiratory compromise

3.      Severe encephalopathy, delirium or active seizures

4.      Significant hyperglycemia in the critically ill patient

5.      Gastrointestinal bleeding at significant risk of aspiration

6.      Severe metabolic or electrolyte disorder in the critically ill patient

7.      Sepsis syndrome

 

Procedures

1.      The Pulmonary/Critical Care Division will provide the co- management thru consultation by the medicine ICU service on 3100 and thru the pulmonary consult service on 4100.

2.      The Medicine attending will retain all the rights and responsibilities of the attending physician for critically ill “Yellow category” patients consulted upon by the intensivists physician.

3.      Critically ill patients admitted to the ICU team for primary management (ie “Green category” patients) will remain the responsibility of the Pulmonary Division faculty throughout their hospital stay unless the patient is accepted in transfer by another attending, following faculty-to-faculty communication.